The inspection took place on 25 and 26 January 2017 and was unannounced. The service provides accommodation and personal care but not nursing for up to 64 older people. On the days of our inspection 62 people were using the service.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The entranceway to the service had been refurbished as had the majority of the service and was welcoming, with lots of relevant information displayed around the walls for visitors and family including the latest CQC report on the wall.

People were protected from the risk of abuse as far as reasonably possible as staff had attended training to ensure they had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager had shared information with the local authority when needed to ensure people were safeguarded.

People were supported by a sufficient number of suitably qualified staff. The provider had ensured appropriate recruitment checks were carried out on staff before they started work. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Positive and caring relationships had been developed between people and staff. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times. People were given choices in their daily routines and their privacy and dignity was respected. People were supported and enabled to be as independent as possible in all aspects of their lives.

Staff knew people well and were trained, skilled and competent in meeting people’s needs. Staff were supported and supervised in their roles. People, where able, were involved in the planning and reviewing of their care and support.

People’s health needs were managed appropriately with input from relevant health care professionals. People were treated with kindness and respect by staff who knew them well. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health. Staff ensured that people’s health needs were effectively monitored.

People were supported to maintain relationships with friends and family so that they were not socially isolated. There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views.

People were supported to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions abou

This inspection took place on 28 October 2015 and was unannounced. The last inspection of this service took place on 17 July 2014, when one breach of regulations was found. The service provided an action plan and at this inspection we found that the action taken had resolved the breach.

Larchwood Care Home provides care and accommodation for up to 64 people and some people will have a diagnosis of dementia.

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.

The provider had a range of systems in place for the good governance of the service and to inform them of what going on in the service and any actions to take in response to any difficulties encountered. This included increasing staffing in response to identified individual need.

However on the day of our inspection we found that a controlled medicine had not been booked into the service.

Staff interacted with people who lived at their home in a caring and professional way. People were supported to attend religious services if they wished to do so. Staff talked with people individually and in groups using photographs to stimulate memories.

People living at the service, staff and visitors described the management of the service as open and approachable. Some people did tell us they were bored at times and would like more activities and for organised outings. Other people told us that they thought the service offered choice and variety with regard to activities.

Some people who used the service felt that it could benefit from another member of staff. This was because whilst staff addressed their needs, they did not always have time to chat. Other people felt that the service was sufficiently staffed and that call bells were answered very quickly. Where people had limited mobility, their call bell had been placed very close to them and within easy reach.

People had their mental health and physical needs monitored. The service had identified and addressed recently the accuracy of food and fluid charts. This had been achieved through staff meetings and training workshops, plus working with local professionals. Staff were confident in how to monitor and respond appropriately to peoples identified needs regarding their nutrition needs had improved.

People who used the service felt safe and secure. Staff spoken with, knew how to keep people safe and report any allegations of safeguarding and were confident they would be fully investigated to ensure people were protected. Staff received supervision and an appraisal.

The service provided training in the form of an induction to new staff and comprehensive on-going training to existing staff. The senior staff of the service were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the Local authority to support people who used the service with regard to (MCA) and (DoLS).

We saw that risk assessments and resulting plans of care had been recorded in the individuals care record. The service staff had worked hard with the GP Practices to ensure that the best service available was provided to the people who used the service.

Throughout the inspection we saw that peoples consent was sought and dignity respected. Each person had a care plan which was regularly reviewed and changes recorded.

The service had a complaints process in place and the management undertook regular audits and surveys to identify issues and how the service could be improved.

The management of the service provided an on-call system to support staff at the service if so required.

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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service was last inspected on 04 July 2013 and at the time no breaches in regulations were identified. This was an unannounced inspection. Larchwood is a residential care home providing personal care for up to 64 older people. The service also provides care for people living with dementia. There were 46 people living at the service when we visited. This was because the first floor of the service was closed for refurbishment. The ground floor was divided into units; Acorn and Rowan.

Staff told us that there were times during the day when there were not enough staff available to meet people’s needs. They told us that this put staff under pressure and meant people had to wait for assistance. Our observation of the midday meal in the main dining room confirmed this. Four staff were observed serving meals and supporting those that needed help to eat. Five people required assistance to eat their meal. This left one person waiting for half an hour before a member of staff had finished supporting another person and was able to assist them. Discussions with the management team identified that staffing levels had been calculated by the provider for the numbers of people using the service, rather than the care required to meet their individual needs.

The shortfall we found breached regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and you can see what action we told the provider to take at the back of the full version of the report.

A newly appointed manager had been in post since 16 June 2014 and was in the process of making an application to us, the Care Quality Commission (CQC) to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The manager demonstrated clear management and leadership and despite being in post for approximately four weeks, had made significant improvements to the service. Staff told us that morale in the service had been low due to a lot of changes, including changes in ownership and managers. However they informed us that the atmosphere and culture in the service had improved since the manager and deputy manager had been appointed. They told us the management team were very knowledgeable and inspired confidence in the staff team, and led by example.

The provider had systems in place to manage risks, safeguarding matters and infection control. Specific care plans had been developed where people displayed behaviour that was challenging to others. These plans provided guidance to staff so that they provided support in a consistent and positive way, which protected people’s dignity and rights. A thorough recruitment process was in place that ensured staff recruited had the right skills and experience and were safe to work with vulnerable adults. Staff told us that HC-One Limited was a good company to work for and the training they received gave them the skills and knowledge they needed to carry out their roles.

There was a lively atmosphere in the service and people were seen involved in the running of their home laying tables and tending to the gardens. This provided an opportunity for people to feel valued and have a meaningful life. The interaction between staff and people was warm, caring and friendly. People were relaxed with staff and confident to approach them throughout the day. Staff treated people kindly and were emotionally supportive where people showed signs of distress.

The manager had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) legislation, and whether these needed to be considered for people who lived at the service. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests.

People were able to discuss their health needs with staff and had contact with the GP and other health professionals, as needed. People were protected from the risks associated with eating and drinking. People spoke positively about the choice and quality of food available. Where people were at risk of malnutrition, referrals had been made to the dietician for specialist advice.

There was a strong emphasis on promoting and sustaining improvements already made at the service. The provider was a member of several good practice initiatives, such as the Dementia Pledge, working to develop good quality care for people living with dementia. Additionally, people and their relatives were asked to nominate staff for a ‘Kindness in Care Award’. Twice a month two staff nominated received this award for providing good personalised care and the winners received a badge, certificate and money voucher.

The environment had been designed to meet people’s needs. Signage, decoration and adaptions in the service had been arranged to promote people’s wellbeing. Communal areas had been decorated with murals and paintings which enabled people to find their way around the service and their own rooms. The service had a range of outdoor areas that were regularly maintained by staff and people who used the service, so that they couldsafely use the garden.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Systems for recording and managing complaints, safeguarding concerns and incidents and accidents were monitored and management took steps to learn from such events and put measures in place which meant they were less likely to happen again.

We used different methods during our inspection of Larchwood Care Home to help us understand the experiences of people who used the service. Where some people had complex needs and were unable to tell us about their experiences, we used observation and noted people’s responses to staff. We noted that people appeared calm and relaxed. We saw that staff supported people in a patient and sensitive manner.

During our inspection on 4 July 2013 we saw that staff were knowledgeable about people who lived at Larchwood and promoted people’s independence and choices. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. One person told us: “The staff are lovely, there’s always a choice of what to eat.”

Our observations and the records we looked at, showed us that people received the support they needed to maintain their independence. During our visit we saw some people were preparing to go out to a tea dance.

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service. Staff told us about the training they had received to enable them to carry out their roles in supporting people. Staff told us they felt supported by the manager.

We found that the provider had systems in place to monitor and respond to any complaints received by the home.

When we inspected this service in June 2012, we found that the service needed to improve in three key areas. On 7 February 2013 we returned to inspect the service and found that some improvements had been made, but we still found concerns around the management of malnutrition. We saw that improvements had been made to the bathroom facilities and that communal areas had been decorated. The home looked and smelled cleaner. However clinical waste bins remained unlocked and dangerous waste was still stored in areas accessible to the public. Staff had received training around dignity and privacy.

We chatted with people as we walked around the service and asked whether they were well looked after and happy. Everyone that was able to tell us, confirmed to us that they were well and that staff supported them when necessary. Where people were not able to communicate their experience to us, we sat with them and observed that people were relaxed and that staff assisted them appropriately. We asked people whether they enjoyed the food and all except one person said that they did. One person told us that they did not like either of the menu options available. We noted that staff offered this person an alternative. Two visiting relatives told us that staff were helpful and treated their relative with dignity and respect. One person told us, "There has been a marked improvement in the way that staff communicate with my relative. They support my relative well at meal times."

We obtained evidence of peoples’ experiences of the service throughout our visit when people shared their views with us. We also spoke with eight relatives.

Comments made were varied but all those received were generally positive about the quality of service provided. One person who used the service advised us that they were treated well by the staff and were happy living in the home. They told us that they felt safe and that the food was good. They also said that they would like to go into the garden more often. Another person responded positively to our questions about care provided by the staff.

A visiting family member told us, “Larchwood is a good home for people with dementia. Cleaning is generally good although sometimes there is a smell of urine. The staff are approachable and we know that we can ask questions at any time. They tend to work across the three different units which must be confusing for people with dementia.” Two family members mentioned that they were not aware of ‘end of life’ care planning and that they would like to find out more. Another relative told us, “I feel that I could have been better involved in care planning. Initially I was told that I could not see my relative’s care plan without their permission. Given that my relative has dementia, I felt that I should have been able to have more influence. I do not have any major issues with the service, but I do feel that I need to be present in the home in order to make things happen. I rarely see the manager when I visit.”

A healthcare professional who visits the service told us, “The care is pretty good at Larchwood. Staff are helpful. Nevertheless, mouth care needs to improve and more needs to be done to ensure that people get drinks during the night.” Another healthcare professional in regular contact with the service explained, “Care at Larchwood is of a good standard and staff are genuinely caring. However communication between day and night staff needs to improve to allow good continuity of care.”