The Larches - Tiverton

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 Requires Improvement. At this assessment the rating has changed to Good.

Good: This meant people were safe and protected from avoidable harm.

This service scored 69 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

For example, although we found a culture of safety in the service and staff were aware of how to support people when they were distressed or at risk of decline, we were not assured systems and processes in place enabled staff to carry out their roles effectively. Staff had recently been instructed to not attend handovers and to instead read the handover book or the handover on their electronic care app. This is an app on handheld phone devices staff carry with them while working which allows instant access to daily notes, charts, and care plans. Only senior staff were instructed to attend daily handovers. This put people at risk as staff were not given sufficient time to read the handover book or their electronic care app before needing to attend to people.We found one instance where a person had been admitted to hospital, but as staff did not attend handover, they were not informed and went to look for the person, only to find they were not in the service. This was fed back to the provider and manager, and they gave assurances this practice was going to be reviewed.

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.

Initial assessments were completed for people moving into the service; however, staff told us some people’s needs were higher than they felt they could cope with. The manager shared information with other health professionals when appropriate to support people’s needs and provide continuity in their care. Staff told us they were given a verbal handover about people before they moved into the service.

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.

Whenever a safeguarding concern was reported, the provider's internal systems meant senior leaders were notified and able to review and contribute to actions to mitigate future risks. This also formed part of the manager’s systems to learn lessons, update care plans and communicate this to the staff team to reduce the risk of recurrences. Staff had received safeguarding training and knew who to report concerns to externally if needed. Deprivations of Liberty Safeguard (DoLS) referrals were made and improvements into how the service recorded restrictions to people had been embedded. However, we found the service had not always completed appropriate mental capacity assessments and staff we spoke to were unfamiliar with DoLS and what they meant for people living at the service. The staff had received training in mental capacity and DoLS, and the manager had plans to assess staff’s knowledge and understanding in this area. People and relatives, we spoke with did not have any safeguarding concerns. A relative said, “When I come to visit there are plenty of staff, it is pretty secure here and I am happy they are keeping [relative] safe and well.” A person said, “If anything goes wrong, they call my [relative], everyone here takes very good care of me.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments and care plans were in place, specifically addressing risks people could experience, including health risks. For example, where a person was known to experience disorientation and was not always able to use their call bell, the care plans and electronic care app guided staff to confirm their whereabouts and well-being regularly. People’s needs in relation to assistive safety equipment had been assessed, and we observed people had safety equipment such as sensor mats. A person said, “[Staff member] helps me walk around a bit when I'm in my room, I’m unsteady but the staff are very good at helping me.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider maintained a good-quality, homely environment. A relative said, “When we visit it is clean and tidy here.” Equipment such as lifts, hoists and those related to fire and gas safety had been inspected in line with requirements. People’s equipment, such as their beds, call bell systems, wheelchairs and walking aids, were regularly assessed for safety and audits were completed monthly. The maintenance schedule for the lift was up to date.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make 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.

Recruitment checks had been carried out to ensure staff were safe to work with people and the provider had made improvements since the last inspection in this area.

We spoke with 4 people using the service and 10 staff members. Some people we spoke with felt there were not enough staff. People shared examples of the impact of this including their perception of not being able to go out, not having anything to do or anyone to talk to. Staffing concerns impacted on people's perception of often they were offered outings, activities and personal care. Although personal care was delivered daily, people told us they would have preferred more frequent showers. Other people spoke about not being able to have personal care as often as they would like to. One person told us, “I had a shower today, but I won’t be having another until next Wednesday, but I’d like to have one every day, that is what I used to have at my own home and that is because there is not enough staff.” Another person commented, “Staff can only do what they can but that is the trouble if there are not more staff. It depends how long you have to wait for and if some person needs 2 people, then that takes the staff away so then they are short of staff, and you have to wait.” Staff also told us there were times when they felt more staff were needed to ensure people’s needs were met in a timely way. Where people did not receive support to shower, they were supported by staff with washing to maintain personal hygiene.

We observed staffing levels in the morning to be sufficient, however staffing levels were insufficient in the afternoons.

Staff had received a range of training to provide them with the skills and knowledge required to meet people’s care and support needs. However, some staff told us they hadn’t received training on the electronic care app system. One staff told us, “I was on holiday when the system was introduced, and training was only given to people who were there on the day. I don't know if I'm using the system correctly.” We found in the training records only half of all staff had received training on the electronic care app.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff consistently followed infection prevention and control practices. We observed staff, without exception, wearing personal protective equipment (PPE) and following the correct hand sanitising processes. The provider had worked closely with the service to ensure staff felt skilled and confident in what was expected and the appropriate times to wear PPE. One member of staff told us, “We have certain colour codes in certain areas of the service and every day I wipe all the handles and switches and anywhere they might put their hands and I always wear PPE and I change it as I go into a new room and what we did from covid I have not stopped doing so you change your apron and gloves every room and so you know you are keeping people safe.” However, the provider had recently cut the cleaning team down to working 6 days a week, with no staff working on Sundays. We brought this to the provider’s attention as posing a very high risk, especially if there were to be an outbreak, and this practice could result in infections spreading very quickly. After the on-site inspection, we were informed this decision had been reversed and cleaning staff were now working 7 days per week.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

There had been improvements to the way medicines were managed since the previous inspection. Medicines records were clear and showed people received their medicines safely as prescribed for them. Staff were knowledgeable about people and their medicines, and people’s preferences were recorded and considered. There had been improvements to the way medicines prescribed ‘when required’ were managed. There were personalised protocols in place with information to guide staff when these might be needed. When medicines were given in the form of patches, the site of application was not always recorded to show these had been rotated in line with recommendations. However, we were told a new system would be implemented immediately to ensure this would always be recorded going forwards. Risk assessments were now in place for higher-risk medicines such as anticoagulants and flammable paraffin-containing topical preparations. There were suitable arrangements for ordering, storage and disposal, and temperature monitoring was carried out to make sure medicines would be safe and effective. Staff had training and competency checks to make sure they gave medicines safely. Regular medicines audits took place, and we saw these identified areas and actions for improvement. There were appropriate systems in place to identify, record and report any errors or incidents.