We inspected Larkrise on 26 June 2018. The inspection was unannounced. The overall rating for this service has changed from Good to Requires Improvement.Larkrise is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care home accommodates up to 60 people. At the time of the inspection there were 56 people living at the service. The accommodation was divided into three wings namely Park Lane which was a dementia unit, Abbey Road which was a nursing unit and The Strand which was mainly a residential unit.
There was a registered manager in place. 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.
Larkrise did not have enough staff to meet people’s needs. On the day of the inspection we saw staff worked continuously to attend to people needs. Staff told us they often worked short staffed and records confirmed planned staffing levels were not always met. People and their relatives also told us staffing levels needed to improve.
We saw the home had staff vacancies which were covered by regular agency staff to meet people's needs. Same agency staff were used to maintain continuity. The management team told us they were doing all they could to ensure safe staffing levels. The registered manager had recruited staff who were waiting to start working. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.
People living at Larkrise were supported to meet their nutritional needs. However, the dining experience varied. People on the ground floor did not receive their meals in a timely manner. Staff were poorly deployed during meal times
The service was not always well run. People, their relatives and staff had mixed views on how the service was run. Some people, relatives and staff felt the home was well run whilst others felt it was poorly run. The shortage of staff we identified had had an effect on general staff morale.
The provider had quality assurance systems in place some of which were used to drive improvement. However, dining audits were not always used effectively. We could not find evidence of audits around staffing levels and people’s experiences and views.
Risks to people’s well-being were assessed and managed safely to help them maintain their independency. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage people’s medicines. People received their medicine as prescribed.
People had their needs assessed prior to living at Larkrise to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.
People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular ‘trust in conversations’ (one to one meetings with their line managers) and appraisals to help them meet the needs of the people they cared for.
People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.
People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible.
The home had established links with the local communities which allowed people to maintain their relationships.
We identified one breach of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we told the provider to take at the back of the full version of this report.