What life is like for people using this service:

People were cared for by staff who were kind and respectful. Staff had developed good relationships with people and knew them well. Staff worked in partnership with other professionals to achieve positive outcomes for people in regard to their healthcare and well-being.

Activities were provided which people enjoyed and engaged with if they wished. Activities were meaningful and appropriate for people living at Larkhall Springs Nursing Home.

The service was clean and well maintained. People enjoyed the environment and the refurbishments that had been completed. However, further consideration of how the environment could support people living with dementia would be beneficial. People had access to outdoor areas.

People’s medicines were managed and administered safely. Care plans were person centred and people were supported in an individual way. Feedback was sought from people, relatives and staff through meetings and questionnaires. Changes were made in response to areas identified.

Rating at last inspection: Good (June 2016)

About the service: Larkhall Springs Nursing Home provides personal and nursing care for up to 47 older people, some of whom were living with dementia. At the time of the inspection there were 39 people living at the service.

Why we inspected: This was a planned inspection based on previous rating. The service’s rating remained Good. We made a recommendation in regard to the process for reviewing reportable incidents to the local authority and Care Quality Commission.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

The inspection took place on 23 and 24 May 2016 and was unannounced. The service was last inspected in December 2013. There were no breaches of the legal requirements at that time.

Larkhall Springs Nursing Home is registered to provide nursing care for up to 36 people. On the day of the visit, there were 36 people at the home.

There was a registered manager for the service. 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.

Some staff assisted people who needed extra help with their meals by standing next to where the person they were assisting was seated. This practise was not dignified for the people who were being supported. This was because the mealtime experience for those people was not being treated as an interactive and person centred event.

Everyone we spoke with told us they always felt safe and secure at the home. They said that staff were kind and always respectful towards them. When risks to people were identified suitable actions were put in place to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse. The team were trained to know how to report concerns correctly.

People had their needs met by enough suitably qualified staff. Staff provided people with care that was safe. The numbers and skill mix of staff deployed at any time of the day or night meant peoples’ needs were met in a timely manner.

People told us how much they liked the programme of regular one to one and group activities taking place in the home. People told us they liked the entertainers who performed at the home on a regular basis.

People said that they liked the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs.

People who lived at the home and the staff had built up positive and caring relationships. This also extended to include relatives and friends.

Care plans were informative and guided staff so that they knew what actions to follow to meet people’s range of care and nursing needs. Staff knew what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs.

People were supported by a team of well trained staff. The staff had attended regular training and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Nurses were able to go on regular training and updating of their skills. This was to help them know how to provide nursing care based on up to date practice.

When people had the capacity to, they were encouraged to be included in making deciding how they wanted to being cared for. There were effective systems in place that helped ensure staff obtained consent to care and treatment in line with legislation and guidance. When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and the how to act in someone’s best interests.

People knew how to complaint and make their views known .The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the services when needed.

Staff spoke positively of the management structure of the organisation they worked for. They said that senior managers and the registered manager provided strong and effective leadership. The staff team told us they were well supported by the registered manager who spoke positively about their role, Staff said they saw them every day and the

People told us that they were able to make choices about their care and that staff asked before providing them with care or support. One person said ‘they ask before helping me’.

We saw evidence that people’s needs were assessed and a variety of needs were taken into account in care planning.

People told us that they were offered a choice of food and drink that met their individual requirements and that staff supported them at meal times if needed. One person said ‘there is a very good choice of food’.

We saw evidence that staff received appropriate training, supervision, and professional development to enable them to provide appropriate care and support to people living at the home.

There was an effective complaints system available which meant that people were protected from the risks of unsafe or inappropriate care or treatment.

Larkhall Springs offers a high level of support to people who had physical and mental health needs. People at the home told us that they were happy with the support given to them at the home. Relatives we spoke to told us that they had a high level of confidence in the home and its staff.

Care plans were in place to ensure that appropriate and safe care was given and that people who used the service and their relatives were involved in individual care planning. Staff worked closely with other professionals outside the home to ensure that the best strategies of supporting people were used.

People who lived in the home told us that they felt safe. Both they and their relatives were clear that they knew what to do if they were concerned about bad practice or abuse. Staff had training in adult safeguarding and knew how to raise a safeguarding alert. Safeguards were in place within the home to prevent abuse.

Staff at the home received relevant training and supervision. There was a training programme and the opportunities for continuous professional development.

Systems were in place to monitor quality; these included clinical audits and other environmental safety audits. Feedback on quality was sought from people who use the service, their representatives and staff.

We visited Larkhall Springs Nursing Home on 4 January 2012 and spent the day at the service. We met and talked with a number of people who live at the home and met and talked with some of their family members. We also talked with members of the management and nursing team, healthcare assistants and the chef.

During our visit we looked at the state of the premises including the decor and cleanliness of the rooms. We looked at care and medical records and information used by the service to assess and monitor the quality and safety of care delivered. We talked with staff about safeguarding vulnerable adults and how they were supported to carry out their roles.

People who lived at Larkhall Springs told us that their care was "good" and that staff were "very caring." The close family member of one person who lived at Larkhall Springs said that "care is very good." We were told that staff were respectful and protected people's privacy and dignity "at all times". People said and we observed that staff knocked on doors before entering and made sure that people were given intimate care in private.

The home had comprehensive care plans, although some areas, such as people's capacity to consent were not fully completed. The home had recently converted the lower floor of the premises to dedicate to the care of people with dementia. The home was in the process of making changes to the layout and decor of the building to address the different needs of people with dementia.

We talked with the chef about people's food and nutritional needs. People were given choice in what they ate, and the chef talked with people most days to make sure that they were getting enough food and drink.

Staff were clear about what constituted abuse of a vulnerable adult and what they would do if they suspected that a person was being poorly treated. Staff were well supported by the organisation although training records were not always clear and consistent. Appraisal and supervision were not always being carried out when they were due.

During our visit to the home we saw care delivered with kindness, warmth and sensitivity. Staff knew the people they cared for well and were meeting their needs. Some people told us that they did not have much to do during the day. The home had recently recruited an activity coordinator who would work with the organisation's activity lead on a growing and evolving programme of activities and events.

Some of the bathrooms at the home had not been deep cleaned recently, and the flooring was marked in places and showing signs of age. A number of the bathrooms were sparse and not welcoming. Otherwise the home was clean and tidy. All bedrooms were clean and warm. The lounges had comfortable chairs and the dining room was spacious and welcoming.