Archived: Larkhill Hall

Updated 2 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 29 September 2015 and was unannounced.

The inspection team consisted of two adult social care inspectors and an expert by experience in residential and dementia care. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the local authority who provided information. We used all of this information to plan how the inspection should be conducted.

We observed care and support and spoke with people living at the home and the staff. We also spent time looking at records, including five care records, four staff files, medication administration record (MAR) sheets, staff training plans, complaints and other records relating to the management of the service. We contacted social care professionals who had involvement with the service to ask for their views.

On the day of the inspection we spoke with three people living at the home. We also spoke to nine relatives. We spoke with the registered manager and four other staff.

Updated 2 December 2015

This unannounced inspection was conducted on 29 September 2015.

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Larkhill Hall is registered to provide accommodation for up to 66 people with nursing and personal care needs. The location has two specialist units for people living with dementia. It is a large three storey property which is fitted with a passenger lift. Each bedroom has its own en-suite facilities.

At the time of inspection 61 people were using the service.

A registered manager was 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. All staff spoke positively about the influence of the registered manager.

We had received information of concern relating to incidents between people living at the home. The provider had taken appropriate action to reduce or eliminate the risk of further incidents through engaging with external healthcare services, introducing changes to care plans and additional monitoring. People told us that they felt safe living at the home.

Staff knew how to recognise abuse and discrimination and were seen to intervene in a timely and appropriate manner when people showed signs of distress. This reduced the risk of behaviours escalating to a point where personal safety was threatened.

People living at the home had detailed care plans which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

The location had produced a personal emergency evacuation plan (PEEP) for each person living at the home and had conducted regular fire drills and fire alarm testing. Procedures had been assessed by the local fire service.

Accidents and incidents were accurately recorded and subject to monthly assessment to identify patterns and triggers. Accident records were particularly detailed and included reference to post-accident observations and actions taken.

Staffing numbers were adequate to meet the needs of people living at the home. The provider based staffing allocation on the completion of a dependency tool. We were provided with evidence that this information was reviewed monthly and following incidents where new behaviours were observed. The provider recruited staff following a robust procedure.

People’s medication was stored and administered in accordance with good practice.

Staff were suitably trained and skilled to meet the needs of people living at the home. The four staff we spoke with confirmed that they felt equipped for the role.

People spoke positively about the food and drink available to them. People were given a reasonable choice at mealtimes. Meals were nutritionally balanced. We sat and ate lunch with the people living at the home. Tables were laid out with table cloths, crockery and cutlery. Some people used adapted crockery and cutlery which allowed them to eat their food and consume their drinks more independently. Staff were attentive but busy serving and monitoring people.

Most of the people that we spoke with had a good understanding of their healthcare needs and were able to contribute to care planning in this area. For those people who did not understand the provider had identified a named relative to communicate with.

The physical environment and equipment were not fully adapted to meet the needs of people living with dementia. With the exception of bathrooms, colour schemes were bright but lacking in contrast. The arrangement of chairs in the lounges and the colour of their coverings meant that they blended-in and didn’t provide the contrast and definition that would benefit people living with dementia.

All of the people living at the home we spoke with said that they were treated with kindness and compassion. Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual. Staff took time to listen to people and responded to comments and requests. Staff at all levels demonstrated that they knew the people living at the home and accommodated their needs in the provision of care. All of the people living at the home that we spoke with said that staff listened to them.

We asked people if they had been involved in their care planning and if they were able to make decisions about their care. Some people were unsure what this meant but had family members to represent them. Other people explained how they had been involved and what changes had been made as a result.

Each of the people living at the home that we spoke with said that they were encouraged and supported to be independent. Throughout the inspection we saw people moving around the building independently and engaging in activities of their own choosing. We saw that people declined care at some points during the inspection and that staff respected their views.

People’s privacy and dignity were respected throughout the inspection. People living at the home had access to their own room with en-suite facilities for the provision of personal care if required.

We received conflicting information regarding restrictions on visiting times. Relatives told us that restrictions were in place around mealtimes. The registered manager told us that the times were only a guide because these were the busiest times of the day. They said that people were free to visit at meal times if they chose to.

All of the people living at the home told us that they received care that was personalised to their needs. People’s preferences and personalities were reflected in the décor and personal items present in their rooms. Important items and photographs were prominently displayed.

We observed that care was not provided routinely or according to a strict timetable. Staff were able to respond to people’s needs and provided care as it was required.

Information regarding compliments and complaints was clearly displayed and the provider showed us evidence of addressing complaints in a systematic manner.

Staff expressed confidence in the registered manager and were supportive of their management approach. We saw evidence that staff were encouraged to be constructively critical and to report errors without fear of repercussions.

We also saw that the views of people living at the home and their relatives were sought and used to develop the service. This was achieved by actively and regularly seeking their views and changing care delivery as a result.