Larchfield House

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 good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People told us they were happy living at the home and felt safe and well cared for. Their comments included, “I feel very safe here, nothing to worry about, the staff are great”, “I haven’t seen any abuse or anything here” and “I never feel worried.” Relatives agreed and said, “They always check [family member’s] wellbeing before [family member] gets in the wheelchair” and “I’m sure they do [keep people safe]. I haven’t seen anything to lead me to believe otherwise.”

Staff knew how to report and document any incidents or accidents. Lessons were learned when things went wrong. The provider analysed all incidents and accidents that occurred at the service to find out what went wrong and how to prevent these from happening again in the future.

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.

People told us the staff were always available if they needed support. Relatives stated they were informed and involved when their family members required support or treatment from different services.

The staff team and registered manager told us they worked well with other professionals to ensure continuity of care, including when people moved between different services or required temporary stays in hospital. Records we viewed indicated working relationships and communication with external professionals were good.

The provider also had a good working relationship with the local care home support team. External healthcare professionals involved in the service provided a range of training sessions to enhance the staff’s skills and knowledge.These included training in end-of-life care, syringe driver, dysphagia and covert medication guidance. Dysphagia is the medical term for swallowing difficulties. Staff were then equipped to put this learning into practice, reinforcing a collaborative culture of learning.

The service had up to date policies and procedures in place. Staff were required to read and sign these to evidence they understood and agreed to follow these.

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.

People who were able to tell us said they felt safe from harm and abuse. One person told us, “They are just a nice lot of people, nice lot of staff.” Relatives agreed and said, “Is [family member] safe? Yes, [they are]. I have no hesitation in saying that. [They] took a while to settle but now we can see that [they are] so happy” and “I have never had a doubt about [family member’s] safety.”

Staff were aware of their responsibility to safeguard people and who to contact in the event of any safeguarding concerns. One staff member told us, “We work properly together, making people comfortable and safe.” Staff used respectful language when talking to and about people and displayed a caring approach.

There was a safeguarding policy and procedures, and the staff were aware of these. Staff received safeguarding training and knew how to report any concerns. We did not see any evidence of a negative or closed culture within the home. We found the staff to be responsive to people’s needs and to be kind and considerate when supporting them. People told us the staff were kind and nice and looked after them well.

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred. We saw evidence of this in the documents we viewed during our visit.

The provider did not always work with people to understand and manage risks by thinking holistically. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People said staff knew their needs and met these safely. They said staff were responsive and answered their call bells promptly. Processes to help ensure risks to people were assessed and mitigated were mostly effective. Overall, we observed safe care being delivered to people.

When people could become distressed, there was clear guidance to inform staff how to support them to de-escalate or reduce their anxiety. However, in one of the units, the staff seemed unsure how to support a person who was displaying agitation and had come into the room during an activity. We observed the staff repeatedly asking the person to go back to their room and watch a film instead of including them into the activity or spending time trying to reassure and engage them. Another person was asking for their mum, but the staff did not reply to them or offer reassurance. We fed this back to the registered manager who told us they would look into this and take appropriate action without delay.

There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff.

Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

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

People were supported in a safe and well-maintained environment that met their needs. People and relatives told us they liked the home and felt it was homely and well decorated.

There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. The management team and staff worked together to help ensure any potential risks were identified and addressed promptly such as faulty equipment or trip hazards. The maintenance person completed daily and weekly checks of all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment. They also responded promptly to any reports from the staff where repairs were required.

Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date plan in place to help ensure people were supported in the event of an emergency.

The home had been inspected by the Food Standards Agency in 2024 and had received the highest rating of 5. During our visit, we found the kitchen to be clean and well organised. Staff wore appropriate uniform and protective wear. Fridges were clean and food items stored correctly. All checks were carried out regularly. The laundry was well organised, and staff followed correct infection control procedures.

The home was clean and well-maintained with good quality fixtures and furnishings. Communal areas were light and airy which allowed people to mobilise easily. There were areas available for people to rest, enjoy activities and spend time following personal interests or have visitors.

People’s bedrooms were personalised with photographs and items belonging to them. There was some signage around the home, and objects and pictures to help people living with memory loss with reminiscence.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People who could tell us thought there were enough staff available to meet their needs. A relative agreed and said, “I do visit other homes and the staffing level here is incredibly high in comparison” and another stated, “It is natural to feel that there are never enough staff and sometimes you think they could need more but overall, I think the numbers are right. I don’t see there is any difference in staff levels at weekends.”

Staff told us they were happy working at the home, felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service.

The provider used a dependency tool to calculate the staffing levels based on people’s individual needs. The staff rota indicated the staffing levels recommended were consistent, including for staff working at night.

Before this assessment, we received information of concern in relation to staff recruitment and followed up this concern at the site visit. We checked 14 staff recruitment files including staff recruited from overseas. We did not find anything of concern.

We found the provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom, Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. A member of the provider’s HR department was undertaking a full audit of all staff recruitment files.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service. A relative told us, “That cleaner never stops. [They] must start all over again as soon as [They have] finished [their] round.”

The home was clean, hygienic and well-maintained. We observed a domestic team ensured the service was kept to a high standard. Cleaning staff followed a cleaning schedule and used appropriate personal protective equipment (PPE).

The staff received training in infection control and followed safe guidelines. Care staff wore appropriate PPE when supporting people to help protect them from cross infection when supported people with their meals.

Appropriate systems were in place in relation to infection control. The provider ensured staff were trained in the use and disposal of PPE. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The management team carried out audits to ensure standards of cleanliness were maintained.

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.

People who were able to tell us said they received their medicines as prescribed.

There were systems in place to ensure people received their medicines safely and as prescribed. Our observations and records we checked confirmed this. Medicines were stored securely and at the required temperatures. Medicines care plans were in place to help staff understand and support the health needs of people living at the home.

There was a relatively high proportion of people who received their medicines covertly. We saw evidence that the staff followed the appropriate process and consulted the required individuals such as the GP, pharmacist, and next of kin before a decision to administer medicines covertly was agreed. Covert administration is when medicines are administered in a disguised format. The staff were trained to use electronic medicines administration records and care plans system and there were adequate devices for staff to use this system effectively.

The staff received training and had their competency continually assessed to help ensure they handled medicines safely. Staff carried out audits to identify gaps and make improvements. Medicines reviews were carried out by the local GP. There was a process to report and investigate errors and incidents.