The Larches - Tiverton

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At a previous assessment we rated this key question Good. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s safe care and treatment, dignity and respect.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not know people’s care needs.

The provider told us ABC records were not used as ‘we have no residents that fall in this category.’ ABC observational records are used to understand a person’s specific behaviour by recording what happens immediately before, during, and after an incident. It helps identify triggers and patterns to develop effective staff interventions to reduce, for example, the risk of anxiety.

However, staff described how 1 person’s actions could impact on the safety of others. For example, they hit staff, were verbally confrontational and grabbed other people. Despite the provider saying they were not used, we saw ABC records were incomplete with neither the antecedent, behaviour or consequence sections recorded. This meant the charts were not effective and did not support staff to understand people’s behaviour and reduce the risk of incidents recurring.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Prior to our assessment, we were made aware a new person was moving to the home. We asked the provider who would complete the care plan as there was no manager or deputy manager in post. They assured us a senior member of staff would be supported by experienced staff from their other care home.

However, when we reviewed the person’s care assessment, it contained contradictory evidence linked to the person’s continence, risk of pressure damage, cognitive impairment and pain relief. Documents did not show the input of other staff members or a review by other staff members, contradicting the provider’s previous reassurances. This meant the provider had failed to ensure the care plan was fit for purpose. The care plan did not clearly lay out what the person’s care needs were and how staff should support them to be safe. These contradictions placed the person at risk of receiving unsafe and inappropriate care.

The provider did not always work well across teams and services to support people.

The home had been without a registered manager since November 2025, and senior staff were expected to step up to cover managerial duties. They did not always have the skills or knowledge to perform this role. The provider had not supported them with additional supervision, training or oversight from external sources. Staff said, “I find it stressful…because you don’t know who to turn to and who to go to. Now we have (new manager) I am hoping it will be better, but it was a bit overwhelming with everyone leaving all at once.”

On a day to day level, staff worked well as a team and communication was good. For example, care staff shared information about people’s dietary needs with the cook and worked together when people experienced unplanned weight loss. People were complimentary about the food and staff knew their personal preferences. Information sharing included daily written handover sheets to update staff on the well-being of people at the beginning of their shift, and a diary with health appointments in it. During our inspection, we saw good examples of care staff liaising with health professionals when people became unwell.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control.

The provider had not identified there was a skills gaps for some staff who were overseeing care plans and daily records and charts. There was poor oversight of known risks such as severe constipation. We reviewed care plans for 2 people and saw staff had not recognised the significance of this known risk. Appropriate action had not been taken and health professionals not involved in a timely manner.

We heard staff regularly checking with people about how they were feeling, listening to them and, where appropriate, calling a health professional to seek further advice. However, people were not routinely involved in reviews of their health care and treatment and therefore not given the opportunity to consider if there was improvement or if pain relief met their expectations.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or they met both clinical expectations and the expectations of people themselves.

Before the arrival of the new manager, there had been a lack of oversight of whether people’s pain was being managed appropriately. People discussed their pain with us, and how it negatively impacted on their mood and independence. People’s pain relief was not always well managed with mistakes made with the application of pain control patches and the administration of ‘when required’ pain relief medicine. This meant outcomes for people were not always positive or consistent.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We saw staff respected people’s decisions, and relatives confirmed staff worked closely with them when consent or best‑interest decisions were required. In our conversations with staff, they were able to demonstrate their understanding of consent. For example, “You should never take it for granted that they cannot make decisions for themselves…and not take away their rights …” Staff described how they presumed capacity, offered choices, and adapted their approach to help people understand decisions. Appropriate applications had been made when equipment was used such as alarmed mats, which alerted staff when a person at risk of falls moved from their chair or bed. Staff requested copies of legal documents to ensure families had the legal right to make specific decisions for people who’d been assessed as not having mental capacity to make decisions themselves.