The Larches - Tiverton

At our last inspection, April 2024, the service was rated overall as requires improvement. At this inspection, the overall rating has changed to inadequate. Our assessment was in response to concerns linked to the provider’s poor recruitment practice and the way the home was run.

During this inspection, we identified 6 breaches of regulation in safe care and treatment, safeguarding, staffing, recruitment, dignity and respect and governance. 5 of these breaches were repeated concerns raised at 3 previous CQC inspections starting in 2023. The provider’s governance arrangements were not adequate in ensuring the health, safety and welfare of people.

Previous improvements had not been sustained. There was a lack of learning from events that had put people and/or staff at risk of harm. Known environmental risks were not addressed including an on-going safety issue with the lift, which was in use. There was one functioning shower room in the home; the bath was not accessible to most people.

Recruitment was unsafe, and the provider’s safeguarding processes were poor. Potentially harmful chemicals were not stored securely, and we had concerns about practices to mitigate infection control risks. Medicines were poorly managed.

Incidents and accidents were not recorded in a way which could be easily audited to find patterns and trends. Known risks to people’s health were not consistently monitored and audits failed to identify contradictory information and gaps in recording.

Care records were variable in quality depending on which staff member had completed them and their own knowledge. Staff were hampered by poor oversight of their training, an unstable staff team, at times a lack of effective management and poor support regarding supervisions and appraisals.

A number of experienced and long standing staff had left in a period of over 4 months, including the previous registered manager and the deputy manager. Staff told us they were unsettled and worried. There had been a period when there was no manager or deputy in post and other staff had been given extra tasks and responsibilities without appropriate support.

However, a new manager had started 3 days before our inspection and staff told us they were approachable and reassuring. The new manager was proactive and had begun to review the service improvement plan and address medicine management. They told us they had submitted their CQC application be assessed for the role of registered manager.

The staff group, including non-care staff were committed and showed a genuine fondness for people living at the service and their families. They wanted to do the best they could and worked well with health professionals. They were attentive and knew the people they supported well. Deprivation of Liberty Safeguards (DoLS) were well-managed. DoLS is a legal protection under the Mental Capacity Act 2005 (MCA), to protect the rights of people in care homes who lack the capacity to consent to their care arrangements, and who may be deprived of their liberty as a result. Staff had access to the information they needed to ensure they supported people appropriately in line with the MCA.

Information was not provided in an up to date or accessible manner. The provider did not consult with staff about proposed changes. Goods and agency staff had not been supplied due to unpaid bills.

Staff said they were reluctant to raise concerns with the provider. They did not feel confident they would be treated with compassion and understanding, and were worried they would be blamed, or treated negatively if they did so.

The provider’s monthly audits were poorly completed and did not show a progress of actions. They had chosen to also be the nominated individual; a role which includes oversight of the home and the monitoring of standards.

This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.