Larchwood Care Home

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 requires improvement.

At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

The registered manager described changes that they had introduced at the service since coming into post which included additional training for staff and improving the culture to ensure that information was collated, analysed and reviewed to ensure that lessons are learnt and improvements made.

Action was taken to reduce the risk of falls such as increased monitoring and use of assistive technology such as sensor mats. Records were completed for accidents and incidents and this information was analysed so that changes could be made to reduce further risk.

Daily meetings took place to ensure good communication, and to address and escalate any concerns or deterioration in people’s health and welfare. Monthly organisational learning meetings were held to review practice and ensure improvements were on track. The minutes stated, ‘We are in the sustainability stage of the improvement process, and I know that this feels like the ‘nagging’ stage, but you have all improved so much and come so far – let’s build on this as a team and make the changes made into habits so we can then move on the next stage of the service development. We can really make this home great.’

Staff told us that the systems in place had improved, and the registered manager was approachable and visible. They said that they had confidence that if issues were raised, they would be actioned.

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.

The registered manager was clear about the needs of people they could meet safely within the service and worked with partner agencies to support people to relocate when a more specialist service was required.

When people moved between services some information was provided but this would benefit from more detail. The registered manager agreed to review the process.

People had access to the healthcare they required. The GP service visited the service regularly to review people’s health needs and where people required additional monitoring such as weekly weights, this was actioned. Staff recognised people’s changing health needs and referred people appropriately to a range of professionals which included occupational therapy, the mental health support team and district nursing team. Staff documented advice provided by healthcare professionals into people’s care records to ensure consistency of practice.

We spoke to two visiting professionals as part of our assessment who told us that the staff communicated well with them. One told us, “The staff have a good knowledge of the residents here…. they ask the right questions…. we have no concerns or safety issues…we see consistent staff who are always smiling …which is good.”

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 appropriately.

People told us that they felt safe at the service and described the staff as kind and caring. Where concerns had been raised, there was records to show that matters had been escalated and were in the process of being investigated. For example, they had a number of unwitnessed falls, which were being reviewed as safeguarding concerns to identify learning. Where shortfalls had been identified action was being taken, such as additional training in stroke awareness for staff, to ensure a timely response to deterioration in health.

Staff understood their responsibilities to protect people from abuse and harm. Staff had received training and knew how to recognise the signs of abuse and how to report. Staff were confident their managers would take any concern seriously. One member of staff told us, “I am confident to report anything I see. I know that I can go above the manager. I’d go to the quality team, but I know that the manager has control of it. I’d follow my training.”

Where people required any deprivation of liberty in order to keep them safe, the provider had applied for lawful authorisation from the local authority. Information about deprivation of liberty safeguards was clearly recorded in people’s care records.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s individual care needs had been assessed and were regularly reviewed. This included the risk of developing pressure sores, mobility and falls. Where risks were identified, a care plan and risk assessment were developed so staff knew what action to take to reduce any risk of harm.

Staff were knowledgeable about people’s identified risks. Records showed where people required positional changes to prevent pressure sores, these were accurate and up to date. People had been provided with equipment such as specialist mattresses, crash mats and sensor alarms to mitigate risks. Staff told us that they received training in a range of areas including moving and handling. One member of staff told us, “A senior trained everyone. Slings can be changed quickly, you just let them know if things are not right or need reviewing.”

The service supported some people who displayed emotional distress, and we saw that they had consulted with community mental health teams and documented their advice. However, one person’s distressed care plan could not be located, we were assured that this was an oversight, and this was immediately actioned by the registered manager. Systems were in place for recording what happened before and after an incident however there were gaps in the recording, and in the quality of the information. Some training had already been provided and the registered manager agreed to undertake further work to ensure that this was fully embedded.

Relatives told us that they were involved in discussions about their family members changing needs and the management were proactive at addressing risk. One relative told us, “They moved my relative’s bed for instance because they fell out of bed, so now it has one side against the wall and the other side has a mat for security. Now they are less likely to fall. They are still mobile so that move was important for them so they can walk without the risk of falling out of bed.” Another relative told us how a pressure mat was in place and “Staff check on my relative all the time, no one ever walks past, they always put their head around the door.”

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 lived in a service which was maintained and designated staff completed regular checks on the physical environment and equipment to minimise the potential for harm.

Equipment was serviced and checks were undertaken on electrical items, moving and handling and fire safety equipment to ensure that it was safe to use. Personal emergency evacuation plans (PEEPS) outlined the levels of support people required in the event of an emergency. The provider undertook health and safety audits on a regular basis to identify any shortfalls in safety systems. We identified some potential ligature risks which the registered manager immediately risk assessed. Where safety shortfalls were identified an action plan was in place to drive improvement.

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.

There were systems in place to ensure staffing levels met the changing needs and number of people who lived in the home. People’s dependency levels were assessed and regularly reviewed. Staff told us that they had the time they needed to meet people’s needs. One member of staff told us, “There is enough staff, the manager makes sure there is enough ….we can do our job properly.”

We observed that staff were visible in communal areas and ensured that people did not have to wait for care when they needed it. Relatives told us that they could locate a member of staff when they needed to and their relative was supported by a consistent team of staff. There was some agency use to cover staff sickness but the service used a regular team to cover shortfalls.

Staff attended an induction when they joined the team and had access to relevant ongoing training. One member of staff told us, “My most recent training has been dementia training, a course on dehydration and a course on diabetics. They were all done here by a pair of nurses that came in to train us.”

Staff were recruited safely and records evidenced that checks were undertaken prior to new staff commencing employment.

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.

Staff had received training in infection prevention and control. The service was clean and well maintained. Housekeeping staff were observed cleaning touch points and undertaking a deep clean of the dining room.

Regular checks and audits were completed to ensure staff followed the provider’s infection prevention and control policies to keep people safe and the service clean. Personal protective equipment (PPE) was available, we observed staff used and disposed of PPE appropriately.

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.

Medicines were stored securely and there were systems in place to ensure people had access to their medicines as prescribed. Clear records were maintained on the electronic system in place and stock levels checked tallied with the administration records. There were protocols in place for medicines prescribed on an ‘as required’ basis which helped ensure staff followed a consistent approach. We identified one missing protocol for a recently prescribed medicine, and this was immediately addressed by the registered manager. Staff handling people’s medicines had their competence assessed regularly. There were regular monthly audits to check on whether policy and procedures were followed and medicines administered in line with best practice.