CQC report explained · a nursing home
What the CQC found at Larchfield House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, May 2019
Rated Good; inspectors found safe, kind and personalised care, with some improvements still needed in mealtime support and staff supervision.
Inspectors visited the home on 26 and 28 March 2019. They spoke with people, relatives, staff and healthcare professionals. They observed care and mealtimes, and checked care records, medicines records and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found safe medicines systems, suitable staffing, personalised care plans, kind staff and good leadership.
There were some smaller shortfalls. Some people waited too long for food, some staff had not received regular supervision, and there was a slight odour in one corridor. The home responded to feedback during the inspection.
The previous rating was Requires Improvement in March 2018. The report says the home had completed the required actions for Safe, Responsive and Well-led, and was no longer in breach of the regulations mentioned in the previous report.
Safe medicines
Inspectors found organised systems for receiving, storing, giving and disposing of medicines. Medicines records and care plans were accurate for the records checked.
“Medicines systems were organised and people receiving their medicines when they should.” from the report
Kind and respectful staff
People and relatives consistently described staff as kind and caring. Inspectors also observed warm interactions and respect for people's privacy, choices and communication needs.
“Staff demonstrated compassion and respected people's preferences and decisions.” from the report
Personalised care
Care plans included people's backgrounds, preferences, interests and communication methods. Staff showed knowledge of what mattered to people and adapted support to individual routines.
“People's needs assessments included comprehensive information about their background, preferences and interests.” from the report
Good leadership and improvement
Inspectors found strong leadership, an open culture and systems for checking care quality. The home had completed actions following its previous Requires Improvement rating.
“The registered manager provided strong leadership to a motivated staff team who felt valued.” from the report
Mealtime delays and communication
needs fixingSome people waited an unreasonable time to be served because staff were not well coordinated. Staff did not always explain food or give verbal prompts while helping people eat and drink.
“Although there were enough staff we noticed some people waited unreasonable times to be served due to a lack of staff co-ordination.” from the report
Irregular staff supervision
needs fixingSome staff had not received regular supervision. The home had a plan for more consistent supervision and appraisal reviews.
“However, we noted that some staff had not received regular supervision.” from the report
Pharmacy action records
minorThe pharmacy audit action plan did not initially have a clear deadline, and progress was not recorded consistently. The home corrected the documentation during the second day of the inspection.
“We found the provider's pharmacy audit action plan did not have a clear timeframe to be achieved.” from the report
Corridor odour
minorInspectors noticed a slight offensive odour in part of one corridor. The clinical service lead said it would be investigated.
“However, we noted a slight offensive odour in one part of a corridor of a unit which the clinical service lead said they would investigate.” from the report
- 01What changes were made after inspectors saw delays and poor communication during mealtimes?
- 02How often do staff now receive supervision, and how do you check that no one is missed?
- 03What deadlines and checks are now used for pharmacy audit actions?
- 04What was found when the slight odour in the corridor was investigated?
- 05How do you check that the improvements made since the Requires Improvement rating have been maintained?
This was a scheduled inspection covering all five CQC questions, including the premises and the care provided; the report also checked progress since the previous inspection. This explanation was written from the published report of 16 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2018
Larchfield House was rated Requires Improvement; inspectors found kind, effective care but ongoing safety, complaints and management problems, although it had been removed from special measures.
This was an unannounced inspection on 1 and 2 November 2017. Inspectors reviewed information held about the home, observed care, spoke with people, relatives and staff, and checked care records, medicines records and management records.
There had been clear improvements since the previous inspection, when the home was rated Inadequate and placed in special measures. However, medicines and care records were not always accurate, infection control practices were not always safe, and some people did not receive medicines when required. Legionella was still present, although the home was monitoring the risks.
Inspectors rated Effective and Caring as Good. Safe, Responsive and Well-led were rated Requires Improvement. This means the home had made progress, but important areas still needed reliable improvement.
Kind and respectful care
People and relatives described staff as kind and compassionate. Inspectors saw staff protecting people's dignity and responding sensitively to their needs.
“People and their relatives felt staff treated them with kindness and compassion.” from the report
Staff training
Staff had completed relevant training and received supervision and appraisals. Inspectors found staff had the knowledge and skills needed to provide effective care.
“Staff were appropriately trained; supervised and appraised. The service achieved good health outcomes for people.” from the report
Mental capacity and choice
The home followed the Mental Capacity Act and involved people, families and professionals in best interest decisions. It also considered less restrictive options.
“During this visit, we found the service was compliant with Mental Capacity Act and its codes of practice.” from the report
Personalised activities
Activities were linked to people's histories and interests, including activities designed for people living with dementia. People could choose whether to take part.
“This showed the service ensured social activities were meaningful and tailored to meet the needs of people living with dementia.” from the report
Medicines and records
seriousAn incident involving inaccurate fluid records and medicines not being properly processed led to a person being admitted to hospital. Inspectors also found that lessons from medicine errors were not being analysed.
“This meant the person did not receive all of their required medicines, when required.” from the report
Infection control
needs fixingStaff shared mops between rooms and the water was not always changed. The home did not have a clear, service-specific documented cleaning process.
“We saw staff shared mops between rooms and the water was not always changed.” from the report
Complaints
needs fixingSome complaints were only partly answered. Inspectors found that all the concerns raised had not always been fully considered or investigated.
“This meant, complaints were not thoroughly investigated.” from the report
- 01How are medicines received, checked and recorded now, and what has changed since the incident where medicines were missed?
- 02What documented cleaning process is now used to prevent cross infection, and how is it checked?
- 03What is the current position on Legionella, replacement pipework and the continued closure of the showers?
- 04How are care records checked for accuracy, including information about choking risks, thickeners and disabilities?
- 05How will you make sure every part of a complaint is investigated and answered?
This was an unannounced inspection covering all five key questions, including the home, care provided, records, medicines and management systems. This explanation was written from the published report of 21 March 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Larchfield House
5 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2018Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 6 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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