Larchmere House Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were very detailed in relation to most areas of people’s care and support needs as well as nursing needs. Care plans were person centred and included individual preferences, likes, dislikes and favoured routines. However, some care plans were very sparse in relation to people’s care and support needs around epilepsy, skin care and oral care. It was not clear that people were having their needs met in relation to their oral health care as limited guidance was provided on peoples individual oral health needs. Staff had not always been recording when they had offered teeth cleaning support or when people had declined. A person’s records for July 2025 showed they had been supported with their oral care 22 times in 30 days. Another person’s records showed that they had been supported with oral care 24 times in 29 days. These gaps represented potential risks to the people’s oral health. Staff had documented they had supported the person to brush their hair 25 times in 29 days. These people’s care plans showed they needed support with these elements of their care. The management team told us that the records relating to haircare and oral care had not been completed but people had received this care. A person’s repositioning records did not show that being repositioned regularly in accordance with their care plan. The person had skin integrity concerns. These gaps represented risks to the person’s skin integrity.

A relative told us, “Mum is dressed as she would want, her hair is clean, she looks smarter and happier here than she was in hospital. Her hearing aids are in and batteries in.” Another relative said, “[Person] always looks nice, clean and hair nice and clean and brushed.”

Staff knew people well. A staff member said, “The care plans are always open and available for reading, we talk through people’s needs as we go around. We ask each other questions and new residents share information about themselves. The care plans do give information, you learn more from working with the person. We hand over any changes to the nurses, they are quick to act.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service worked with other health professionals involved in people’s care. Staff told us how they supported people and their relatives. Relatives told us, they felt staff supported people with appointments and communicated well with GPs and health specialists to ensure people received continuity of care. A relative told us, “She can see the doctor who comes in. Her nails and teeth look good; a chiropodist comes in and a hairdresser comes in.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was a lack of dementia friendly signage and way marking around the service to direct and orientate people. There was no dementia friendly signage on doors such as toilets, bathrooms and shower rooms. Some people had been actively walking around the service. People and staff told us a person had regularly walked in rooms of others. Door guards were in place to stop people entering other people’s rooms and the kitchen. Staff were aware of people’s individual communication needs for example, people who may have hearing or visual impairments. Staff used a whiteboard with one person, which enabled them to communicate more effectively. The registered manager showed us the service had a bank of easy to read documents ready and available if anyone needed them.

There were some notice boards around the service which had some easier to read information on display. These included a board in the hallway with pictures of staff so that people and relatives knew who was who.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. We observed good practice from staff in relation to listening and involving people with their care and making decisions. The registered manager shared with us meeting records to show that they had met with people living at the service. The meeting records showed people were involved in decision making. Minutes of the meeting were available for all people living at the service, regardless of whether they had attended the meeting.

People were offered informal opportunities to feedback about the service, the registered manager spent time walking round the service daily and chatting with people. A person told us, “The manager is lovely, I can go and talk to her, she’s a sensible one to go to.”

People and their relatives were sent surveys about the service, the surveys had been sent out in 2025, and 7 responses had been received. Surveys showed positive feedback from those that had responded. Comments included, ‘Good food but my appetite is getting smaller’; ‘Thank you for all round good care’ and ‘Girls asked me if I’d like to go to church. They have taken me and fetched me back every Sunday. Thank you, lovely.’

People were listened to. The service had a ‘You said, we did’ board on display in the corridor which showed that people, relatives and staff had made suggestions, and these had been listened to and responded to.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People told us they had access to the nursing staff within the service as well as visiting health professionals. Staff gave us examples of when they had recognised people were not acting in their usual manner and the action they took. Staff were knowledgeable about how to recognise signs of deterioration and care staff said they would report health changes to the nurse on duty if necessary. Care staff told us if they witnessed people having medical emergencies they would press the emergency call bell. A staff member told us, “If a catheter is empty, I would check with a colleague to see if they had already emptied it, if they hadn’t it could be blocked so I would call the nurse.” Another staff member said, “I normally tell the nurse when people need assistance when they are constipated. We can’t see when they last went on the handsets. The nurse must check on the computer.”

There were processes in place to ensure that people could receive care, support and treatment when they needed it. People were also supported to attend healthcare appointments at the hospital when required. Records showed that TVN’s (Tissue Viability Nurses) provided input and support to manage wounds where people’s skin had broken down. Staff took action to report concerns, for example advice had been sought from the GP regarding significant changes to a person’s health and mobility.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. The provider had a clear policy in place in relation to equality, diversity and inclusion. The provider set out in this policy a number of clear actions the service will take. Such as ‘Act decisively if anyone receiving our services experiences offensive or abusive treatment directed against their ethnicity, religion or sexual orientation, whether gay, lesbian, bisexual, transgender or preferred gender. Work out with each person using our service what they want and need, and how they will be provided with the required service; this will be influenced by the person’s gender, sexual orientation, culture, personal choices and other characteristics, and it should not be assumed everyone wants the same thing.’ We observed that this policy was embedded into practice in the service. People’s care and support was tailored to their own needs and wishes. A person said, “I would recommend them, I get freedom, to do almost what I want, I have a normal life here, I would give them 10 out of 10.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. Some people had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. Some people had ReSPECT (Recommended Summary Plan for Emergency Care Treatment) forms in place. A ReSPECT form records a person's wishes about a range of care and treatments.

End of life care plans were as comprehensive as the person wanted it to be and plans were clear in cases where people had chosen not to discuss this element of their care. The service provided a lot of care to people at the end of their lives. Staff told us that they worked closely with the local hospice to ensure people had effective support and pain relief to ensure people had dignified, pain free deaths. Staff told us they had attended additional training to support people at the end of their life. A staff member said, “Even after someone’s passing and we are washing and dressing them, I still talk to them as if they were alive and tell them what I am doing to continue to treat them with dignity and respect.”

A person told us, “I want to die here, I have told them that and that I don’t want to go to hospital.” A relative said, “When people die here, they don’t leave them to deal with it. They handle it well as a fact of life and they bring an order of service in. Other families can go to each other’s funerals.”

The service had received thank you cards from relatives of people who had passed away. A card read, ‘A huge thank you to everyone for the superb cake for our mother [name] she was looked after so wonderfully enabling her latter years to be as comfortable as possible. She had a lovely long healthy life and to leave this world pain free in her sleep, we couldn’t have asked for more.’