Larkland House

Larkland House is a residential care home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The home accommodates up to 55 people across three floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We found the service needed to make some improvements to its leadership so people using the service could benefit from an inclusive and open culture. The provider acknowledged these issues and we saw strategies were in place to build team work. The service followed the provider’s governance framework to monitor the quality of the service, although there were sometimes shortfalls in the evaluation of information which meant learning outcomes were not always clear. The service sought people’s feedback and took action to make improvement to meet people needs.

We have made a recommendation about quality assurance processes to support continuous learning.

The service had responded to whistleblowing concerns about medicines errors and moving and positioning to protect people from the risk of harm. There were systems to monitor staff practice and people’s care plans were updated to ensure staff knew how to support them safely. Medicines management systems were reviewed and incorporated guidance from external medicines experts. There was closer oversight from the management team and we saw these strategies had successfully reduced medicines errors at the time of our inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People benefitted from staff who received ongoing training. The service assessed people’s needs and choices and delivered care in line with guidance.

People told us that staff treated them kindly and were generally happy with the care they received. Records showed people and relatives were involved in decisions about their care. The service protected people’s privacy and dignity and made sure that people’s information was kept confidential.

The service provided care and support to meet people’s individual needs and preferences. We saw the service made efforts to involve and engage people with activities in line with their interests and personal history. People were provided with information about how to make a complaint and we saw documentation that showed the manager took complaints seriously and responded promptly. People needs and wishes about their end of life care were explored and documented by the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 16 February 2017).

Why we inspected

The inspection was prompted in part due to concerns received about medicines errors, moving and handling of people and the management of the service. A decision was made for us to inspect and examine those risks.

We have found some evidence that the provider needs to make improvements. Please see the well-led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Larkland House on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Larkland House provides care and nursing for up to 55 people, some of whom may have dementia, mental health needs or a physical disability. At the time of our inspection there were 49 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their families told us they felt safe at Larkland House. One relative told us “I know mum is safe as she if very happy here.”

Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People and their families told us people had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs were identified for staff and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the registered manager and all of the team at the home. Staff supervision and other meetings were scheduled as were annual appraisals. People, their relatives and staff told us all of the management team were approachable and there was a good level of communication within the service.

Relatives told us the team at Larkland House was very friendly, responsive and very well managed. Comments received included “Its home from home.” The service sought people’s views and opinions and acted on them.

The management teams’ ethos was echoed by staff and embedded within the culture of the service.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us they were happy with how they were looked after. Another person said "everything I want is here".

We found that people were provided with appropriate support in a safe way in line with their care plan. Equipment was in place to promote people's comfort and safety. Equipment was properly maintained and staff received appropriate training in using equipment.

The staff received appropriate training and supervision. Although staff had not received annual appraisals during the previous twelve months we saw the new manager had scheduled appraisals for all staff over the weeks following our inspection.

The provider had effective systems in place to monitor the quality of the service. There were regular resident and relatives meetings and an annual survey was carried out of the people who used the service. Regular quality audits were carried out by the provider and action was taken to address any issues arising.

The provider may wish to note that at the time of our visit there was no registered manager for the service. We were told the provider was making arrangements for a manger to register with the Commission.

We saw staff knocking on doors before entering rooms and their interactions with people were respectful. Staff delivered care in an appropriate way to people who lived at the home. For example we saw staff always worked in twos when helping people to mobilise. At lunch time we saw people received help to eat where necessary.

Staff told us people who lived at the home were involved in their care planning and also people's relatives were involved where this was appropriate. Staff said they were made aware of the home's safeguarding and whistle blowing policies. They said the management of the home was approachable and they felt confident in raising concerns with a nurse or the manager. The staff we spoke with said the training they received enabled them to care for people appropriately.

Relatives of people who use the service told us they attended or were aware of relative and resident meetings. One relative said they had attended one of these meetings and management "seemed responsive to feedback". Another relative told us there had been improvements to the environment within the home in recent months.

We saw the home had effective systems in place to monitor the quality of the service.