Archived: Reach Care Services - Arden House

Reach Care Services – Arden House is a residential care home providing personal care up to a maximum of 24 people. The service provides support to older people, people living with dementia and people who have a physical disability. At the time of our inspection there were 17 people using the service.

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

The service was not well-led, and a closed culture was present. Safe and effective governance systems were not in place which meant people were at risk of harm. The provider did not have robust oversight, and when concerns were raised, they did not appropriately respond to promote safety and improve care.

Staffing levels were not safely assessed and reviewed. There were not enough appropriately trained staff to meet peoples’ needs. Lessons were not learnt when things went wrong, and people were not protected from harm. Safety risks were not appropriately identified, reviewed and acted upon by staff, and oversight was not effective. Medicines were not managed safely, and risks relating to infection prevention and control were present.

People were at risk of dehydration and malnourishment and were not actively involved in their care planning and reviews. People’s representatives and health professionals were not able to freely visit and faced restrictions from staff. Staff undertook tasks which were outside of their scope of competence which placed people at risk of harm. The provider had failed to appropriately supervise their staff, and staff had not received effective training to keep people safe.

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

Staff did not treat people with dignity and respect. Kind and considerate care was not promoted in practice. People were not treated as individuals and their rights were not upheld.

People, or their representatives if appropriate, were not supported to be involved in the care planning process. Responsive care planning did not take place for people who experienced changing needs or health deterioration. Meaningful social opportunities, engagement and activities were limited, and people were at risk of social isolation.

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 2 May 2019).

At this inspection we found the service had deteriorated and the rating has changed to inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about safe care and treatment; safeguarding; staffing; person-centred care; privacy and dignity and good governance. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these and other concerns.

Please see the safe, effective, caring, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to safeguarding people from abuse; safe care and treatment; staffing; premises and equipment; nutrition and hydration; person-centred care; dignity and respect and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ There were various processes in place to support safe visiting. These included a purpose-built screened pod which could be booked in advance. All visitors to the home were required to complete a health questionnaire, a COVID-19 lateral flow test and have their temperature taken.

¿ Staff wore personal protection equipment (PPE) including a face mask, apron and gloves and these items were also available for visitors to wear during all visits. Time was scheduled between each visit to allow for cleaning of the screening pod and visiting area. Window visits, use of computer tablets, video calls and telephone calls were also promoted to support people’s well-being.

¿ Seating in the communal areas had been placed with consideration of spacing between chairs to promote social distancing.

¿ Internal training had been provided to staff including how to wear and how to put on and take off PPE safely. The registered manager also completed competency checks of staff ensuring they demonstrated safe practise and use of equipment whilst at work.

¿ New admissions and those who attended external appointments were asked to isolate for 14 days in their room as a precautionary measure.

People’s experience of using this service:

• People showed they were happy living at Reach Home Care – Arden House. One person said, “I’ve only got nice things to say about this place. It’s perfect, absolutely nothing wrong with it at all.”

• Staff were very kind, caring and compassionate and knew each person well. They enjoyed working at the home and praised the registered manager for her kindness and support. One member of staff said, “At the end of the day we’re here for the residents. As long as they’re happy.”

• The provider had systems in place to manage risks and keep people safe from avoidable harm. Staff followed good practice guidelines to prevent the spread of infection and gave people their medicines safely.

• There were enough staff on duty to meet people’s physical care needs and to spend time with people, chatting and making sure they were comfortable.

• Staff received training, supervision, guidance and support so that they could do their job well. They worked well as a team.

• People made decisions in all aspects of their lives. 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.

• People were involved in deciding on the care they wanted. Their preference for how staff delivered their care was recorded in their care plans.

• Reach Home Care – Arden House was people’s home and staff did everything they could to make people’s lives as comfortable and fulfilling as possible.

• The home was very well managed by a registered manager who was passionate about giving people a high-quality, personalised service.

Rating at last inspection: At the last inspection we rated this service Good (report published on 28 September 2016).

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

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 we receive any concerning information we might inspect sooner.

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

Reach Home Care- Arden House provides care and support for up to 13 people who are physically and mentally frail; some of whom may be living with dementia. There were 13 people living at the service when we visited.

The service has a registered manager. 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.

People felt safe living at the service. Staff were aware of the processes in place to report incidents of abuse; and had been provided with training on how to keep people safe from abuse and harm. Processes were in place to manage identifiable risks and to promote people’s independence and safety. The service’s recruitment procedure was robust to ensure that staff were suitable and fit to be employed. Systems were in place to ensure people’s medicines were managed safely and given at the prescribed times.

Staff were provided with induction and essential training to keep their knowledge and skills up to date. They had regular one to one meetings to support them in their roles. People’s consent to care and support was sought before any care was provided. This was in line with the requirements of the Mental Capacity Act (MCA) 2005. People were supported with food and drinks to maintain a balanced diet. When needed, staff supported people to access health care facilities.

People had developed good relationships with the staff team who treated them with kindness and compassion. Systems were in place to ensure that their views were listened to; and their privacy and dignity was upheld.

Before coming to live at the service people’s needs were assessed. This was to ensure that the care provided would be responsive to their needs. The service had a complaints procedure which was accessible to people and their relatives.

There was a positive, open, inclusive and transparent culture at the service. Staff supported people to maintain links with the local community. There was a quality assurance system in place to monitor the care provided and to drive continuous improvements.