Larkswood

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

The home was safe, tidy and clean. Staff and leaders understood safeguarding procedures and how to keep people safe. People felt confident to speak to staff about concerns, and were sure issues would be dealt with. Staff understood the need for smooth, safe, transitions of care. Care was managed safely. Care plans were in place to record care needs and risk. Staff involved people in the creation of care plans where possible, and discussed risk with them. Staff were recruited safely and trained in all necessary aspects of care before they could start work. Staff had completed training on infection prevention and control and used PPE as necessary. Staff administered medicines safely and in accordance with policy, although some medicines did not have appropriate opening dates recorded. People told us staff looked after them safely. Despite a high turnover of staff people knew the staff well and liked them. A person told us ‘There’s been quite a lot of changes of staff over the last few weeks, but the new ones seem to be OK.’ People knew who to report any concerns to, and staff were aware of whistleblowing and safeguarding policies. People had given their consent, or had best interest decisions made for them, to having sensor mats in their bedrooms if they were at risk of falls.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt confident to speak to staff about concerns, and were sure issues would be dealt with and they told us this. Relatives told us they did not always feel that the manager acted on their suggestions. A relative said “There’s not much cooperation. I have to take him to appointments otherwise they’d cancel them, and they don’t listen to what I say about the activities.”

Staff learned from past incidents. Staff told us about actions taken when a staff member used medicines inappropriately. Staff told us processes were reviewed and the incident was used as an example for staff reflective practice. However action was not always taken after issues were discovered during audits and this is an area for improvement. Some medicines audits had recognised the need to record opening dates and expiry dates for certain medicines. For example the audit in December 2023. However on our visit we found medicines lacking expiry dates or not having an opening date recorded. The audit did not show any actions taken to ensure this did not happen in future.

Staff were able to use the whistleblowing policy to speak up if they had concerns. The policy was clear about how staff could raise concerns and what they should expect to happen afterwards. Staff were encouraged to raise any safety concern no matter how small and the policy confirmed it would be investigated. The manager carried out audits, including for recorded incidents or accidents. However some audits, such as medicines, did not always lead to action when they discovered concerns.

People told us they felt safe. When people’s needs increased staff assessed their care needs so that people could be moved to more appropriate care settings if necessary. However people were not always consulted about moving from the service and we spoke to the provider about this during our visit.

Staff understood the need for smooth, safe, transitions of care. A staff member told us for new admissions, “We talk to the person and their families as well.” The manager said for new admissions, assessments were completed, and they would receive information about the person’s care and support needs, either from social services or from hospital. The manager would then look at the information received, discuss this with another staff member or the provider, then a decision would be taken as to whether the person’s care and support needs could be met at Larkswood. Assessments were completed on line, not face to face, although sometimes families would visit the home before their loved one was admitted.

There had been some concerns raised by other agencies that visited the home. For example, concerns about the turnover of staff and how this had affected continuity of care. Some staff were working extremely long hours each week. Some safeguarding documentation was incomplete or disorganised and the Local Authority contracts team discussed this with the nominated individual and the manager at the time of their visit.

Care was managed safely. Care plans were in place to record care needs and risk. Assessments with other healthcare professionals, such as the Speech And Language Therapists, were carried out as needed to keep people safe.

People felt safe at Larkswood. They told us “Yes, they look after you pretty well, and the food’s not too bad.” Another person commented, “Yes, I do feel safe because of the people around. The carers are great, they’re brilliant. They give you peace of mind. They make you feel safe and welcome. I feel at home and safe here.”

Staff and leaders understood safeguarding procedures and how to keep people safe. Staff completed safeguarding training online. A staff member told us most training is completed online, but is in person for moving and handling, first aid and fire safety. Staff defined their understanding of safeguarding as, “Making sure that someone is safe from abuse. There are different types of abuse, financial, sexual, emotional, physical.” A staff member said they had no direct experience of safeguarding nor had they witnessed any incidents of abuse or alleged abuse. They said, “I would report any concerns to the manager, the provider or CQC. There are safeguarding policies in the staffroom which we can look at.” Staff understood their responsibilities around whistleblowing. A staff member said “Yes, it’s about how to look after people to keep them safe. We can whistle blow or tell social services or the manager, but I’ve never had to do that. If something happened to a resident, another staff member did something for example, I would report it.”

People were comfortable in their surroundings and relaxed in the presence of staff. Staff were quickly available when people needed assistance, and there was a staff member present in the dining room at lunchtime, in case anyone required support. We saw staff regularly checked in with people who were cared for in bed.

There were policies in place to remind staff of their training and to explain the correct safeguarding procedures.

People felt risks involved with regard to their care were managed safely, although they did not always feel involved. We talked to people about this. One person said, “Yes, they do their best.” Although some people said they were not really involved in the care planning and left that to the staff.

Staff tried to involve people in their care wherever possible. Staff gave examples, such as where people were at risk of gaining weight, and this having a negative effect on their health, staff spoke to them about how this could be managed. Staff told us the ways they changed diets and portion sizes and how people were involved in the decisions.

At the last inspection, every person had a sensor mat in their bedroom and it was not always clear if this had been discussed with the person. This had saved the staff from doing night-time checks. Now, where they were able, people had given their consent to having sensor mats in their bedrooms. Only people identified as at risk of falls had sensor mats. For one person, a best interests decision had been taken after discussion with their relative, although the person was aware of the sensor mat.

We saw risk assessments had information for staff on how to speak to people to remind them how to stay safe. For example reminders about using walking aids and for staff to ensure appropriate healthcare appointments were kept.

The environment was safe. A relative told us, “Very safe here. They’re very concerned about her safety. They’ve got a new bed for her; they’re very pro-active.”

Staff told us how they used equipment, with people’s consent, to keep them safe. For example, after a person had a fall staff installed 2 sensor mats, one by their bed and one by their bedroom door. This enabled staff to monitor their movements and alert them if help was needed.

The environment provided a safe, comfortable setting for people. Handrails along corridors enabled people to feel safe when moving around the home. There was a lift for people to use between floors and ramps instead of steps outside. The home was light and airy, with no clutter or over-furnishing to hinder people’s movements. The provider was in the process of refurbishing the home. The dining room had been newly decorated, with new tables and chairs. The lounge was going to be next, with new armchairs on order. New beds and mattresses had been added for people’s comfort. Larkswood provided a homely setting for people.

We saw documents reminding staff when to assist people to reposition to keep them safe from pressure injury. Staff were able to keep people safe because the environment was monitored and safety audits completed. No one at the home currently needed the use of a hoist to move them in bed, but staff had appropriate moving and handling training to reposition people safely.

There were usually enough staff to support people safely and effectively. We asked if there were always enough staff to ensure people received the care they needed when they wanted it, including at night and weekends. People told us “Well there seems to be, unless they’re off sick.” Another person told us, “They are short staffed a lot of the time and then you wait longer, but you don’t wait that long.” A relative said, “I’ve always thought so. Although if someone is doing something out of the ordinary [referring to a hospital appointment], they can’t meet people’s needs. There’s not enough staff to cope with [name of their loved one].” We asked people if they knew the staff or if there were lots of changes. People told us “There are lots of changes of staff.” “There’s been quite a lot of changes of staff over the last few weeks, but the new ones seem to be okay.” One person said “There’s not many changes, I recognise them.” And another told us “Yes, I know the staff. They bring the tea in and have a chat.”

Staff said there were enough of them for safe care, despite the high turnover of staff in the last twelve months. A staff member told us said, “It’s enough staff. After breakfast we attend to people. If people want to go to bed early, some want night staff to get them ready for bed. People go to their rooms early. One person likes home movies on his i-Pad, we check on him.” The manager said, “Staffing levels are fine, I think we are adequately staffed. Lunchtime can be a bit busy. We do complete dependency assessments, but I always think we could do with an extra pair of hands.” The manager said they have added an extra member of staff to come in from ten until four when possible. The manager also said they would work night shifts if staff numbers were low.

People were comfortable in their surroundings and relaxed in the presence of staff. Staff were quickly available when people needed assistance, and there was a staff member present in the dining room at lunchtime, in case anyone required support. We saw staff regularly checked in with people who were cared for in bed.

Staff were recruited safely and trained in all necessary aspects of care before they could start work. We saw the induction plans and the staff training matrix, which was in place to ensure all staff remained up to date with mandatory training. The manager showed us evidence of training by other healthcare professionals to expand staff knowledge.

The home was clean and tidy, and people told us their bedrooms were cleaned regularly. One person said, “Oh yes, I’ve no complaints at all. They never leave a plate in your room, they take it as soon as they can.” Another told us, “Yes, they have a lady with a Hoover, the cleaner, she cleaned the bedroom curtains.” We asked people whether staff wore personal protective equipment (PPE) when providing personal care. One person said, “Yes, they have plastic aprons. They’re pretty good. You don’t hear there’s been an outbreak of anything.” Another person told us, “Yes, that’s health and safety, they wear gloves and masks.” A third person said, “Always.”

Staff confirmed they had completed training on infection prevention and control. A staff member said, “PPE is used, we have gloves and aprons. If anyone is infectious, they are isolated and PPE is used to prevent the spread.” Another staff member said, “There’s stocks of PPE in all bathrooms, no shortage and all available for staff to wear.”

The home was very clean, and provided cheerful surroundings. There were fresh flowers all around the home. The gardens were well kept. Windows had been open to let in fresh air. The wet rooms and bathrooms were spotlessly clean. We saw housekeeping staff undertaking cleaning and vacuuming throughout the day.

Staff used PPE in accordance with documented policy at the home. There were rotas in place for cleaning to ensure no areas were missed. The food standards agency had awarded the home a ‘Very Good’ (5) rating for food hygiene at their visit in 2022.

We asked people if they knew what medicines they were taking and whether staff discussed their medicines with them. One person said “Not really. They give it to me and I take it.” However other people told us “Yes, I know what I take and what it’s for.” And “Yes, and they always bring it.” People said they received their medicines at the correct times.

Staff administered and managed medicines safely. We saw staff undertaking the medicines round and wearing a red tabard indicating that they were giving medicines and were not to be disturbed. Later we spoke to the staff member who told us they had received medicines administrations training. We spoke to the manager about the audits and the concerns we had with undated medicines. The manager told us the senior staff were responsible for the medicines audits. The manager said that in future she would ensure she had better oversight of the audit results.

There were clear policies and procedures in place for staff to follow when managing and administering medicines. For example policies on how and when to administer ‘as required (PRN) medicines. The policies reminded staff of the ‘Six Rs of Administration, Right resident, Right medicine, Right route, Right dose, Right time, Resident’s right to refuse.’ However we saw some medicines, which should be used within a fixed time of opening, were being used after the expiry date, or did not have an expiry date recorded.