About the service: Larkhill hall is a care home providing personal care. It can accommodate 66 older people. The accommodation is a purpose built three storey residential care home in North Liverpool. Some people using the service are living with dementia. At the time of the inspection 65 people were living at the home.

People’s experience of using this service: People told us they felt safe living in the home due to the support they received from staff. Staff understood the risks to people and the measures were in place to keep them safe. Safeguarding procedures were followed and incidents were raised with the appropriate professionals.

Some care plans lacked detail. We did see other care plans that were very detailed and supported staff in providing person centred care. The registered manager had reviewed care plans for the second day of inspection.

There were some inconsistencies with record keeping. We saw the amount of fluids people had been offered and drank wasn’t always accurately recorded.

Staff were supported in their role and had access to relevant training to help ensure they had the necessary skills to meet people's needs.

People’s medicines were managed safely. Improvements had been made to medicines audits since the last inspection.

Measures were in place to reduce the risks associated with the spread of infection. We found the home to be clean and well maintained. Environmental risks were assessed and well managed to prevent any harm to people.

Sufficient numbers of staff were employed to meet people’s needs. Staff were caring and always promoted people’s dignity and independence.

A system was in place to monitor applications and authorisations to deprive people of their liberty and any conditions attached to them. Consent to care and treatment was sought and recorded in line with the principles of the Mental Capacity Act. Staff supported people in the least restrictive way possible.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people's dietary needs and people told us they enjoyed the food available to them. People could enjoy snacks throughout the day, and were able to choose alternative meals if they did not like what was on the menu.

People were given the opportunity to have interesting and fun activities to do.

Staff worked with other health professionals to ensure people’s health outcomes were met.

The registered manager notified CQC about some important events which happened at the home, so they could be sure they were consistently meeting their legal obligations.

Staff understood their role and had confidence in the manager. Staff told us they worked well together as a team, and there was good morale amongst them. People, staff and relatives were highly complimentary about the managers. We were told the management team were approachable and responsive to any issues. Systems were in place to gather feedback from people.

There was good oversight from the provider and the registered manager was well supported.

People told us they would recommend the home to others.

Rating at last inspection: Requires improvement (Report published 28 March 2018).

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 30 January and 7 February 2018 and was unannounced.

When we conducted a previous inspection on 14 and 15 March 2017, the service was rated Requires Improvement with breaches of regulations in relation to; need for consent, safe care and treatment, good governance and staff support. This is the second consecutive time the service has been rated Requires Improvement. Following the last inspection we asked the provider to complete an action plan to show what they would do to address the issues identified.

During this inspection we looked to see whether improvements had been made to ensure that the provider was meeting the fundamental standards of care. We found that the service had made significant improvements to address the issues found in the last inspection and had met some breaches of the regulations.

Larkhill Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home is a purpose built three storey residential care home in north Liverpool, providing specialist services for up to 66 people living with dementia. During the inspection, there were 60 people living in the home.

A manager was in place and were applying to be registered with us at the time of our inspection. 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.

We observed a member of staff while they administered some medicines. We also checked records, storage arrangements, stocks and audits - We found that medicines were not always managed safely.

We checked for risks to people regarding the environment and equipment and found whilst safety checks were completed regularly, risk was not always identified and minimised effectively.

The provider remained in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment.

During the last inspection it was identified that whilst systems and processes were in place to monitor the quality and safety of the service actions had not been taken to address all the concerns raised. During this inspection we saw evidence that improvements had been made in the monitoring of the quality and safety of the service, however some areas were still not being monitored effectively.

From the improvements that were made we found the provider was no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014;Good Governance.

During the inspection we recommended that the manager delegate tasks within the management team to allow the manager to effectively address the issues highlighted in relation to quality assurance audits to improve the systems currently in place.

We checked four staff recruitment files and found they reflected safe recruitment processes.

Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. Staff had received appropriate training in safeguarding and were able to explain how to keep people safe from abuse - Staff were also aware of the whistleblowing policy.

Individual risks to people living in the home were accurately assessed and reviewed regularly with measures in place to reduce the risk in order to keep people safe.

Staff had received training in areas such as infection control, health and safety and manual handling.

Accidents and incidents were reported and recorded. They showed evidence of analysis, review and action taken where needed.

Peo

This inspection took place on 14 and 15 March 2017 and was unannounced.

Larkhill Hall is a purpose built three storey residential care home in north Liverpool, providing specialist services for up to 66 people living with dementia. During the inspection, there were 64 people living in the home.

There was no registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had commenced in post in September 2016 and was in the process of registering with CQC.

Records showed that not all staff had completed recent training in relation to safe medicine administration and not all staff had had their competency assessed each year. Since the inspection the manager has confirmed that all staff who administer medicines has had a competency assessment completed.

We found that medicines were not always stored safely. Medicines were stored in two clinic rooms within the home; however they were not always secure. We observed one clinic room door to be unlocked during the inspection and on another floor, we observed keys to the clinic room to be left unattended in a dining room. We found that records regarding administration of medicines were not always accurate and there were gaps in the recording of medicines that had been administered.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety. Most were completed accurately and reviewed regularly. We found however, that not all assessments reflected people’s needs accurately.

We looked at the environment and found that risks to people were not always minimised. For instance, we observed unlocked bathroom cupboards which contained creams and razors. The manager rectified these issues straight away. A fire risk assessment of the building was in place and regular internal checks of the environment were completed, as well as external contracts to ensure the building was properly maintained.

People told us they felt safe living in Larkhill Hall and their relatives agreed. Staff were aware of safeguarding procedures and how to report any concerns they had.

We looked at how the home was staffed. Prior to the inspection we had received concerns regarding staffing levels within the home. We had written to the provider regarding this and they told us a number of new staff were being recruited. We found that a number of care staff had commenced earlier in the week and were now in post. Our observations showed us that there were sufficient staff on duty and people we spoke with agreed.

We found that safe recruitment procedures were followed.

Records showed that applications to deprive people of their liberty had been made appropriately.

The principles of the Mental Capacity Act were not always adhered to when seeking and recording people’s consent to their care and treatment. For example, one person's care file contained consent that was signed for by a relative who did not have the legal authority to provide consent on the person's behalf and there was also no evidence that the person lacked capacity to consent themselves.

Staff were provided with an induction that reflected the requirements of the care certificate when they started in post. All of the staff we spoke with told us they received regular supervision and records we viewed reflected this. There was however, no evidence that annual appraisals had taken place for all staff, although the manager had taken steps to address this. Training records showed that staff had completed training in a variety of areas, however not all staff had completed training that the provider considered mandatory, such as safeguarding.

A fire risk assessment dated