The Larches - Tiverton

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement.

Requires improvement: This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not foster a positive culture for people. The provider’s values were not upheld by the management team and staff morale was low. There was a clear lack of leadership and oversight of the service which impacted directly on care provided to people. Decisions made by the provider were not aligned to the values of the management team or the staff. There was an impact to people living at the service as several staff members had made the decision to leave the service as they did not feel valued, supported or listened to by the provider.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

At the time of the inspection, there was no registered manager in post, the manager was in the process of submitting their registered manager application. They were supported by a deputy manager. The deputy manager worked in the office and worked shifts with the staff. This enabled sharing of good practice and learning. Staff members said, “The manager is lovely, and I imagine it is a hard role” and “[Manager] is brilliant.” People and relatives knew who the manager was and said they were approachable. A person told us, “I know who the manager is and if I had anything I needed to say I would talk to her.” The manager told us about the improvements put in place and the action plan put in place to improve the shortfalls identified during the previous inspection. We saw improvements were implemented or in the process of being completed.

There were regular opportunities for staff to provide feedback about the running of the service; however, staff felt the provider did not listen to their feedback and ignored their opinions on safety. Although staff told us they trusted the manager, they were not confident the provider would make decisions in the best interest of people living at the service. The provider and the manager were different persons and when we spoke to 8 staff members, the majority of staff were dissatisfied with the provider. One staff member told us, " I don't get on with [the provider], I don't understand why he does the things he does. It's so dangerous now we don't have handover and especially as we are losing staff that means we're going to have more agency. We won’t have the time to give them handover and let them know things when we have to start answering bells as soon as we walk through the door. I know a lot of staff are against what [the provider] are doing and are unhappy with him.” The provider did not attend staff meetings and communicated directly with staff either by letter or instant message.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The manager told us, “We aim to treat all staff fairly and equally and I will always support the staff and be on their side.” Staff were supportive of people who had been recruited from outside of the UK. One staff member told us, “We have some people who are from other countries, they are very good.” The staff also told us they found working with agency staff difficult as they did not always have a high level of English and they found it time consuming to orient them to the service while also answering call bells and administering medicines. This was especially an issue when, on the afternoon shift when there were only 2 staff members, if 1 was an agency staff member, the full-time staff member found they had to spend significant amounts of time and effort supporting them if they had not worked in the service before. The manager told us they always try to have agency staff who have been to the service before, but acknowledged this is not always possible.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The manager told us they had reviewed the systems for monitoring the care provided, including developing audits. The management team worked alternate Saturdays to ensure the weekends were also monitored. There was always a senior staff member on the night shift. Managers walk around audits were in place, these identified where shortfalls had been identified and actions were taken to address them. This included cleaning, medicines and environmental actions. Care plan audits were detailed and showed these were reviewed thoroughly and required actions had been implemented. The manager understood care plans required ongoing monitoring and had systems in place to ensure this happened.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The manager told us they had good relationships with other professionals involved in people’s care. This included commissioners, the district nursing team, and the GP service, who visited weekly. This was confirmed by a staff member who shared examples of how joint working had improved outcomes for people, this included using guidance to review a person’s care plan when their needs had changed. We received feedback from external professionals which demonstrated the staff worked with them to meet people’s needs in a joined-up way. People were supported to access the local area on outings and many people living at the service had lived locally prior to moving into the service and shared the service had a long-standing reputation in the community for providing good care.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

There was a programme of training provided to staff, and they were reminded when this needed updating. The service offered a large variety of optional training opportunities for staff. Since the last inspection the manager had made improvements to systems and processes which had a positive impact on the safety of the service. Identifying people’s declining health had improved and staff escalated concerns quickly which had led to positive impacts on their outcomes. People were now happier and safer, despite the recent negative changes made to how handovers were conducted. We did receive assurances from the provider they would review the handover process and were planning on reversing their decision to not have a cleaning staff member in on Sundays. The provider was also planning on reviewing with the manager the staffing levels on afternoon shifts.