The Larches - Tiverton

Updated 24 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They telephoned relatives to ask for their views about the service.

Service and service type

The Larches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. The Larches is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We asked for feedback from health and social care professionals who support people at the service. We used all this information to plan our inspection.

During the inspection

We met with people who lived at the home. We spoke with 5 people who could tell us about their experience and views about the home. Some people were unable to fully express their views to us as they were living with dementia. We therefore spent time observing care in the main communal area and the interactions between people and staff.

The expert by experience spoke with 10 relatives to hear their views.

We spoke with 9 members of staff, this included the deputy manager, activity person, senior care workers, care workers, a housekeeper and the cook. We also spoke with the registered manager and the nominated individual The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 5 peoples' care records and a sample of medication records. We looked at a variety of records relating to the management of the service, including training records, 2 staff recruitment files, incident records, quality monitoring processes and various policies and procedures. We attended a handover on the first day by the morning staff to the afternoon staff.

We spoke with a visiting chiropodist and emailed the GP who supports people at the service to ask their views, we did not receive a response.

Updated 24 August 2023

About the service

The Larches- Tiverton is a residential care home providing personal care to up to 20 people. The service provides support to people aged 65 and over with a physical disability or dementia. At the time of our inspection there were 17 people using the service.

The Larches is a large, detached property in the market town of Tiverton and located near the historic Grand Western canal. People’s bedrooms are on the ground and first floor, which people access using a lift.

People’s experience of using this service and what we found

Medicines were not always safely managed. Practices at the home were not in line with the providers medicines policy. Which meant people were at risk of not getting their medicines safely.

People had not always been protected from the risk of fire at the service. Improvements were made during the inspection regarding fire management.

Staff levels had been reduced by the provider. Staff said there had been poor communication about the changes and they did not feel there were enough staff to support people safely. Improvements were made during the inspection to increase staff levels. We have made a recommendation regarding staffing levels. Improvements were needed to ensure recruitment processes were more robust to ensure all documentation and checks were accessible.

People were kept safe from avoidable harm because the management team and the staff knew them well and understood how to protect them from abuse. People and their relatives were positive about the home and the way staff cared for people.

Audits were in place. However, they did not always identify risk. Where risk was identified, we could not see if action had been taken.

Improvements were needed in relation to infection control which were being implemented by the registered manager. We have signposted the provider to resources to develop their approach.

Accident and incident oversight was not robust. Staff completed incident and accident records on the providers computerised care system. However, there was not a system in place to analyse themes and trends.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives were not given the opportunity to attend meetings or complete surveys about their views of the service. However, it was a small service and people and relatives said staff knew people well. There was a suggestion box in the main entrance should visitors which to make any suggestions.

Monitoring systems had failed to identify all shortfalls found during the inspection process. In particular, medicines were not safely managed, unsafe fire risk management, managing staffing levels to meet people’s needs, infection control risks and oversight of accidents and incidents. This meant opportunities to drive improvements to quality and safety were missed.

Records were not available at the time of the inspection in relation to staff employment and staff training. When we did receive these, they were not comprehensive.

The provider and manager were receptive to the concerns found during the inspection and started processes to reduce the risk of harm to people living at the home. We were assured the provider and registered manager wanted to further improve their processes because they agreed to work with the local authority quality team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 3 May 2018).

Why we inspected

We received concerns in relation to the management of the service and risks to people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Larches-Tiverton on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.