Larchmere House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

There were breaches of legal regulations in relation to managing risks, managing and controlling infection, managing people’s medicines safely and providing staff effective training to meet people’s needs safely.

This service scored 47 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and report safety events. Lessons were learnt to continually identify and embed good practice. The provider had a process in place to ensure lessons were learned across the service when incidents and accidents occurred.

For example, a person slid from their wheelchair when being supported to travel down the ramp. Staff were advised to wheel people backwards down the ramp and safe ways to support people using wheelchairs was then discussed at handover. Staff were also reminded to challenge poor practice.

Staff told us that accidents/incidents and changes to people’s health was discussed in handovers. Relatives told us they were made aware of incidents and accidents when they happened. A relative said, “They let me know every little thing, a resident kicked him, and they rang me straight away.” People told us they felt safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. When people were supported to go to hospital, either through routine or planned admission, emergency admission or consultation day visit, support was in place as well as hospital passports. A hospital passport helps people to give hospital staff important information about them and their health when they go to hospital.

People were supported to maintain their health, attend appointments both inside and outside of the service. Where routine health checks were undertaken people had support from people who they know well to understand what was happening. A person told us, “I have seen 2 doctors in the past 2 weeks.” They detailed that a staff member had supported them to visit the dentist.

The service had maintained regular contact with local authority social workers. This included good ongoing work with the GP and other health and social care professionals. Staff told us they were able to contact the GP. A staff member told us, “We have new GPs at the surgery they are very good, and the GP comes every week.”

A relative detailed how their loved one had been moved to the service safely. They said, “The hospital tried to discharge mum in the evening. The home said no and waited until morning. The home called me to say she was on the way.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People were safe and were protected from harm. Staff were aware of the whistle blowing policy and told us they always had access to all policies. We observed interactions between staff and people during our visit. We saw safe practice whilst enabling people to maintain their routines and come and go around the service as they wanted.

Staff had received safeguarding training. Staff understood their responsibilities to report a safeguarding concern. A staff member said, “If there was abuse, I would tell the nurse, it would be definitely dealt with. I would tell CQC or social services.” Another staff member told us, “I would report safeguarding to a superior, write a statement, action would be taken. I could take it up to the owner, if that didn’t work, I would report to CQC.”

Relatives told us, “He is really safe here and he is happy here” and “I know 24 hours a day she is safe.” People told us, “I feel safe.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks to people in relation to possible harm from constipation were not always well managed. For example, action had not always been taken to give people as and when required laxative medicine according to their risk assessment and care plan. Such as when they had not opened their bowels for more than their recommended number of hours. We found some cases where this has exceeded the time limit, and no action had been taken. We reported this to the management team and the GP and actions were taken to address people’s constipation and possible discomfort. After we raised concerns about constipation management, the registered manager put in place a system to ensure the bowel charts for all people were reviewed each night and added to the handover records.

Risk assessments were inconsistent. For example, some were detailed and provided clear guidance to staff about how to work with people safely. Others were vague and did not give clear guidance. For example, a person’s epilepsy care plan did not provide staff with information on what actions they should take. Epilepsy risk assessments had not fully explored the risks and actions to mitigate risks such as SUDEP (Sudden Unexpected Death in Epilepsy) and choking. The provider could not be assured people’s seizures were effectively monitored. The provider had not considered specialist bed sensor equipment to detect seizures. Several people with a diagnosis of epilepsy spent prolonged periods of time in bed, due to their deteriorating health needs. A staff member said, “no equipment in place to detect seizures so we would not know if [person] was having seizures in her bed if you were not there to see them.” A person’s skin integrity risk assessment showed they were at very high risk of pressure damage. The care plan showed they had a pressure injury on their foot, but the care plan did not state what actions care staff needed to take and what pressure relieving equipment was in place. We observed that people were not always repositioned in accordance with their care plans.

Records showed that relatives had been contacted when there had been incidents and accidents and actions had been taken. People told us they felt safe. Staff told us changes to risk assessments were shared across the team. Staff had a good awareness of most people’s choking risks, and we saw them supporting people to sit up more to eat and drink.

Personal emergency evacuation plans (PEEPs) were in place in the service to detail people’s support needs if they required to be evacuated in an emergency. People were supported to move around the service safely and were supported to spend time where they chose. People were given food and fluid in a consistency which was in accordance with their assessed needs (including diabetic diets). The food was well presented, and people seemed to be enjoying the experience. Staff told us about safe ways of working with people which demonstrated they knew them well.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

We observed that risks to people related to the building were not always well managed. A door to a hot water cylinder cupboard was unlocked and we saw exposed pipework to a newly refurbished bathroom. We observed a person open the cupboard. The accessible pipework in the cupboard and in the hallway was hazardous to people from accidental burns. We reported this to the registered manager. They arranged for the maintenance staff to put a lock on the door to the hot water tank and temporary insulation was placed on the exposed pipework. They explained that the pipework would be boxed in as a permanent solution.

Maintenance tasks appeared to have been completed in a timely manner. Rooms were mostly clean and tidy and had been personalised in accordance with the person’s wishes. Essential servicing and maintenance of the service, utilities and equipment had taken place. Window restrictors were in place and secure. The maintenance team told us they carried out daily checks of the service including people’s rooms, they then completed any maintenance jobs that were needed. Relatives told us that the service and grounds were well maintained. A relative said, “The garden is nice too.” A staff member told us, “They are improving the décor, it is important to have a homely feel.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They made sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff had regular supervision meetings, induction was a mixture of training and shadowing experienced staff to gain confidence and experience. The training matrix showed that most staff had completed mandatory training. However, the training records showed that staff had not completed additional training to meet people’s assessed needs, such as epilepsy, catheter care and diabetes. Some nursing staff had not attended training in catheterisation. Some nursing staff had not completed epilepsy training. Some staff did not have any experience of working with people with epilepsy. Whilst we had not identified any direct impact to people in relation to this, risks of not meeting people’s needs safely were identified, particularly for a person who had been given different medicines to help them with their seizure. Staff told us “We have a lot of online training, it is a shame there is not more face to face”; “I get emails to do updates on training, we haven’t done epilepsy or diabetes, but I have done my own research and learning about diabetes”; “Moving and handling training is done face to face. Part of the training includes the trainer watching us demonstrating use of equipment to look at competence. I have done epilepsy training in the past, not at Larchmere. I have not been there when anyone has had a seizure.”

We observed call bells were answered quickly. We received mixed feedback from people. Comments included, “Buzzer varies, they are busy when people are going to bed, waiting times are acceptable. They come and say we will be another 10 minutes and say a reason but don’t go into details, that would not be proper”; “I do ring at night for the toilet, about the same waiting time, works just the same at weekends” and “Not really enough staff, they work their socks off and at times there is not enough of them at bed times.” Relatives told us, “Seems to be enough staff” and “There's always plenty of staff, there seems to be enough. There is continuity of staff.”

Staff gave us mixed feedback about the staffing levels. Comments included, “There are certain periods where everyone wants something at once. For example, at bedtime when everyone wants support at the same time, if it gets really busy sometimes, we leave the laundry if we run out of time. We are all there for the same purpose, we should all work together. The nurse does support at night. New staff are shadowing”; “I think there is enough staff on, there is a good team of carers, they work together well”; “When it is fully staffed there is enough of us, when there is sickness not so good. Today someone was sick, and agency could not cover.”

Staff had been safely recruited. All required checks had been carried out and documents were all in date. The information helps employers make safer recruitment decisions. Nurses were registered with the Nursing and Midwifery Council. The provider had made checks on their personal identification number, registration status and renewal date.

The provider assessed and managed the risk of infection. They did not always detect and control the risk of it spreading. They shared concerns with appropriate agencies promptly. The provider had not taken action to address the infection control risks that had been highlighted in the infection control audits undertaken by the management team. We observed several toilet areas within the service which had holes in the flooring where previous rails had been installed. These holes presented an infection control risk as they could not be effectively cleaned, we reported these to the registered manager, and they arranged for the maintenance team to seal the holes.

The provider had a daily cleaning programme in place. The service employed housekeeping staff to carry out daily cleaning, cleaning schedules were in place which included deep cleans for people’s rooms. Infection control audits were completed regularly and most actions were taken in a timely manner if any issues were found. The provider had plenty of PPE (Personal protective equipment) in place to keep people and staff safe. The kitchen areas were clean and well managed. We observed that the staff were using PPE effectively and safely

Staff told us they had sufficient equipment and PPE to provide safe care. Staff had received infection prevention and control (IPC) training and were familiar with IPC processes to mitigate infection risks. A staff member told us, “There is always plenty of PPE.” Relatives told us, “The home is clean. It’s a sensible place, never any rubbish” and “Always clean and smells fresh.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were not well managed. Some people were prescribed as and when required (PRN) medicines for laxatives. These had not been given when they were required. Nursing staff responsible for administering the medicines had marked them as not required on the medicines administration record (MAR). We reported this to the registered manager and appropriate action was taken to ensure bowel monitoring was more effective.

A person had not been given the appropriate medicine when they experienced a seizure. Records showed a person prescribed rectal Diazepam if they had a seizure had been given a Midazolam injection. Midazolam had been prescribed for agitation and should not have been used during a seizure. Medicines records had not been completed to show that Midazolam had been administered. We reported this to the registered manager and appropriate action was taken to protect people from harm.

Some medicines given had not been adequately recorded on MAR charts. For example, one person had been given laxative medicines on 29 July 2025. It was recorded in their care notes but not on a MAR. The person was not prescribed laxatives, and the GP had not signed a homely remedy sheet to show that this person could be given this medicine. This did not follow the provider’s medicines policy.

We identified that 3 people had been having too high a dose of paracetamol for their weight. We reported this to the registered manager who requested that the GP review these people. Since the assessment the GP has been and reviewed these people’s medicines and doses changed.

Medicines were securely stored and timed medicines were given appropriately. The ordering process for prescribed medicine was effective, and we were able to reconcile medicines stock with prescribing. The management team carried out regular medicine audits. A person told us, “They say what my tablets are, I have Parkinsons medicines and other regular tablets, they come on time, and none are missed.”