This unannounced inspection took place on 6 November 2018. Larchwood Nursing and Residential Home provides nursing and accommodation for up to 48 people. At the time of our inspection, 44 people were living in the home. Larchwood Nursing and Residential Home is a ‘nursing and residential home’. People receive accommodation and personal care as a single package, and some people receive nursing care as a separate package. CQC regulates both the premises and the care provided, and these were looked at during this inspection.
Larchwood Nursing and Residential Home accommodates people in individual rooms, each with an en suite toilet and basin facility. Each floor has some communal bathrooms and toilets in addition, as well as a dining area and lounge.
The service had a recent history of non-compliance. Our inspection in September 2017 found the home to be inadequate in four areas with eight breaches of Regulations of the Health and Social Care Act 2010 (Regulated Activities) Regulations 2014 and one breach of CQC Registration Regulations 2009. We placed additional conditions on the provider’s registration requiring them to submit monthly reports to us setting out how they would assess, monitor and, where required, take action to improve the quality and safety of the care and support provided to people living at Larchwood.
At our last inspection on 12 March 2018, we found that improvements had been made in some areas, following the inspection on 19 September 2017, where there were serious concerns about this service. Following that inspection, we took action against the provider and met with them to confirm what action they would take to improve the service. We served a Notice of Decision to impose positive conditions on their registration, which they have complied with.
At our last inspection on 12 March 2018, some improvements had been made but the provider remained in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was inconsistent management and oversight of the service, and there were concerns around infection control and the management of risks to people. Further improvements were also required to ensure people received person-centred care, and to ensure there were enough staff deployed effectively to care for people.
At this inspection on 6 November 2018 we found four repeated breaches of Regulations and one further breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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.
There was poor leadership in place, with concerns not being identified. The registered manager was not often visible throughout the home and was not aware of all areas requiring improvement. Staff working in the home were not always well supported.
Staff working in the home were not always deployed so that a mix of competency and experience worked together. New staff and agency staff were not always supported to gather enough knowledge of people before working as part of the staff team. This resulted in there not always being competent staff available to people when they required care.
Risks to people because of their health conditions had not all been identified and mitigated, and there was no guidance around some of these in people’s care plans. Risks to people due to their environment, such as unsafe equipment, had not always been identified. There remained poor infection control practices and unclean areas and equipment.
People were not supported to eat and drink enough, and drinks and meals were consistently left out of reach for people. People were not always given choices of what they were going to eat, or communicated with about what their meal was. There was poor recording around eating and drinking when people were at risk of malnutrition or dehydration. Where further action was needed, such as weekly weights, this was not always completed.
Staff had not always considered people’s mental capacity to make important decisions to ensure their rights were upheld. There was contradictory information about people’s mental capacity in some people’s care plans. The service was therefore not adhering to the Mental Capacity Act 2005 (MCA).
People were supported to see a doctor if they required, however people were not always referred to specialists such as a dietician in a timely way when required.
Care plans were not always person-centred and did not contain sufficient guidance for staff around people’s conditions. People were not always able to choose how to spend their time and staff did not always listen to people. As a result, people did not consistently receive support as they preferred.
Relatives and people knew who to complain to if they required. However, not all people, relatives or staff felt as though they could raise any concerns.
The systems in place for checking, monitoring and improving the service were not robust and had not led to a sustained, suitable level of improvement. Many concerns found on the inspection were not identified by the provider, and previous improvements made to the service had not been sustained.
There were activities on offer for people, both within the home with the activities coordinator, and external outings. The activities coordinator completed one to one activities with some people in their rooms, and group activities such as bingo and flower arranging.
The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. In two key questions the service is still rated ‘Inadequate’, and for the remaining three key questions, the ratings are ‘Requires Improvement.’
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.