We undertook an unannounced inspection of Larkland House on 16 January 2017.

Larkland House provides care and nursing for up to 55 people, some of whom may have dementia, mental health needs or a physical disability. At the time of our inspection there were 49 people living at the service.

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 2008 and associated Regulations about how the service is run.

People and their families told us they felt safe at Larkland House. One relative told us “I know mum is safe as she if very happy here.”

Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

People and their families told us people had enough to eat and drink. People were given a choice of meals and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs were identified for staff and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the registered manager and all of the team at the home. Staff supervision and other meetings were scheduled as were annual appraisals. People, their relatives and staff told us all of the management team were approachable and there was a good level of communication within the service.

Relatives told us the team at Larkland House was very friendly, responsive and very well managed. Comments received included “Its home from home.” The service sought people’s views and opinions and acted on them.

The management teams’ ethos was echoed by staff and embedded within the culture of the service.

We spoke with four people who used the service and looked at four people's records. We found that people's right to make decisions and choice in their daily lives was considered and respected.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us they were happy with how they were looked after. Another person said "everything I want is here".

We found that people were provided with appropriate support in a safe way in line with their care plan. Equipment was in place to promote people's comfort and safety. Equipment was properly maintained and staff received appropriate training in using equipment.

The staff received appropriate training and supervision. Although staff had not received annual appraisals during the previous twelve months we saw the new manager had scheduled appraisals for all staff over the weeks following our inspection.

The provider had effective systems in place to monitor the quality of the service. There were regular resident and relatives meetings and an annual survey was carried out of the people who used the service. Regular quality audits were carried out by the provider and action was taken to address any issues arising.

The provider may wish to note that at the time of our visit there was no registered manager for the service. We were told the provider was making arrangements for a manger to register with the Commission.

People who use the service and their relatives told us the home provided appropriate care and treatment to people who use the service. They said they felt the home was safe. One person told us "Staff are splendid, they can't do enough for you."

We saw staff knocking on doors before entering rooms and their interactions with people were respectful. Staff delivered care in an appropriate way to people who lived at the home. For example we saw staff always worked in twos when helping people to mobilise. At lunch time we saw people received help to eat where necessary.

Staff told us people who lived at the home were involved in their care planning and also people's relatives were involved where this was appropriate. Staff said they were made aware of the home's safeguarding and whistle blowing policies. They said the management of the home was approachable and they felt confident in raising concerns with a nurse or the manager. The staff we spoke with said the training they received enabled them to care for people appropriately.

Relatives of people who use the service told us they attended or were aware of relative and resident meetings. One relative said they had attended one of these meetings and management "seemed responsive to feedback". Another relative told us there had been improvements to the environment within the home in recent months.

We saw the home had effective systems in place to monitor the quality of the service.

This inspection took place on the 14th and 15th October 2015 and was unannounced on the first day.

Larkland House provides care and nursing for up to 55 people some of whom may have dementia, mental health needs or a physical disability. At the time of our inspection there were 30 people living at the service.

At the time of the inspection Larkland House did not have 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. Before our visit we confirmed the recently appointed manager had applied to the CQC for registration. Shortly after the inspection visit we were informed their application had been successful and that the registration process was being finalised and a certificate issued.

In the most recent inspection of Larkland House in January 2015 we rated the service overall as; "Requires Improvement". We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of staff recruitment and staff training. We asked the provider to inform us of the action they would take to address these. The provider submitted an action plan dated 12 May 2015 which set out the action already taken or to be taken. The action plan indicated the necessary action would be completed by the end of June 2015. This inspection provided an opportunity to assess whether the action plan had been successful.

We found people were now protected, as the provider had put in place effective staff recruitment and recruitment monitoring procedures to ensure all new staff were suitable to provide care and support to people. They had also taken steps to ensure all staff had the necessary training support to enable them to provide effective and safe care and support to people.

The current rating following this inspection reflects the fact that we found the service was in a process of transition since the manager took up their post in April 2015. This had been recognised by the newly appointed manager and a senior manager for the provider. There were plans in hand for a reconfiguration of the service to enable staff to better meet the needs of people in the service. These changes had been discussed with people who lived in Larkland House, their relatives and staff.

In view of the short amount of time the manager has had to embed the improvements which have been recognised, an overall rating of ‘requires improvement’ is appropriate. The body of the report includes evidence of how the service has improved in the recent past. A future inspection will be able to judge if those improvements have been sustained.

We received mixed assessments of the standard of care experienced by people. However, the majority of people who lived in Larkland House and their relatives we spoke with thought the service was improving and were positive about the changes that had been made to the service and the standard of care they received or observed.

There had been a recent and significant medicines administration error which was under investigation at the time of this inspection. The service had and was co-operating with the investigation. The medicines policy and procedure of the service, including administration and recording, had been subject to a recent review by the Clinical Commissioning Group. This inspection included two CQC pharmacy inspectors who also carried out a thorough review of medicines administration and recording practice. We found medicines practice was now more robust and the records we looked at were accurate.

We found people were being cared for by staff who now benefitted from more regular staff training and supervision than had been the case previously. Because of a number of staff changes and the use of agency staff, it was not always possible for people to receive care from staff who knew and understood their history, likes and dislikes well. The manager indicated that wherever possible they used the same agency staff to help with this. When we spoke with regular agency workers, they had a good working knowledge of the people they supported. They said care plans and handover meetings provided them with information which helped them provide appropriate care for people.

The interactions we saw during our visits were positive and people told us they felt safe. Staff were able to tell us how they would recognise if people were not safe or if they had been subject to any form of abuse and the action they would take to protect them and report this.

The majority of people who lived in Larkland House and those relatives who spoke with us said they thought health and social care needs were being met effectively. A relative confirmed; "Knock-out, I can leave my (relative) and not worry. I recommend this home to everybody…can’t find fault." Another person reported how when their relative came to Larkland House they were bed-bound, but that now "They can walk with a frame".

People told us staff listened to what they said and the views they expressed. There were relatives’ and residents’ meetings from time to time where people could say what they thought about various areas of the home’s operation. For example, we saw minutes of a relatives’ meeting in May and July 2015.

The majority of the eight people’s relatives we spoke with told us they thought the newly appointed manager was effective. One person had a very different view. We saw minutes of meetings between relatives and the manager held in May, July and September 2015. These provided an opportunity for the manager to listen to people’s views and to share information with relatives. The minutes recorded; "Relatives were happy with the new staff and proposed changes and gave positive comments about how Larkland House is now improving."