Larchfield

We found the following examples of good practice.

A programme of COVID testing for both people living in the home and staff was undertaken in line with current government guidance. Appropriate procedures were in place should anyone display any symptoms or test positive. All visitors, including healthcare professionals, were subject to a range of screening procedures. This included showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

The home had comprehensive policies and procedures to manage any risks associated with the COVID pandemic, including the management of people with a COVID positive diagnosis. At the time of our visit, none of the residents were currently COVID positive.

There were sufficient supplies of personal protective equipment (PPE) available for people. Hand sanitiser was readily available throughout the home. Staff had been trained in infection prevention and control (IPC) and the use of PPE. We observed staff wearing PPE appropriately.

Daily cleaning schedules were in place. All cleaning was undertaken by designated domestic staff, which included touch point cleaning. At the time of our visit we observed that there were a couple of areas which could have impacted on infection prevention and control, such as unused board games, crayons and paper not stored away in cupboards. This issue was rectified immediately during our visit.

Staff supported the social and emotional wellbeing of residents, which included residents participating in activities outside of the care home. Appropriate procedures were followed to support COVID testing and minimise risk.

People’s experience of using this service: People were happy living at the service. They told us they felt safe and well looked after. Staff received safeguarding training and knew how to recognise and report any concerns. Staff were recruited safely and there were enough staff to meet people's needs. People received their medicines as prescribed. The service was clean and staff followed good hygiene practices.

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 practice. The provider and staff acted within the law when people lacked capacity to make their own decisions. People's health and nutritional needs were met and understood by staff. Staff received induction, training, supervision and support to enable them to feel confident and be competent in their role.

Staff were patient and friendly, and people's privacy and dignity was respected. They showed they valued people as individuals and had formed supportive relationships with people. Staff knew how people preferred their care and support to be provided.

Care plans were kept up to date and reflected people's needs. The provider was responsive to complaints and concerns. There were opportunities for people to discuss any concerns or ideas they had about the service. People chose to pursue a variety of activities and interests at the service and in their local community.

The service had an open and supportive culture. Audits and checks were carried out to monitor the quality of care delivered. There was a commitment for improvement and learning from any actions identified. The registered manager and management team were committed to providing good quality care and support for people.

Rating at last inspection: Requires Improvement (Published 27 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good. If any concerning information is received we may inspect sooner.

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

Larchfield 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 is a purpose built home owned and maintained by Anchor Trust. It provides personal care for up to 40 people who have physical disabilities, mental health needs and moderate learning disabilities. Larchfield is situated in Hunslet, Leeds.

At the time of our inspection 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.

At the last inspection carried out in December 2015 the service was rated Good overall with the Well-led domain rated as Requires Improvement. At this inspection we rated the service Requires Improvement overall.

People told us they felt safe when receiving care from the staff team. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of vulnerable adults and staff knew what action to take to ensure people were protected from potential harm.

Potential risks to people had been identified and assessed appropriately. There were staff enough staff on duty to meet people’s needs but sometimes staff became task orientated during busy times of the day, which meant they were not always able to meet people’s needs in a person centred way. Safe recruitment practices were followed. Medicines were managed safely.

Staff had not always received all their essential training set by the provider. Most staff training was up-to-date. Team meetings and supervisions were held but not always in line with the provider’s policy. We have made a recommendation about staff support.

People were supported to have choice and control of their lives as much as they were able and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to have sufficient amounts to eat and drink and maintain a healthy diet. They had access to healthcare professionals in order to maintain their health and wellbeing. People's rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were respected by the staff who supported them.

People were involved in decisions about their care. Their privacy and dignity was respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People's personal preferences and their likes and dislikes were documented so that staff knew how people wished to be supported. There was a variety of activities on offer which people could choose to participate in.

Complaints were dealt with in line with the provider's complaints procedure.

Weekly and monthly checks were carried out to monitor the quality of the service provided. There were regular meetings with people and staff and feedback was sought on the quality of the service provided. The registered manager and area manager were aware of the current challenges that faced the service. However checks had not identified elements that led to a safeguarding concern.

People and staff were able to influence the running of the service and make comments and suggestions about any changes.

You can see what action we told the provider to take at the back of the full report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe. People had been cared for in an environment that was safe, clean and hygienic. There were effective systems in place to reduce the risk and spread of infection. Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. A plan was in place for dealing with emergencies so that people were not put at risk. A plan was in place for responding to unexpected events that could affect the running of the service, for example fire or loss of the power or water supply.

Is the service effective?

People's health and care needs were assessed with them. We looked at the care records for five people who lived at Larchfield. We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met. Information about people who used the service was obtained and shared appropriately. We saw evidence that demonstrated staff were provided with regular formal supervision. Staff told us they were supported by management who enabled and encouraged them to access appropriate training on a regular basis.

Is the service caring?

Staff communicated well with people and were attentive when they needed support. We saw that care workers showed patience and gave encouragement when supporting people. We saw staff caring for the needs of people in a professional manner. They ensured the people they cared for were supported in taking part in activities in the local community.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People's views of the service were sought and we saw the manager responded where improvements were needed to the service.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service at all times.

We spoke with the manager and one member of staff, who confirmed training opportunities had improved significantly since our previous visit. We found staff had completed and embarked upon National Vocational Qualifications and other training which enhanced their knowledge in their role.

We looked at the training records, which confirmed what the manager and the staff member told us.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw that all areas of the home were clean, tidy and accessible to people. We saw refurbishment was taking place at the time of our visit to improve the dining rooms. People who lived in the home told us of plans for a new conservatory, which they looked forward to. People were proud to show us their rooms and said they liked them.

We spoke with staff and saw they had good relationships with people. However, we found there were not sufficient numbers of skilled staff on duty and this impacted on the care of some people.

We looked at records that showed how people's care was managed. We found information was only accessible to those who needed to know, which ensured confidentiality for people.

People who used the service who told us they were supported in maintaining their independence and community involvement. They said that routines were flexible and they could choose how to spend their day. People told us that they were able to go out on their own when they wanted and others said they would go with a member of staff or a volunteer.One person said 'I get a taxi to the club and I like it because I go when I want.'

People on the whole thought the food was good and they were able to have as much as they wanted. One person said 'The food is delicious here and you can have seconds if you want.' A number of people were observed sitting smoking in the lounge and one person said 'I like it here if I can have my cigs.' However, two people told us they did not like to go into the lounge because of all the smoking.

One person said "If I have a problem I go to the staff." Another person commented that the staff were helpful. People who used the service and staff said they were comfortable talking to the manager and they could approach the manager if they had any issues. The manager said that she held forum meetings with people in the home to get their views with a view to improving the service for people.