The Larches - Tiverton

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

During this assessment we identified 2 breaches of regulation in the well-led key question for Good governance and Receiving and acting on complaints. Improvements were needed in the quality statements of Governance, management and sustainability and Learning, improvement and innovation. Staff at the service spoke positively about the manager in post. Staff said they did not feel valued by the provider and felt business decisions were financially based as opposed to meeting people’s needs. The providers governance arrangements were not adequate in ensuring the health, safety and welfare of people. There was no effective complaints process to aid learning and improvement.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not a culture which showed collaboration with staff that promoted trust and understanding. This meant staff did not always feel valued and did not have a shared vision for the future of the home. Changes to roles and hours meant they felt unsettled without clear explanations for the decisions behind them. There was a lack of clarity over break times, such as the length and their availability to answer call bells, and there was uncertainty as to what type of training they were paid to complete. However, supervisions were being re-introduced and staff spoke positively about the leadership of the new manager and the support she provided.

Staff contracts were being re-written with new working conditions and some staff said they did not have a contract, which led to them feeling vulnerable regarding their job security. Staff did not feel the provider actively engaged with them. for example being kept up to date about any risks and challenges for the service. This led to speculation and unease amongst the staff group.

The manager had taken over the role at short notice; staff praised her approach and the way she supported them. Staff expressed their loyalty to the manager and the people living at the home. However, they said they did not feel valued by the provider. Staff said their feedback or views were not sought and if concerns were shared, they were not acted upon.

Despite changes to the management of the home, relatives had not been formally informed to offer reassurance about the new arrangements. The manager had informally told relatives when they visited or rang the service. Minutes from a residents’ meeting were displayed in the hallway but were not sent out to families who lived further away. People living at the service interacted and were at ease with the manager. The manager was visible, and their office was based in an accessible part of the home. Staff confirmed the provider regularly visited the service at weekends but there were no established processes to record who they engaged with and how they measured the safety and running of the service.

There had been no recent surveys to gather feedback from people living, working or visiting the service. Staff said the provider visited regularly. However, at the time of our assessment there were no records of the outcome, or the areas covered, during their visit. The manager was re-introducing meetings for people living at the home, and for staff, to give them a space to express their views and update people on any changes.

The service had whistleblowing policies to support staff when identifying concerns or raising issues. Staff meetings were held for staff at all levels to seek feedback and communicate key messages. The service had policies relating to the Duty of Candour detailing the providers responsibilities in the event something goes wrong.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff expressed concern how the provider made decisions based on cost rather than considering the impact on people living at the home. For example, changes to staff roles, hours and a reduction in entertainment.

Governance arrangements were insufficient in ensuring the service had financial viability to ensure security and sustainability of the service. We found several key invoices had not been addressed. Clinical waste had not been collected for 6 weeks due to an unpaid bill. Outside the home, was a large industrial clinical waste bin. The lid could not be shut as it was too full. On the ground were multiple piles of full clinical waste bags. Neighbours had made numerous complaints about hygiene issues and the unsightly appearance. Governance arrangements had not addressed poor recruitment practice. For example, there was missing required documentation in staff files. This meant there was the potential for people unsuitable to work in care being recruited. We found a range of examples which showed the provider’s governance systems were not robust as they had not addressed areas for improvement, which were found during our assessment. These included the management of complaints and applications for deprivation of liberty safeguards, recording of staff inductions and the management of medicines.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

People using the service, their families and carers were not routinely involved in developing and evaluating improvement in the service. For example, through regular surveys. However, the manager and staff had recently introduced meetings for people living at the service to express their views and provide feedback. Minutes were taken and displayed in the building but were not shared with people choosing to stay in their room or with families who were not able to visit regularly. The manager said this would be addressed.

Processes to ensure that learning happens when things go wrong were not effective. There was a complaints policy, but this was not followed as we were aware of complaints raised, but these were not logged. This meant there was no effective oversight by the leadership team to recognise patterns and themes to complaints. It also meant the outcome for people and other complainants could not be audited to ensure they were addressed effectively. However, the manager and staff had tried to reassure complainants, for example neighbours who were unhappy about the clinical waste not being collected. There were 2 previous breaches of regulation in safe care and treatment and good governance from the last inspection. Before our visit, we reviewed the subsequent action plan submitted by the provider to address the breaches. Evidence from this current assessment showed the same regulation breaches had been repeated with additional concerns in other areas. This showed the action plan was ineffective and the provider had not addressed concerns effectively through their governance arrangements. In addition, the registered manager had not notified the Care Quality Commission (CQC) of events in the service which impacted on the running of the service and safety of people living at the home. This is a legal requirement and meant CQC had not received the required notifications to help them judge if risk had increased in the home.