Larkhill Hall

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified a continued breach in relation to safe care and treatment. Medicines records did not always demonstrate people received their medicines safely. We found no evidence people had been harmed and this resulted in a continued breach. You can find more details of our concerns in the evidence category findings below. People told us they felt safe living at Larkhill Hall. The manager understood their role and responsibilities. Staff understood the course of action to take if someone disclosed an allegation of abuse. People felt appropriate action was taken when they raised concerns and feedback. Historically people told us that the concerns they reported had not always been reported on. There was enough trained and qualified staff on shift and staff were recruited safely. Staff knew how to support people and people told us they had been involved in their care and support plans. Lessons had been learnt from previous shortfalls and safeguarding recommendations were being recorded, however, it was not always clear from the record if the recommendations had been implemented.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they felt the management team had made a difference in the home. One member of staff told us “In the last 18 months we have had 4 managers. I have always been managed well. I do think managers now are here to help and they learn from mistakes.” Another member of staff told us “Yes if something goes wrong, there is always a meeting to explain what has happened and how to fix it.” There were processes in place which ensured incidents and accidents were recorded and learning was taking place as a result of this. We tracked a number of incidents and accidents and saw multiple examples of where extra training, and supervision had been implemented following incidents. For example, 1 person had been incorrectly moved following a fall. The staff involved had been re-trained straight away and not permitted to use any moving and handling techniques until their competency in this area had been observed and assessed by the company trainer. Everyone we spoke with said they felt safe living at the home and could raise any issues. Comments included. "I haven't had any problems. I am okay and it is nice here. If I needed to I would speak to the care staff for help but I have never had to. I know I can just shout out if I need to.” Another person told us “I had to speak with someone about my medication because I thought I was getting it too late at night. I spoke with someone and they started giving it to me earlier. This was about a month ago. I told them I had a problem, and they fixed it for me."

Systems were in place to ensure a safe transfer between services. Each person had a ‘hospital pack’ which was used for admissions out of the service. This ensured key information about a person's personal situation and care needs could be shared appropriately between services. The provider had recently made the decision to move people within the service. This was in part to reduce the reliance on agency workers. One family member told us their relative was, ‘Happy with the move.” The same family member explained a member of the management team undertook an assessment of their relatives needs prior to them moving into Larkhill Hall. They told us, “I can't see anything wrong with the place. The staff are absolutely super. [Name] is happy. That's the main thing.” Staff told us they felt people were safely transitioned between services.

People told us they felt safe and well looked after and would speak out if they had any concerns. One person told us, “We are looked after like royalty.” One person told us they were not always happy with the support they received and said they has been ignored by staff that morning. The person confirmed they knew who to complain to and did not want us to raise concerns on their behalf. One relative told us they felt staff would always raise things with them if there was a problem. We observed people were treated with kindness throughout our assessment. Staff took time to speak with people and seek consent before providing them with assistance. Systems were in place to ensure appropriate authorisations were in place to deprive people of their liberty where it had been determined the person lacked the capacity to consent to living at Larkhill Hall. There were processes in place such as a safeguarding policy and procedure. Staff were able to describe the correct course of action to take to ensure people were protected from harm and abuse. This included escalating to the manager or the Local Authority safeguarding teams. Safeguarding recommendations had been recorded within the safeguarding log to evidence any learning from safeguarding’s, however these were not always in order so it difficult to tell what actions had been implemented. We raised this with the manager at the time who agreed to make this processes clearer.

People told us they felt safe and well involved with their risks.

Staff were able to describe to us how they used their electronic devices and the online system to access people’s care records, risk assessments and monitoring information.

We observed staff practices which demonstrated there was an understanding of how to provide safe care in a way which mitigated risk. For example, we observed safe moving and handling practices.

There were risk assessments in place, however there was some improvement required to the way remedial actions for managing risks were recorded. For example, 1 person who was at risk of constipation did not have a detailed person-centred explanation in place for when additional medical help should be sought. When we cross referenced this with their bowel chart, a high number of days had passed before they opened their bowels, and we were not sure from the records what action staff had taken before this. Therefore we were not assured this persons continence needs were being managed appropriately. We raised this with the area manager who took immediate action to rectify this. We saw another person had a risk assessment in place for weight loss. They were underweight. A recent review of their care plan had indicated that a referral was needed to the dietitian. However, when we checked this person’s records there was no evidence that a referral had been made, therefore putting them at risk of malnutrition.

The environment was safe. Routine checks were made on the safety of the environment and equipment. We observed the environment was well maintained. People had the equipment they needed to keep them safe. One person told us, “I have a call bell, But I don't need to use it.” Staff used electronic devices to ensure they kept up to date with checks, such as mattress checks throughout the day. During the assessment we identified the pressure mattresses for 2 people were not switched on. We raised this and staff responded immediately to establish the reason for the equipment being switched off. The mattresses were switched back on ready for people to use. We were satisfied by the checks in place the equipment was regularly checked, no harm had come to people as they were not using the beds at the time.

Staff were safely recruited. Appropriate checks had been made before being offered employment. Agency workers confirmed they had received an induction to the service on their first shift. Records were maintained. Records also demonstrated checks on staff competency were made where the agency worker was required to administer medicines. One agency worker told us, “I was given a staff to work with and had induction. I got to observe and was encouraged to ask questions. [Staff] are very welcoming when I come.” There were enough staff on duty to meet people’s needs. We observed staff were always present in communal areas throughout our assessment. Staff members were on hand to respond to people's immediate needs as well as encourage people to engage with others through a range of activities including quizzes, conversation and group games. All staff were appropriately trained. There were subjects in place which covered a range of topics plus additional training which had been identified through incident analysis such as IDDIS training to ensure staff could support people safely with their eating and drinking requirements. Rotas demonstrated where agency workers were used, attempts were made to ensure these workers were prebooked and consistent workers. Previous rotas demonstrated a high level of agency workers had been utilised during the night. However, in recent weeks this had improved due to recruitment of new staff and reducing support to 2 floors of the service. Most people we spoke with said there was enough staff. One person said, “Sometimes they are short of staff, but it is unusual for that to happen.” One person we spoke with told us they felt on occasions there was not enough staff. A relative we spoke with also said “Agency staff seem less engaged.”

Systems were in place to protect people from the risk of infection. The service was clean. A family member commented, “It’s almost like a hotel. Always spotless.” There were enough staff on duty to maintain the home and look after people's laundry. One domestic staff member told us, “My workload is manageable”. Domestic staff members maintained robust records to demonstrate cleaning had been undertaken. Staff were able to describe additional cleaning processes they would follow in the event of an infectious outbreak, such as enhanced cleaning of frequently touched areas and separation of laundry. One staff member told us the new provider was making changes ‘for the better’. They told us, “100% there is more structure, more leadership and more support. There are better procedures for dealing with any outbreak.” The provider completed routine audits in infection control. These identified areas of improvements, and the actions taken.

People confirmed they received their medicines safely.

The management team at the service had identified areas for improvement around the management of medicines and were working to address these. At the time of the inspection there were still a number of areas to be improved. The actions identified on completed audits had been recorded as completed, however we found a number of the same issues during this inspection. Staff told us they knew where to find the medicines policy and how to report an incident. They also told us the provider was supportive of staff development and provided training. The service worked with health professionals to review people’s medicines.

When people were prescribed medicines to be given at specific times, records showed these were not always given at the correct time. We also found some medicines were not given at the times they were prescribed; this placed the person at risk of experiencing unnecessary side effects. We found when medicines needed to be given with a time interval between doses, the actual time the medicine was given was not always recorded, therefore there was a risk people might be given their medicine to close together which placed them at risk of side effects. One person’s medicine administration record did not list all of their medicines, there was a risk their medicines might not be reconciled correctly if they were to attend hospital, which placed them at risk of harm. When people were prescribed topical preparations, for example patches the records showed they were not always applied following the manufacturer’s instructions; there was a risk people might have experienced unnecessary side effects. When people were prescribed topical preparations for example creams, the records were not always accurately completed, placing their skin integrity at risk of damage People’s medicines allergy information was not always recorded on the relevant documents so there was a risk people might be given a medicine they had previously reacted to. Several people were prescribed ‘when required’ medicines or medicines with an option to give 1 or 2 tablets, person centred information to support staff to safely administer these medicines was not always available. This meant there was a risk people might not have got their medicines, or the correct dose of medicine, when it was needed. The medicines fridges were not being safely monitored as maximum and minimum temperatures were not being recorded and the current temperature of one fridge was higher than the required maximum. This meant medicines requiring refrigeration might not be safe for use.