The Larches - Tiverton

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to people’s dignity and respect and good governance.

This service scored 50 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider’s website stated, ‘We are determined to be the difference in senior care; as part of our core values ‘respect’ and dignity’ are at the forefront.’ There was limited information in the monthly checks by the provider concerning whether person centred care was being provided to promote people’s dignity. For example, they had not demonstrated whether people’s personal care choices were being met.

There were 2 bathrooms in the building, and both were in the basement. However, staff told us most people could not access the bath as there was a basic bath seat, which had mouldy straps, so it was not used. The bath equipment had not been updated to reflect people’s increasing frailty and lack of mobility. Therefore, people’s choice was limited to a shower or a strip wash.

The remaining bathroom was a shower room, which was not a welcoming place to spend time in with no natural light. There was a rusty shower chair, unclean tiles, communal toiletries and stained flooring.

One person told us the shower “petrifies me.” We shared this with the new manager who said they would talk with the person to find out the reasons behind this. Another person said they were more willing to have a shower when they were supported by a particular staff member who made them feel safe.

On the second day of our assessment, we saw 3 people’s hair was lank and greasy in appearance. This undermined their dignity. When we checked their records, we could see they had not recently been to the visiting hairdresser or had a shower. The new manager said they would check why this was and assured us our concerns would be addressed. Some families said they were pleased with their relative’s appearance and understood they could be reluctant to have their hair washed.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider did not demonstrate a working knowledge of the needs of the people living at the service, particularly those people living with dementia. This was demonstrated by allowing known risks to people’s safety to persist. They had not considered how the environment could impact on people’s well-being, such as the shower room. They had not ensured staff who were stepping up to cover management roles had the skills and confidence to undertake these additional tasks.

The provider did not always supply appropriate, accurate and up-to-date information in formats tailored to individual needs.

Information was not provided in an up to date or accessible manner. Families said they generally found out about changes to the management team and staff from the staff group not the provider. Staff said the provider did not always update them about changes which left them feeling apprehensive and worried.

In the entrance of the home, there was a display board with the photos of staff and their names. This is good practice as it helps people and visitors identify who is working and their roles. However, we saw it had the photo and name of the previous registered manager who had resigned approximately 4 months previously. We went through the photos with staff who confirmed many photos were out of date as staff had left. On the second day, the new manager took down the board to update it.

The provider’s website for the service did not display its rating of ‘Requires Improvement’ which it is required to do. It provided a link to its ‘latest’ CQC report. This was not accurate as it showed a report which was from 2022 and not the most recent report from 2025. The timeline on the website also did not contain current accurate information.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

It was not always clear how people, and where appropriate their families, had contributed to the content of care plans. People told us they could not remember seeing their care plan and families said they had only been involved when their relative moved to the home but had not been part of regular reviews.

We spoke with the family of a person living at the home; they were unhappy about the slow response from the provider regarding a payment issue and the provider’s most recent proposed solution. This meant there was no satisfactory outcome in the family’s view which had caused anxiety and frustration.

We raised this concern with the provider and highlighted the delays. We also shared our concerns with the local authority who were now funding the person’s care to help resolve the issue. Despite the family’s growing unhappiness, the provider had not logged this as part of their complaint process which should then have provided a clear audit trail of how the situation was being managed.

Staff made sure people could access the care, support and treatment they needed when they needed it.

Our discussions with staff showed they knew the people they supported well. They understood what was important to them and generally recognised when their health or well-being was deteriorating and referred them accordingly to the appropriate health services. This was confirmed by health professionals. However, during a period when there had been no stable leadership some issues had been missed, such as constipation, or delayed such as organising new dentures.

People told us staff helped them access health professionals, including the GP. We saw how staff skilfully managed the expectations of 1 person for an immediate resolution to their perceived health issue. Staff worked well as a team to provide a consistent message.

The provider did not always make sure people could access the care, support and treatment they needed when they needed it.

People told us they would like to go out of the building more and spend time outside. There was a communal space at the back of the home, shared with flats attached to the care home, but this was not secure and was not easily accessible. One person said they preferred to spend their time in the conservatory rather than the compact lounge area. They said this at least enabled them to see the trees and watch the birds in the home’s car park. We saw from electronic records the most access to outside space for people had been 45 minutes in a month. It was not clear whether this was a trip with a family member or arranged by the home. Access to outdoor spaces can have a positive impact on people’s health and emotional well-being.

Staff who supported people with their well-being and social engagement explained how they sought to provide a range of activities to meet the varied needs of people living at the service. This included people preferring to stay in their room. A new member of staff had joined the team, and we heard positive comments about the new ideas they were introducing, including art. They also organised some external entertainment. Several people said they would like to be involved in more art because this was a previous occupation they enjoyed.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We sampled a mix of care plans and saw people’s wishes had been recorded regarding their funeral wishes and how they were supported nearing the end of their life. Several people had prescribed ‘just in case’ medicines in place in recognition their health was deteriorating. One person chose to speak with us about their final wishes and was confident these would be carried out.