Larchfield Community

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Larchfield Community provides care and support to people living in a 'supported living' setting, so that they can live in their own home as independently as possible. At the time of our inspection 36 people were receiving personal care from the service

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: The service maximised people’s choice, control and independence 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. Where people lacked capacity to make certain decisions appropriate support was sought to support them.

Staff were safely recruited. They received an induction followed by training from the provider. Training was monitored and staff were supported with regular meetings and supervisions. Staffing capacity was enough to meet people’s needs. The provider followed current best practice guidelines to effectively manage people's medicines and risks associated with infection prevention and control (IPC). People and their relatives were very positive about the care provided. People told us they felt safe, and staff had the skills to support them.

Right care: Care was person-centred and promoted people's dignity, privacy, and human rights. People were encouraged to communicate freely and accessed community for activities when they wanted to. Staff supported people to learn new skills and maintain important contacts. People's care records were extremely detailed and up to date. Staff knew people well and understood their support needs which empowered people to make decisions about their care.

Right culture: People who use the service live confident, inclusive, and empowered lives thanks to the leaders' and care staff's values and behaviours. The staff team coordinated efficiently to ensure that people's rights and preferences were respected. The management team set a good example, and people were encouraged to take positive risks and were supported to complete more tasks independently.

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

Rating at last inspection and update

The last rating for this service was good (published 4 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed not changed. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service was last inspected in March 2017 and was rated Good.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection 34 people were receiving personal care from the service.

There was a registered manager in place. 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. At the time of our inspection the registered manager was on planned leave and we were assisted by the general manager of the service.

People told us staff at the service kept them safe. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Emergency plans detailed how to support people in emergency situations. Policies and procedures were in place to safeguard people from abuse. Staff understood the principles of good infection control. Staffing levels were monitored to ensure there were enough staff deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. We found the arrangements for medicines management kept people safe.

We have made a recommendation about the management of some medicines concerning the use of ‘as and when required medicines’ and audits.

Staff received the training needed to support people effectively but improvements were needed in training records. Staff were supported with regular supervisions and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this. People received support with managing food and nutrition. People were supported to access external professionals to maintain and promote their health.

People spoke positively about the support they received from staff and told us staff helped them to maintain their independence and to live life as fully as possible. People appeared to be happy and relaxed around staff and were treated with dignity and respect. Staff spoke passionately about their role and were committed to providing high quality care. Policies and procedures were in place to support people to access advocacy services.

Care planning and delivery was person-centred. Some people received support to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody at the service was receiving end of life care. Procedures were in place to arrange this should it be needed.

Staff spoke positively about the culture and values of the service and said they were supported in their role by the provider and registered manager. The provider and registered manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people and their relatives in an annual survey. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

The service was last inspected in April 2015 and was rated Good. However, it was not meeting one of the regulations we inspected. This related to care plans not always being person centred and containing information on their capacity to make decisions for themselves. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had been addressed. At this inspection we found the service remained Good.

Larchfield Community is domiciliary care service registered to provide personal care to people with learning disabilities and mental health conditions. People receiving personal care live in houses on the service’s farmland premises, though there was no link between the personal care provided and people’s tenancies. Some people lived at the service who were not receiving personal care from Larchfield Community. At the time of our inspection 12 people were receiving personal care from the service. The service did not have a registered manager but there was a manager in place who had previously been registered manager. They were training a care and support manager to be registered manager, and the care and support manager was applying to CQC to become registered manager.

People told us the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. People’s medicines were managed safely. Policies and procedures were in place to help safeguard people from the types of abuse that can occur in care settings. Staffing levels were monitored by the manager to ensure they were sufficient to support people safely. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People spoke positively about the support they received at the service, describing staff as kind and caring. Staff knew the people they were supporting well, including which communication methods the person preferred to use. People were supported to maintain their independence and were treated with dignity and respect. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services.

Care plans we looked at were person-centred and contained information on people’s personal interests, likes and dislikes. People told us they received the support they wanted and needed. Some people received support to access activities they enjoyed. Procedures were in place to deal with complaints and people told us they knew how to raise issues.

People said they knew who the manager was and would be happy to raise any issues with them. Staff said they were supported in their role by the manager. Staff told us the service had an “open culture” and that links with other organisations that could benefit people living there were encouraged. The manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people and acted on. The manager had informed CQC of significant events in a timely way by submitting the required notifications.