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Inspection carried out on 22 November 2017

During a routine inspection

The inspection took place on 22 November and 4 December 2017 and was unannounced on the first day. The previous inspection was held in September 2015. There were no breaches.

The Larches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Larches provides accommodation for up to 20 people requiring personal care. At the time of the inspection there were 18 people living at the service. There was a registered manager. 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.

People using the service, their family and professionals all said that The Larches provided a caring and safe service. Medicines were managed and stored safely. We found there were some gaps in medicine administration records but none of these omissions had resulted in harm to any individual.

People were protected from abuse by staff who had been trained to identify safeguarding concerns and knew how to act on them to keep people safe. Risks relating to the care of people living at the service were assessed and appropriate measures were put in place to minimise risks to people.

There were enough staff on duty to support people’s needs. Staff recruitment processes were robust and had ensured appropriate staff were employed. Staff turnover was low and staff morale was high. Staff received induction, training and the opportunity to undertake national qualifications.

The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made as appropriate.

People received care from visiting health professionals as required who expressed confidence in the service. People were offered a varied and balanced diet.

People were supported by kind, caring staff who demonstrated warmth and compassion. People and their relatives praised the staff for their caring approach. One person said, “Nothing is too much trouble.”

Care plans were written to meet individual needs and in consultation with people and/or their relatives. Attention was given to specific communication needs.

People were offered a range of activities including outings for shopping and coffee. Different spiritual and religious needs were catered for in the service. Visitors were able to come and go at any time and praised the service for the warm and welcoming atmosphere. People knew how to raise a concern and felt confident these would be acted upon.

There was a range of systems in place to monitor the quality of the service.

Inspection carried out on 3 and 7 September 2015

During a routine inspection

An unannounced inspection took place on 3 and 7 September 2015. It was carried out by one inspector. The Larches provides accommodation for up to 19 people and 16 people were living at the home on the first day of our visit. On the second day of the inspection, an additional person was staying at the home for two weeks.

A registered manager was in post. 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.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, applications had been made to the local authority in relation to people who lived at the service. The registered manager told us most of these were waiting to be approved. One person’s application had been approved but CQC had not been notified of this decision, which the registered manager said they would rectify.

People looked confident as they moved around the home and people told us they felt safe. Accident and incident records were analysed and action taken. Staff knew to report poor or abusive practice, and the registered manager and seniors responded to concerns appropriately. Staffing levels met people’s care needs. Tea times were busy as some people became restless and an additional staff member had been recruited to address people’s care needs at this time. The atmosphere was calm and friendly. Medicines were well managed. Risk assessments were in place for people’s physical and health needs.

Staff treated people as individuals and checked how they wished to be supported. Staff understood the importance of gaining consent and their legal responsibilities. People told us staff were kind. People benefited from a staff group that were trained and supervised. People had access to health services.

Staff were calm and unhurried in their approach when they supported people. People complimented staff on their friendliness and kindness. Care records were personalised.

The service was well run by a committed manager who was approachable. Safety checks were up to date and the home was well maintained.

Inspection carried out on 20 August and 5 September 2014

During a routine inspection

The inspection was unannounced and lasted over two days. This was because the registered manager was not available on the first day. We brought this scheduled inspection forward because we had been contacted by someone who raised concerns about the staffing arrangements on one night shift.

There were 18 people living at the home. We spoke with six people living at the home, two relatives, three staff and the management team. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. The registered manager told us she had contacted families by phone to explain that she was leaving in October 2014. We also saw a notice on display in the home advising people she was leaving.

We looked at a selection of care records and staff communication records, as well as records relating to staffing levels, training and quality assurance.

Is the service safe?

We saw risks to people's health and well-being were monitored by caring staff but robust systems were not in in place to make sure that people�s care and welfare was monitored and regularly assessed. This meant there was the potential for risks to people to be inconsistently managed. Assessments had not taken place to assess people who did not have mental capacity and therefore their rights were not protected. Staff did not receive appropriate training and knowledge to promote people�s rights, safety and well-being. Staffing levels meant people were cared for in a safe environment where the atmosphere was calm. The home was clean and odour free, although improvements were needed in the style of the laundry to promote good infection control.

Is the service effective?

People were able to confirm they were happy with their care and they looked well cared for. Two visitors praised the care at the home, and a health professional said they had no concerns regarding the home. We saw people looked relaxed with staff and at ease in their surroundings. People's health and care needs were assessed, and staff knew when to seek external advice when people�s care needs changed. However, risk management records and care planning did not clearly document what steps were being taken to provide effective care. Some aspects of the home�s quality assurance systems did not support improvement, such as irregular supervision, gaps in training, and a lack of staff survey.

Is the service caring?

People were supported by friendly and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that staff were attentive to people�s needs, which people confirmed to us. People told us staff were �kind� and this view was echoed in the feedback from quality assurance surveys. However, people were not always consulted about their care plans.

Is the service responsive?

We looked at people's care plans and we saw staff contacted health and social professionals appropriately when people's needs changed. However, care and risk management was not always recorded in a clear manner. Two relatives told us staff kept them informed of changes and said there was good communication between staff, the registered manager and families. A health professional said the district nursing team were contacted appropriately and in a timely manner. These views were also echoed in quality assurance surveys completed by people living at and visiting the home.

Is the service well-led?

Staff had a good understanding of the ethos of the home and their role in promoting good practice and reporting concerns. This helped to ensure that people received a good quality service. However, the quality of some of the care records was an area for further improvement. Staff did not benefit from regular supervision, comprehensive training and were not given the opportunity to influence the service through a staff survey.

Inspection carried out on 1 November 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

There were 13 people living at the service. We met and spoke with four people and two visitors to the home. We spoke with four staff that were on duty at the time of the visit. We looked at care records for four people, we also reviewed records relevant to the management and administration of the service.

People told us they liked living in the home. One person told us �The great thing about living here is that the staff are always so pleasant and helpful.� Another person said � I like here it�s very nice, I am very well looked after and well fed�

One relative we spoke with said �We are very lucky to have mum here I can�t speak highly enough of the place, I have been fully involved in her care and I have never been unhappy� They also went on to say how emotionally supportive the staff had been especially during the difficult period when their mum first moved. They felt the staff at the home had an open and receptive approach always willing to listen to any concerns.

Another visitor said �The home is very welcoming I can visit any time, the staff are very pleasant and very obliging�

People told us they had plenty of activities to do. Two people particularly enjoyed trips out with the activities co-ordinator, others liked to play games, read books or the newspaper and watch the television. They were all confident that the staff had the skills to care for them.

We observed the serving of lunch in the dining room and drinks and snacks in people�s rooms. People were provided with a choice of nutritious and appetising food and were well supported with their individual needs during the meal time.

Inspection carried out on 26 February 2013

During a routine inspection

At this unannounced inspection we spent one day at the home. We spoke with five people living at the service and heard comments from three health professionals with current links to the home. We spoke with seven members of staff on duty and the Director of Care.

On the day we visited the home was full; 17 people were at the home. Two other people were receiving care in a hospital. We saw all the people in the home and observed some people receiving care and support from staff working in the home. People living at the home were older people, and some people had a diagnosis of dementia. People we spoke with were positive about their experiences. Comments included ��the staff are very nice, they come to me when I need them�� and �I couldn�t want for more.�

During the inspection we read a range of documents used to plan and evaluate care. We found that care and support was well planned, with people being involved in the process where possible. People told us they felt able to raise concerns within the home in order to improve services for them.

We checked the provider�s employment records and found that newly appointed staff had undergone a robust recruitment process which helped keep people safe.

Inspection carried out on 29 November 2011

During a routine inspection

We carried out an unannounced visit to The Larches on 29 November 2011. On the day we visited 17 people were residing at the home. Both women and men were living at the home and all were older people aged 65 years or more. The manager and a senior care worker were on duty. They were assisted by three additional care workers, two domestic staff, a cook and handyman. Also on duty the day we visited was a part-time activities organiser. We saw or spoke to everyone who was living at the home. We asked people if they found there were enough staff rostered on duty to support them each day. People told us that in their opinion there were, and that they did not have to wait long periods for staff to respond for requests of support if they called or rang their bells. During the inspection we observed care and read a range of documents used to plan and evaluate care. Overall we found that people were experiencing good outcomes at the service and they were supported by caring and friendly staff who had the skills and knowledge to meet the people's current needs.

Reports under our old system of regulation (including those from before CQC was created)