Arundel House

Arundel House is a residential care home providing accommodation and support for people who require personal care and are living with mental health needs. One person had a learning disability. It is a large Victorian property spread over 3 floors and has some outside space which is available for people to use. Most people shared communal bathrooms though some people had their own bathroom. There was a communal lounge and separate dining room. The service provides support for up to 15 people. At the time of our inspection there were 13 people using the service.

People’s experience of using this service and what we found

People were not always kept safe from risks associated with fire.

We were not assured the provider was promoting safety through the hygiene practices for the premises or ensuring infection outbreaks would be effectively prevented or managed.

Risks were not always identified and managed, meaning people were potentially at risk of harm. There was a lack of good governance and oversight of the service. Staff appeared to understand and meet people’s needs and preferences, however, they had not received training about some people’s needs, for example, epilepsy, and learning disability.

Medicines were managed safely despite a lack of audits.

The home facilitated visits from family members and relatives told us staff were welcoming, friendly and helpful.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service were not always in place to support this practice.

People and relatives told us they thought the service was well led, and that they (or their relatives) felt people received safe care and were happy living there.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

We have made a recommendation about ongoing DBS (Disclosure and Barring Service) checks in staff recruitment.

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

Rating at last inspection

The last rating for this service was good (published 31 December 2019).

Why we inspected

We received concerns in relation to people’s safety and how well the service was managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. As a result of what we found during our site visit, we opened up the inspection to review the key question of effective as well.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

On our first day of inspection, we asked the provider to carry out some urgent actions to ensure people’s safety, for example, removing broken glass from a person’s bedroom and boarding the window safely. They took some action that day to start making improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arundel House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the provision of safe care and treatment, adherence to the Mental Capacity Act, and the governance of the service at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arundel House residential care home providing personal care and support to people living with Mental health needs. There were 15 people living at Arundel at the time of the inspection. The service can support up to 18 people.

Arundel House is a large Victorian property with accommodation over three floors. The building has been adapted to meet people’s needs such as having stair lifts, grab rails and walk in shower room.

People’s experience of using this service and what we found

People said they were well treated by a staff team who understood their needs and respected their wishes. Comments included “I feel safe yeah, very safe, a lot safer than in the flat it was damp there” (this was previous accommodation).

People’s care and support was well planned. This was because a preadmission assessment was completed looking at all aspects of a person’s care. The service worked in conjunction with other professional to ensure the best outcomes for people. This included mental health workers, GPs and consultants.

Staff were vigilant in respect of monitoring people’s healthcare needs. This was both in respect of the physical and emotional well-being. Staff advocated for people to get the right support and treatment when needed. For example, one person had an issue with their foot. Staff they were unable to get them a GP appointment so took the person to the emergency department of the hospital. This was the right decision as the person needed urgent treatment and an operation. One healthcare professional confirmed staff were highly responsive to people’s needs and wishes. They said the service worked in a way which promoted their independence but also monitored when a person was unwell and may need more support with their mental health.

There were sufficient staff with the right skills to meet people’s needs. Staff had the right training and support to do their job effectively. Recruitment practices were robust to ensure only staff who were suitable to work with people who may be vulnerable were employed.

People dignity, choice and privacy was fully respected. Staff knew people, their needs wishes and preferred routines well. There were clearly good bonds between staff and the people who loved at Arundel House. Staff were kind, compassionate and spoke about the achievements of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain a healthy diet with choice and variety of melas being offered.

There were systems and audits to ensure records, care and the environment was well maintained.

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

Rating at last inspection- The last rating for this service was Good (published xx).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At the last inspection on 23 March, 2015 the service was rated Good.

At this inspection on 21 April, 2017, we found the service remained Good.

People felt safe and cared for in the home. There was a homely, welcoming atmosphere with laughter and chatter. Staff were very clear it is the person’s home and they respected this. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People chose how they wished to spend their days based on their preferences and staff always respected this. Staff treated people with respect and dignity at all times and positive interactions had been developed. People were encouraged to maintain their independence.

People were supported by sufficient numbers of skilled, knowledgeable and trained staff who were safely recruited. Staff felt supported in their roles, received regular supervision and felt listened to. They enjoyed their work and put residents first.

Each person had an assessment, support plan and risk assessments in place. These were monitored and reviewed regularly. Staff had good working relationships with local health and social care professionals. Advice was sought when necessary and their advice acted upon.

People were protected from the risk of abuse as staff understood and knew what to do if they had concerns. People received their medicines safely and on time.

People were supported to have a balanced and varied diet which included their personal food choices. People were able to help themselves to drinks and snacks throughout the day.

People enjoyed individual activities and hobbies suitable to their needs and wishes both in the home and in the local community. People were enthusiastic about choosing a suitable pet for the home.

People knew how to make a complaint and who to address their concerns to. All complaints were investigated appropriately. The service had a suggestion box which people and visitors used regularly. Any comments were acted upon. Regular feedback was sought from people and staff through meetings and surveys.

There was a strong management team who knew people and staff well. Staff felt part of the team.

There were quality assurance systems in place to monitor the service and regular checks took place. Not all the information legally required had always been sent to the Care Quality Commission.

Some of the areas of the home were in the process of being decorated and painted. Other areas had also been highlighted as in need of updating.

Further information is in the detailed findings.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. The systems in place for safeguarding people were not fully robust. Some staff understood their role in safeguarding the people they supported. The management team were not fully aware of the correct safeguarding reporting procedures and the correct action to take which meant that some people were put at risk.

There was no system in place to ensure that the manager and staff learnt from events such as accidents, incidents, complaints and concerns. This increased the risk of harm to people and failed to ensure that lessons are learnt from mistakes.

The manager completed the staff rotas, which took into account people's support needs when making decisions about the numbers, qualifications, skills and experience required. The manager had highlighted any shortfalls in staff provision. This helps to ensure that people's needs are always met.

Systems for the safe administration of all medicines were not in place. This puts people at unnecessary risk of harm of receiving the incorrect medicine at incorrect times.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding, handling of medicines, complaints investigations and learning from incidents and accidents

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Staff had an understanding of when an application should be made and how to submit one.

Is the service effective?

People told us they were happy with the care/support they received and felt their needs had been met. People told us "they look after you properly" and "feel well looked after".

People's health, care and support needs were assessed but they were not always involved in reviewing their care/support plans.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff interacted well and showed patience when supporting people. People were complimentary of the staff and told us "there's enough staff on duty" and "it's difficult for staff but they do a good job". Relatives had commented about the service "X is being looked after with such kindness and dignity" and "staff get to know X".

Is the service responsive?

People's needs had been assessed before they moved into the home. Records showed that people's preferences, choices and needs had been recorded and support plans had been provided that met their needs. People had access to activities that were important to them and these were undertaken in the local community.

The service involved outside agencies when necessary to make sure people received appropriate care.

Is the service well-led?

The service did not have a quality assurance system in place. Records seen by us, for example those relating to medication administration, showed that shortfalls had not been identified and addressed. People were not regularly asked for their feedback on the service or treatment they received.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to quality assurance.

We visited the service on the 24 January 2014 to review some of the care plans and risk assessments to check compliance had been achieved. We looked at four care plans and care files. We saw they had been updated and reviewed with the individual concerned. We also saw the manager had implemented a system for regular reviewing for care files to ensure they remained accurate and up to date. We concluded the records were now accurate and fit for purpose. This helped to protect people using the service as it meant staff had the right information available to plan and deliver care and support.

People told us they felt ''safe, comfortable and well cared for.'' One person who was newer to the service was able to explain how they had come to visit prior to moving in and another person told us ''The staff here couldn't be kinder. We have had a lot of staff changes so I am getting used to the new ones, but they seem very nice.''

We saw daily records gave a good overview of how staff monitored people's physical and emotional well being, however we found improvements were needed in ensuring the care planning process was kept up to date.

The home had good systems in place for the safe recording, storing and administering of medications. People told us they received their medications on time. We saw staff liaised with community psychiatric nurses and doctors where medications needed to be reviewed.

There was a formal complaints process in place, people were given opportunities to voice their opinions, suggestions and concerns via house meetings and in one to one discussions with their key worker.

We found that people's care was being well planned. People were involved in making decisions about their care and treatment. People we spoke with said that they were happy with their care and support. Comments included 'When staff know I am upset, they talk to me. They are very good, they know me well.' Another person said 'we are very well cared for.'

We saw that the service ensured that any new staff had the right checks in place to ensure they were fit to work with vulnerable people, before they commenced employment.

We saw that the home was clean and infection control was taken seriously.

The home had developed systems and checks to ensure that they reviewed and monitored the quality of care provided. This included involving and listening to people who lived at the home as well as staff.