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Archived: Larkstone Supported Living Limited Good

Reports


Inspection carried out on 14 December 2016

During a routine inspection

This inspection took place on the 14 December with an unannounced visit to the registered office. We then completed two further visits to people using the service, which were announced. These occurred on 16 December 2016 and 6 January 2017.

Larkstone supported living service provides personal care to people in their own homes and covers two main geographical areas; Ilfracombe and Bideford. People using this service either have a learning disability or a mental health issue and require assistance with activities of daily living to ensure their safety and well-being.

There was a registered manager in post, who has been working at the service for just over 12 months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care and support was well planned and delivered by a staff team who understood the needs and wishes of people who received a service. Staff showed a good understanding of how to support people in the least restrictive way, promoting their dignity and ensuring their human rights were protected.

Staff knew what mattered to people and were therefore able to offer personalised care and support to suit people’s needs, wishes and preferences. People were actively involved in the development and reviewing of the care plan, where possible. Usually care was well planned, although we did receive feedback from one healthcare professional to say one person they had reviewed, did not have a care plan and their risk assessment was in need of updating. The provider said there was a care plan but this had needed to be updated, which had now been completed. The impact on the individual was minimal as the care workers knew the person well and knew how to support them safely and effectively.

People were protected from the risk of potential abuse as staff understood what to do to minimise risks, report any concerns and work in a way which promoted people’s independence whilst being mindful of their vulnerability.

Recruitment processes ensured new staff employed were suitable to work with vulnerable people. There was a comprehensive induction programme which followed national standards.

Staff had training, support and supervisions to help them develop their role and skills. Staff felt valued and said they had good opportunities to gain further skills and qualifications.

People, staff and relatives of people using the service had confidence in the management approach. There were a variety of ways the service sough their opinions and actioned any concerns or complaints.

People were supported to maintain their health, be encouraged to eat a healthy diet and receive their medicines at the right time.

People’s rights were protected because staff understood the principles of the Mental Capacity Act 2005 and when needed were able to support people to make best interest decisions, including the involvement of independent advocates.

Inspection carried out on 30 September 2014

During an inspection to make sure that the improvements required had been made

The purpose of this inspection was to follow up an outstanding compliance action from our last inspection of the service when we had found some records were not accurate or up to date. That meant care staff did not have sufficient information about the support each person needed. During this inspection we checked to make sure actions had been carried out to improve the records. We met with three people who used the service, two members of staff and the registered manager.

The people we met showed us their care plan files. We also looked at the care plan of a person who was in hospital at the time of our visit. The people we met had varying levels of verbal communication skills and therefore we observed their responses and their interactions with the staff to gain answers to our questions

The provider had completed the actions they had told us they would carry out to improve the records. We found their actions had been effective.

Is the service safe?

The service was safe because up to date information about all aspects of each person’s health and care needs, was available to care workers. Risks to people’s health and welfare had been assessed and the records explained to staff how people wanted to be supported to minimise the risks.

The care plans included information given to each person about the service, including the service user guide and how to make a complaint. The complaints procedure was written in a format that was easy to understand. We asked people if they knew how to make a complaint and they confirmed they would tell someone if they were upset about anything. They told us they liked all of the staff and they had never been upset by any member of staff.

Is the service effective?

The records showed that people’s health and well-being was promoted. Each person had been involved in drawing up their care plans. The records provided clear instructions to staff about the care and support each person wanted and needed. Records had been completed by care staff to show the support that each person had received every day. This showed staff had followed the instructions set out in each care plan file.

Is the service caring?

The records provided detailed evidence of how staff were encouraged to listen to people. Communication needs were explained clearly. We saw information in the records, and the manager told us, that there was an emphasis on understanding people. The records explained why people may become upset, and how to support them in a caring manner until they were calm again. People and staff we spoke with told us there was a happy and the home had a caring atmosphere.

Is the service responsive?

The records showed how people’s wishes, likes and dislikes were taken into account. For example, when assisting one person with their medications the care plan explained “I like the pot placed into my left hand”. Advice and treatment had been sought appropriately for identified health needs such as healthy eating, the risk of choking, and Parkinson’s disease.

Is the service well-led?

The records showed there were systems in place to monitor all daily routines. The manager showed us records they used to review the effectiveness of the service and these provided evidence that changes had been made where necessary to improve the service.

Inspection carried out on 6 March 2014

During a routine inspection

We inspected the service at short notice. We spoke with ten people who use the service, one relative and visited two people in their own homes. We spoke with eight members of staff, the manager and the director.

The total number of people being supported on the day of our visit was 31 with approximately 25 staff employed.

People were happy with the service received. Comments included "I love all the support staff", "they are always kind and nice to me" and "they look after me".

We saw that people had an assessment, care plan and risk assessment in place but that these records did not always contain the information required. People were sent a rota to tell them which staff to expect at which time.

Staff were knowledgeable in their understanding of hygiene requirements.

People and staff told us they were able to voice any concerns to the manager. They told us they were "very supported", "have confidence in X" and "not a bad word to say about X - I'm supported".

We saw that staff displayed a good knowledge of safeguarding procedures and the appropriate action they needed to take if an allegation arose.

We saw that concerns and complaints raised were taken seriously and investigated.

We saw that the service had a quality audit system in place which monitored the service delivered, but that this had not identified the deficits in care record keeping.

Inspection carried out on 14 December 2012

During an inspection to make sure that the improvements required had been made

At our previous inspection on 28 June 2012, we raised concerns about obtaining consent from people that lack capacity and the quality of records about visits to people using the service. We carried out a short inspection on 14 December 2012 to follow up the improvements made. The provider sent written information that we reviewed. We spoke with three people using this service and three staff. We concluded that the provider has now demonstrated compliance with regard to obtaining people’s consent where they lack mental capacity to do so and improved record keeping.

People told us they control their lives with comments like "I do what I want to and tell them I'm doing it, I love living here."

Inspection carried out on 6, 11 July 2012

During an inspection in response to concerns

We carried out this responsive inspection in response to an overall multi agency safeguarding strategy which was being coordinated by Devon County Council. This strategy focused on key themes indicating potential non compliance with regulations relating to: Respect and involvement; consent; fees; health and welfare; safeguarding; supporting care workers and quality assurance.

We inspected the agency office on 28 June 2012 to look at some records for people using the service, including invoices, terms and conditions of service and overall quality assurance. On 29 June and 2 July 2012 we visited two locations where the agency provided care and support to people using the service. We carried out telephone interviews with people using the service, their relatives, professionals and care workers employed on 3 July 2012.

We looked at the records of five people in detail; and spoke with people about their experiences at the service. We spoke with a further seven people in person over the telephone about their experiences. We also observed interactions with six people using the service, whilst they were part of a group activity. We spoke with 11 care workers, including a manager in addition to the nominated individual and a director of the company. We also asked the provider to send us additional information in respect of care workers training and quality assurance.

People told us they were fully involved in directing the level of support they had and also development of the agency. For example, one person told us they had been involved in interviewing new care workers and “Liked doing it and the right person was picked for the job”.

People with capacity were enabled to understand and given information in a way that suited them so that they could make changes to the support given. For example, one person told us “I spoke to XXX and she juggled my hours so I could go to a concert with their help because I needed support and couldn’t go on my own”. Another person told us they needed additional support as a one off and said they were happy to pay for the extra hours so they could go on holiday for a week. Two relatives told us that the agency had responded to requests to situations where they or their relation wanted additional support for specific outings.

People told us that care and support given by their team of care workers was always reliable and flexible around their needs. For instance, one person said “they always come on time”. We also saw several instances of support being delivered as planned during our visits to people. For example, we saw a group of people attending a music session with support as planned.

People were supported by appropriately experienced and trained care workers. The agency had systems in place to support care workers. Care workers told us they were well supported and closely monitored to ensure that they gave a good service. This was echoed by people we spoke with and our observations during our visits. People told us that care workers were “very nice and friendly” and “all very good”.

The agency was well managed and had robust systems in place to monitor the quality of the service people were experiencing. For example, people told us that they were always asked for feedback when they had contact with the office. We heard about regular meetings taking place to discuss how their needs were being met, group meetings to discuss developments with the service in general and opportunities to influence the quality of the service. For example, two people showed us the service users guide that was in draft, which everyone using the service we were told had been encouraged to “make changes” to “so it will be better”.

The main concerns at this inspection related to records and consent. The procedures at the agency did not require care workers to routinely record in detail what had taken place at each visit with a person. Therefore, incomplete records could put people at risk of inconsistent or inappropriate care because the provider would be unable to audit that people’s needs were being consistently met as planned. There were systems in place to gain and review consent. However, these did not adequately protect people that may have limited or lack capacity to make decisions.

We highlighted to the provider that information about additional services, such as counselling, was not covered in either the statement of purpose or service users guide. The latter document was in the process of being reviewed so this could be easily rectified.

Inspection carried out on 8 December 2011

During an inspection in response to concerns

During this unannounced inspection we visited the registered office in Barnstaple on the 6 December 2011, to look at some key records, including staff recruitment files, staff training and care plans for people they support.

On 8 December 2011 we visited two locations where Larkstone provide care and support to people in their own flats. We spoke to a total of ten people who receive a service from the agency. We also spoke to five staff members during this time. We looked at four care plans in the peoples own flats.

We also asked the agency to send us some additional information in respect of complaints and concerns they had received and any details of how they ensured that people are involved in the review and audit of the quality of care and support provided.

People we spoke with said that the care staff that helped them were kind and respectful. We heard that each person had a detailed list of which support staff were supporting them, for how long, and in what tasks or activities. We asked how this worked for people who were unable to read, and were told that the support staff read through the detail of the daily plan for people and that sometimes photos were used to help people remember which staff were supporting them on each day.

One person told us that they had wanted to talk to the Care Quality Commission about the fact that they did not wish to be supported to do their household chores on a Sunday, but that overall they were happy with the support staff and the timetable of care and support that had been set up for them. We were told that this person could have one to one on the Sunday to do other activities and did not have to do their housework and other chores then, if they did not want to.

One person told us they did not like the new young support staff, but when asked, they were unable to say why, but said they thought they were ‘‘lazy and didn’t do their job.’’ We asked if they had any examples of where newer staff had not supported them well, and the person could not think of any. We asked if their concern could be further explored by the new manager, whom they appeared to have a good relationship with. It was agreed that the person may find change and new support staff difficult to adjust to, but that their concerns would be further discussed with them.

Another person told us that staff were ‘very good, help me with my shopping and to cook meals.’ We saw one support worker assisting someone to put washing away and discuss plans for Christmas. We observed people being spoken with in an appropriate and inclusive manner. Some people have complex communications difficulties and we saw that staff had a good understanding of these and worked with people in a way that allowed them the time to respond to any questions they gave them.

We heard that some people who receive the service from Larkstone were involved in interviewing for new staff. They had also been involved in training workshops for finance management and had helped to develop new forms for money management.

We saw that the agency had good records relating to exactly what support hours each person had and who would be supporting them when. We were told that this is monitored and reviewed on a regular basis. When someone had a new support person they are asked after six weeks, how they got on with them and how they rated them.

We were told that the agency try to involve people’s family and advocates, by including them in the six monthly reviews, if appropriate, and by having six monthly general meetings with carers to keep them informed of any changes in the way the agency was working, but also to ensure that there were regular forums that allowed them to voice any concerns, issues or suggestions. The day we visited the registered office, there was also a meeting for carers.

There had been some recent safeguarding alerts, but we are confident that the agency had worked with other agencies to address these and to ensure people were not placed at any further risk.

We have been made aware that since this inspection there have been some concerns expressed from the commissioning team about people not getting the care and support they had been commissioned for. We did not find any direct evidence of this during this inspection.