About the service: Larchfield is a care home for up to 40 people who have physical disabilities, mental health conditions and may be living with dementia. The service was providing care to 36 people at the time of the inspection.

People’s experience of using this service: People were happy living at the service. They told us they felt safe and well looked after. Staff received safeguarding training and knew how to recognise and report any concerns. Staff were recruited safely and there were enough staff to meet people's needs. People received their medicines as prescribed. The service was clean and staff followed good hygiene practices.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider and staff acted within the law when people lacked capacity to make their own decisions. People's health and nutritional needs were met and understood by staff. Staff received induction, training, supervision and support to enable them to feel confident and be competent in their role.

Staff were patient and friendly, and people's privacy and dignity was respected. They showed they valued people as individuals and had formed supportive relationships with people. Staff knew how people preferred their care and support to be provided.

Care plans were kept up to date and reflected people's needs. The provider was responsive to complaints and concerns. There were opportunities for people to discuss any concerns or ideas they had about the service. People chose to pursue a variety of activities and interests at the service and in their local community.

The service had an open and supportive culture. Audits and checks were carried out to monitor the quality of care delivered. There was a commitment for improvement and learning from any actions identified. The registered manager and management team were committed to providing good quality care and support for people.

Rating at last inspection: Requires Improvement (Published 27 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced inspection carried out on 14 and 21 November 2017. Our last inspection took place on December 2015 when the service was overall rated as 'Good'.

Larchfield 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 service is a purpose built home owned and maintained by Anchor Trust. It provides personal care for up to 40 people who have physical disabilities, mental health needs and moderate learning disabilities. Larchfield is situated in Hunslet, Leeds.

At the time of our inspection 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.

At the last inspection carried out in December 2015 the service was rated Good overall with the Well-led domain rated as Requires Improvement. At this inspection we rated the service Requires Improvement overall.

People told us they felt safe when receiving care from the staff team. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of vulnerable adults and staff knew what action to take to ensure people were protected from potential harm.

Potential risks to people had been identified and assessed appropriately. There were staff enough staff on duty to meet people’s needs but sometimes staff became task orientated during busy times of the day, which meant they were not always able to meet people’s needs in a person centred way. Safe recruitment practices were followed. Medicines were managed safely.

Staff had not always received all their essential training set by the provider. Most staff training was up-to-date. Team meetings and supervisions were held but not always in line with the provider’s policy. We have made a recommendation about staff support.

People were supported to have choice and control of their lives as much as they were able and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to have sufficient amounts to eat and drink and maintain a healthy diet. They had access to healthcare professionals in order to maintain their health and wellbeing. People's rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were respected by the staff who supported them.

People were involved in decisions about their care. Their privacy and dignity was respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People's personal preferences and their likes and dislikes were documented so that staff knew how people wished to be supported. There was a variety of activities on offer which people could choose to participate in.

Complaints were dealt with in line with the provider's complaints procedure.

Weekly and monthly checks were carried out to monitor the quality of the service provided. There were regular meetings with people and staff and feedback was sought on the quality of the service provided. The registered manager and area manager were aware of the current challenges that faced the service. However checks had not identified elements that led to a safeguarding concern.

People and staff were able to influence the running of the service and make comments and suggestions about any changes.

You can see what action we told the provider to take at the back of the f

We inspected the service on 21 October 2015. The visit was unannounced. Our last inspection took place on 05 July 2014 at that time we found the service was meeting the regulations.

Larchfield is a purpose built home. It provides personal care for up to 40 people who have physical disabilities, mental health needs and moderate learning disabilities. The home is spaced over two floors with bedrooms on each floor. There is access to both floors via a lift. The home has a well maintained garden and also has car parking facilities.

At the time of our inspection there was a registered manager in the home. 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.

During our visit we saw people looked well cared for. People had their hair styled and also some people had their own jewellery and make up on. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty

Safeguards (DoLS).

Staff understood how to help people make day-to-day decisions and were aware of their responsibilities under the Mental Capacity Act (2005).

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering and disposal of medicines and also the storage of medication.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and they had enough to eat and drink. We observed lunch being served to people in both dining rooms and saw people had sufficient amounts of food to meet their nutritional needs.

We saw the home had activities in place for people to participate in, at the time of our inspection there was an entertainer singing in the home.

We looked at five staff personnel files and saw the recruitment process in place ensured staff were suitable and safe to work in the home. Staff we spoke with told us they received supervisions every three months and had annual appraisals carried out by the registered manager or care manager. We saw minutes from staff meetings which showed they had taken place with staff present and these minutes had being signed by all staff.

We found that staff had training throughout their induction and also received annual refresher training in areas such as, Mental Capacity Act 2005, DoLS, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. Staff had also received training in alcohol and drug misuse.

There were effective systems in place to monitor the quality of the service. However, the home needed to ensure the care manager had access to all files in the home when the registered manager was not present. The regional manager assisted in gaining access to these files on the day of the inspection.

This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe. People had been cared for in an environment that was safe, clean and hygienic. There were effective systems in place to reduce the risk and spread of infection. Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve. A plan was in place for dealing with emergencies so that people were not put at risk. A plan was in place for responding to unexpected events that could affect the running of the service, for example fire or loss of the power or water supply.

Is the service effective?

People's health and care needs were assessed with them. We looked at the care records for five people who lived at Larchfield. We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met. Information about people who used the service was obtained and shared appropriately. We saw evidence that demonstrated staff were provided with regular formal supervision. Staff told us they were supported by management who enabled and encouraged them to access appropriate training on a regular basis.

Is the service caring?

Staff communicated well with people and were attentive when they needed support. We saw that care workers showed patience and gave encouragement when supporting people. We saw staff caring for the needs of people in a professional manner. They ensured the people they cared for were supported in taking part in activities in the local community.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People's views of the service were sought and we saw the manager responded where improvements were needed to the service.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. This helped to ensure that people received a good quality service at all times.

We made an unannounced visit to follow up the action we asked the provider to take when we visited in September 2013. Our previous visit showed there were not enough staff on duty with relevant qualifications to support people who lived at Larchfield.

We spoke with the manager and one member of staff, who confirmed training opportunities had improved significantly since our previous visit. We found staff had completed and embarked upon National Vocational Qualifications and other training which enhanced their knowledge in their role.

We looked at the training records, which confirmed what the manager and the staff member told us.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with four people who lived in the home. They said they were happy living at Larchfield and made comments, such as: “staff bend over backwards to help us”, “it’s like a palace”. We saw evidence that people were involved in monthly reviews of their care and support, which allowed for their changing needs to be discussed and planned for.

We saw that all areas of the home were clean, tidy and accessible to people. We saw refurbishment was taking place at the time of our visit to improve the dining rooms. People who lived in the home told us of plans for a new conservatory, which they looked forward to. People were proud to show us their rooms and said they liked them.

We spoke with staff and saw they had good relationships with people. However, we found there were not sufficient numbers of skilled staff on duty and this impacted on the care of some people.

We looked at records that showed how people’s care was managed. We found information was only accessible to those who needed to know, which ensured confidentiality for people.

People who used the service were generally satisfied with the care they received. One person commented “It’s a lovely place.” Another said “It’s alright.” One person told us she had a lovely room and that the staff were nice.

People who used the service who told us they were supported in maintaining their independence and community involvement. They said that routines were flexible and they could choose how to spend their day. People told us that they were able to go out on their own when they wanted and others said they would go with a member of staff or a volunteer.One person said “I get a taxi to the club and I like it because I go when I want.”

People on the whole thought the food was good and they were able to have as much as they wanted. One person said “The food is delicious here and you can have seconds if you want.” A number of people were observed sitting smoking in the lounge and one person said “I like it here if I can have my cigs.” However, two people told us they did not like to go into the lounge because of all the smoking.

One person said "If I have a problem I go to the staff." Another person commented that the staff were helpful. People who used the service and staff said they were comfortable talking to the manager and they could approach the manager if they had any issues. The manager said that she held forum meetings with people in the home to get their views with a view to improving the service for people.

People who use the service said they were generally satisfied with the care they receive. One person told us the home was “great”. When asked if she felt that staff knew how to look after her properly she said “some know better than others” but she felt that she and her family had “picked the right place”.

People who use the service said they can generally make decisions and choices about their care. However some people who use the service were unable to tell us if they can make decisions about their care.

Some of the things people said: include “The food is nice”, “There is enough staff around to help out and we’ve been treated well”, “We used the buzzer and they came straight away.”

As part of our review we contacted a number of health and social care agencies who have been involved with Larchfield. We received some positive feedbacks which suggest that the service has improved and the new manager was working well with relevant agencies for continued improvement of the service.