Archived: Larchwood Grove

This service is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Larchwood Grove is privately owned, providing personal care and accommodation for up to ten adults with learning disabilities. There were ten people living at the service at the time of the inspection. People had complex needs, including mental health and physical health needs.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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 continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored regularly.

The premises continued to be appropriately maintained to support people to stay safe. Staff understood how to prevent and manage behaviours that the service may find challenging.

Staffing levels ensured that people's care and support needs were continued to be met safely and safe recruitment processes continued to be in place.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. Staff understood the Mental Capacity Act 2005 and how to support people's best interest if they lacked capacity.

People's needs and choices continued to be assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles.

Risks continued to be assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff continued to support people to book and attend appointments with healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

Medicines continued to be managed safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

Systems continued to be in place to ensure the premises was kept clean and hygienic so that people were protected by the prevention and control of infection.

People's diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

Further information is in the detailed findings below.

Larchwood Grove is a privately owned care home, providing personal care and accommodation for up to ten adults with learning disabilities. There were nine people living at the service at the time of the inspection. People had complex needs, including mental health and physical health needs.

Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy in their home by showing warmth to the staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

People and their relatives described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff supported them in making arrangements to meet their health needs.

There was a registered manager employed at the service, who was on leave at the time of the inspection. 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Where people lacked the capacity to make decisions the home was guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in the person’s best interests. Staff were trained in the Mental Capacity Act 2005 (MCA) and showed they understood and promoted people’s rights through asking for people’s consent before they carried out care tasks.

Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal to carry out their roles.

Staff had been trained in how to protect people from abuse, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the provider, the registered manager or outside agencies if this was needed.

There were policies and a procedure in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. People received their medicines when they needed them and as prescribed.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by staff to protect people from harm.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

The provider investigated and responded to people’s complaints and people said they felt able to raise any concerns with staff.

Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

People were given individual support to take part in their preferred hobbies and interests.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

We spoke with the registered manager and three members of care staff. We looked at five sets of records for people who used the service, six personnel files, staff training records, the service's satisfaction surveys, policies and procedures. We spoke with three people who used the service and three of their relatives.

Is the service safe?

We found that people who used the service were protected from the risk of abuse. All care staff were trained in the safeguarding of vulnerable adults and in the principles of the Mental Capacity Act 2005. Staff had been subject to Disclosure and Barring Services (DBS) checks before they started work. We found risk assessments with clear action plans were in place to ensure people remained safe. Staff monitored people's health and referred to health professionals or alerted emergency services when necessary.

Is the service effective?

People and their relatives told us they were very satisfied with the quality of care that had been delivered. We looked at people's assessment of needs and care plans and we checked with people who used the service that the delivery of care was in line with this documentation. We found that people's needs were re-assessed when needed and that their care plans were adjusted to reflect changes in needs. A relative of a person who used the service said, 'The staff are very caring and competent'. We found that the staff had received the training they required to meet the needs of people who used the service and that additional training was available.

Is the service caring?

We found that people who used the service were supported by kind and attentive staff. All the people who used the service we spoke with were complimentary about the care workers' approach and attitude. One person who used the service told us, "I really like the staff they are my friends". A relative of a person who used the service said, "The care workers are very patient and treat our family member with kindness'.

Is the service responsive?

People's needs had been assessed before care and support began and their care plans were reviewed regularly to reflect any change of needs. We saw that people's care plans included their wishes and preferences. People and/or their representatives were involved with the reviews of their care plans. People's views were sought about the quality of care that they received and their views were taken into account. The manager told us, "People who live here are encouraged to speak up and tell us how they feel'. This was confirmed by a person who used the service who said, 'I tell everyone what I want or what I don't like at the meetings'.

Is the service well-led?

We found that the manager had a system of quality assurance in place to identify how to improve the service. People and their relatives or representatives were regularly consulted about their level of satisfaction and survey questionnaires were provided, collected and analysed. We saw the service operated an 'open door' policy where staff were encouraged to express their views. All the members of staff we spoke with confirmed they felt supported by the manager to carry out their roles and were able to discuss any concerns. One staff member told us, "There is an open door policy and we can talk to the manager and express our opinion anytime'. All records relevant to the carrying on of the regulated activity were well organised, maintained and fit for purpose.

We spoke with four people in some depth and informally with most others. People told us that they were very happy with their care and support. One person said, 'Its brilliant here, I like all the staff'. Another stated, 'I love it here, it's great and we do what we want'. One person was unable to communicate with us verbally because of their dementia. We saw from this person's physical appearance, response to staff contact and records that they were well cared for. Staff understood peoples' needs and communication methods. This enabled them to act in accordance with their consent and wishes.

People had been involved in planning their care. Care plans, risk assessments and other records had been reviewed with them or others acting on their behalf. Peoples' rights were respected and they were encouraged to be as independent as they could be.

Staff were professional and friendly in their interactions with people. They demonstrated skill and empathy in their approach.

Risk assessment and risk management activities ensured the safety and security of the environment. Emergency procedures minimised the risk of peoples' care needs not being met in the event of emergencies.

People told us that they had no complaints, but if they had they would inform staff. Systems were in place for responding to concerns and complaints to their satisfaction.

We found that staff placed the care and welfare of people who used the service as their highest priority. People using the service said that they were "in a very safe place" and "could not ask for better care".

We found evidence that service users were encouraged to be as independent as they could possibly manage and we saw that staff helped to support people in achieving the highest level of independence.

We saw that people's choices were included by involving them in the process of care planning by providing documents in pictorial formats, or they were read out and explained by a key worker.

Staff told us that they felt supported in their roles and that Larchwood Grove was "a lovely place to work".