Background to this inspection
Updated
21 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector, one assistant inspector both days including one specialist advisor in nursing care and one Expert by Experience on the first day of the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Larkland House 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.
The service did not have a manager registered with the Care Quality Commission. An application to register a manager was submitted after the inspection. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service and four relatives about their experience of the care provided. We spoke with 18 members of staff including the regional director, manager, quality manager, regional clinical lead, deputy manager, nurse manager, agency nurse, team leader, senior care worker, care workers, domestic staff and the chef.
We reviewed a range of records. This included 13 people’s care records and multiple medicines records. We looked at four staff files in relation to recruitment and staff supervision and five agency profiles. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who were regularly involved with the service.
Updated
21 August 2019
About the service
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.