This inspection took place on 13 June 2018 and was unannounced. Larkfield is a residential care home that provides accommodation and nursing care for up to seven people with learning disabilities. At the time of our inspection seven people were living and receiving support at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had 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 our last inspection of this service in January 2016 the service was rated Good. At this inspection we found the service remained Good overall, although improvement was required to ensure records relating to the administration of people’s medicines was accurately recorded, and that people consistently received their medicines as prescribed.

Risks to people had been assessed and staff were aware of the action to take to manage identified risks safely. There were sufficient staff deployed at the service to safely meet people’s needs. The provider followed safe recruitment practices when employing new staff. Staff were aware of the need to report any accidents and incidents which occurred, and the registered manager reviewed accident and incident records to identify any trends and reduce the likelihood of recurrence.

People were protected from the risk of abuse because staff were aware of the different types of abuse and the action to take if they suspected abuse had occurred. Staff worked in ways which reduced the risk of the spread of infection. People’s needs were assessed, and their care and support was planned in line with nationally recognised guidance. Staff received an induction when they started work for the provider, and received support in their roles through regular training, supervision and an annual appraisal of their performance.

Staff were aware to seek people’s consent when offering them support. 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. Staff supported people to maintain a balanced diet, and to access a range of healthcare services when required to ensure they maintained good health. The provider sought to ensure that people received effective joined up care when moving between different services.

Staff treated people with care and consideration. They involved people in decisions about their day to day care and treatment. People were treated with dignity and staff respected their privacy. People received care and support which reflected their individual needs and preferences. They were able to take part in a range of meaningful activities which met their need for social stimulation, and staff supported them to maintain the relationships that were important to them. The registered manager told us the service was committed to ensuring people received good quality care at the end of their lives and people had end-of-life care plans in place which had been developed in their best interests where appropriate.

The provider had a complaints policy and procedure in place which was available in formats appropriate for people’s needs. Relatives confir

Larkfield provides accommodation and personal care for up to seven people who have a learning disability, such as autism or epilepsy. On the day of our inspection seven people were living in the home.

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 and associated Regulations about how the service is run.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the provider had good management oversight of the home.

People lived in a homely environment and were encouraged to be independent by staff. Staff supported people to keep healthy by providing people with a range of nutritious foods. Everyone was involved in the menu planning and shopping. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful for people. We heard people chose what they wished to do on the day, not only within the home but if they wished to go out.

People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred and staff responded to these by putting measures in please to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were a sufficient number of staff on duty to enable people to either stay indoors or go out to their individual activities. People and staff interaction was relaxed. It was evident staff knew people extremely well, understood people’s individuality and needs and respected people when they wished to have time alone. Staff were very caring to people and empathetic when it was needed.

Staff received a good range of training which included training specific to the needs of people living at Larkfield. This allowed them to carry out their role in an effective and competent way. Staff met together regularly as a team to discuss all aspects of the home.

Staff and the Trust undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place. We read people would be evacuated to another of the Trust homes should the need arise.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led.

As part of this inspection we spoke with the registered manager, service manager, three staff and three relatives. We were unable to speak at length to the individuals who lived in Larkfield because of their complex needs, so we used observation to reach our judgements.

We reviewed records relating to the management of the home which included, care files, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that people were cared for in a clean and safe environment that had been newly refurbished. People were able to move around the building in a way that was safe and free from hazards.

We saw that staff had received training in safeguarding vulnerable adults which ensured they knew what they should do if they suspected abusing was taking place.

Is the service effective?

Relatives told us that they were happy with the care that was provided at Larkfield. One relative said that their family member had, “100% improved” since they had been there.

Is the service caring?

We saw that people were supported by staff when necessary. We saw that people were able to choose how they wanted to spend their time. One relative said, “Excellent care.”

Is the service responsive?

We were told that people who used the service, relatives and other relevant people were involved in regular reviews of care plans and people’s needs. Records showed us that people had been able to indicate their preferences, likes and dislikes and they had access to activities that were important to them.

Is the service well-led?

We saw that staff met with everyone who lived in the home on a regular basis to share information and include the people who lived at Larkfield in any decisions. These meetings were done in a way that people could understand.

Staff told us they were encouraged to make suggestions and that when they did they were listened to.

People who use the service told us that they liked the food and their rooms. One person talked about activities they like doing, such as swimming.

One person’s relative said the building was suitable being on one floor with nice bedrooms, but the garden was sparse and could be better maintained. They also said that the staff asked them their views, kept them involved and informed about their relative’s care and that they didn’t have any complaints but felt confident to make one and that they would be listened to by staff if they did.

We found that the provider had systems in place to gain and review consent from people who use services, and acted on them.

We noted that the person centred plans we saw were not completed in a person centred way. They did not demonstrate the involvement of the person using the service because they had not been written from their perspective and describing how they themselves prefer and want their care to be carried out.

We found that while people who used the service, staff and visitors were protected against the risks of unsafe premises, the premises however were not suitable in design, layout or the use of the surrounding grounds, to meet the needs of the people living there.

We noted that staff received appropriate professional development and support.

We saw that people were given support to make a comment or complaint where they needed assistance and had their comments or complaints listened to and acted on.