Archived: Archers Point Residential Home

People's experience of using this service There were widespread safety concerns that left people at risk of harm. Risks were not always assessed, identified or updated and risk management plans were not always in place to manage risks safely. Care records were not always completed and monitored in line with people’s individual needs. Medicines were not always safely managed. There were not enough housekeeping staff deployed to keep the home clean. There was no fire evacuation strategy in place, staff had not received fire equipment training. Some mobility equipment was not regularly cleaned or maintained. Not all staff training was up to date and staff were not supported through regular supervisions. Governance and audit systems were not effective at identifying and reducing risks to people's safety. There was a lack of effective leadership and oversight of the service. The provider had not implemented improvements required since their last inspection.

People told us they felt safe and that staff were caring. Assessments were carried out prior to people joining the service to ensure their needs could be met. 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 encouraged and supported to eat a healthy and they received a well-balanced diet. People had access to healthcare services when required to maintain good health.

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

Rating:

The last rating of the service was Inadequate (published on 18 February 2022) when we carried out a focused inspection. The service was rated 'Inadequate' and was therefore in special measures. The provider was asked to complete monthly plans and send them to us to address the concerns we found.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection. At this inspection we found the provider remained in breach of regulations.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Archers Point Residential Home on our website at www.cqc.org.uk.

Enforcement:

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.

We identified breaches in relation to risks, medicines management, poor standards of housekeeping and infection control, fire safety, staff training, parts of the premises was unclean and not maintained, and there were no robust systems in place to assess and monitor the quality of the service provided. There was a lack of effective leadership and oversight of the service.

The overall rating for this service is 'Inadequate' and the service therefore continues to be in 'special measures'. This means we will keep the service under review.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority. We will continue to monitor the service and if we receive any concerning information we may inspect sooner.

Archers Point Residential Home is a residential care home that provides accommodation and care for up to 33 older people, some of whom may be living with dementia. There were 21 people using the service at the time of our inspection.

People's experience of using this service Risks were not always assessed, identified, updated and risk management plans were not always in place to manage risks safely. Records were not always completed and monitored in line with people’s individual needs. Medicines were not always safely managed. There were not enough housekeeping staff deployed. The home was dirty, and people were not protected against the risk of infection. Substances hazardous to health (COSHH) namely bleach and antibacterial cleaners were left within people’s reach. There was no fire evacuation equipment or strategy in place. Some equipment was not regularly cleaned or maintained. There were no systems in place to record COVID-19 vaccinations as a condition of deployment in line with government guidance for agency and permanent staff. Safeguarding notifications were not always sent to the local authority or CQC as required. Accidents and incidents were not analysed and learning from this was not disseminated to staff. Not all staff had up to date training in moving and handling people and first aid. There was a lack of activities on offer to stimulate people. There were no effective systems in place to assess and monitor the quality of the service provided.

People told us they felt safe. People told us staff were kind, caring and attentive to their needs. They also said that staff always asked for their consent before supporting them. Assessments were carried out prior to people joining the service to ensure their needs could be met. Staff were supported through supervisions. 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 encouraged and supported to eat a healthy and well-balanced diet. People had access to healthcare services when required to maintain good health.

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 of the service was good (published on 31 January 2017).

At this inspection we found the service had now deteriorated to inadequate.

Why we inspected: We received concerns from the local authority in relation to lack of infection control, people's care needs not being met and lack of governance at the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Archers Point Residential Home on our website at www.cqc.org.uk.

Enforcement: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to risks, medicines management, poor standards of housekeeping and infection control, fire safety, lack of analysis and learning lessons from accidents and incidents. As well as staff training, safeguarding incidents and injuries not being reported, premises being dirty and not maintained, lack of activities, lack of system to record COVID-19 staff vaccinations and no robust systems in place to assess and monitor the quality of the service provided.

Please see the action we have told the provider to take at the end of this report.

Follow up We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 timeframe 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.

¿ The provider had appropriate visiting arrangements in place to help reduce the risk of the spread of COVID-19. Visits were planned in advance. On arrival temperature checks were completed and visitors were screened for symptoms of infection. They accessed the visitors room through a separate entrance and exit to reduce infection risk. Visitors were required to wear personal protective equipment during their visit.

¿ The visitors' room and was arranged to ensure appropriate social distancing with a screen to provide an infection reduction barrier. The room was cleaned between visits.

¿ Staff had received infection control and updated PPE training. They wore appropriate PPE and told us there were sufficient supplies of PPE at all times.

¿ The service was clean and suitable cleaning products were used.

¿ The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing.

Further information is in the detailed findings below.

Archers Point Residential Home is a residential care home that provides accommodation and care for up to 33 older people some of whom may have dementia. There were 29 people using the service at the time of our inspection.

People's experience of using this service People said they felt safe and that their needs were met in a timely manner. Risks were assessed, identified, and risk management plans were in place to manage these safely. Medicines were safely managed, and people were protected against the risk of infection. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Sufficient numbers of suitably skilled staff were deployed to meet people’s needs.

Assessments were carried out prior to people joining the service to ensure their needs could be met. Staff were supported through induction, training and supervisions. 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 encouraged and supported to eat a healthy and well-balanced diet. People had access to healthcare services when required to maintain good health.

People told us staff were kind, caring and attentive to their needs They also said that staff respected their privacy, dignity and always asked for their consent before supporting them. People’s independence was promoted whenever possible. Information was available to people in a range of formats to meet their individual communication needs if required. There was an effective system in place to respond to complaints in timely manner. Staff understood the Equality Act and supported people without discrimination.

People were supported to maintain relationships with those that were important to them and participated in activities that interested or stimulated them. The service was not currently supporting people who were considered end of life, but if they did relevant information would be recorded in their care plans. There were effective systems in place to assess and monitor the quality of the service provided. The provider worked in partnership with key organisations to ensure people's individual needs were planned and met.

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 of the service was good (published on 31 January 2017)

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 any concerning information is received, we may inspect sooner.

At this inspection on 14 December 2016 we checked that the action plan had been completed and the breaches identified at the last inspection had been addressed. Improvements had been made in relation to management of medicines and records. Medicine Administration Records (MAR) charts were completed in full, the controlled drugs record book had been completed and countersigned by a second signatory as required. DoLS authorisations had been obtained in accordance with the MCA 2005 and incidents had been notified to the CQC without delay.

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.

Safeguarding adult's procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Risks to people using the service were assessed and risk assessments and care plans provided clear information and guidance for staff. Medicines were stored, administered and recorded appropriately.

There were enough staff to meet people's needs. The provider conducted appropriate recruitment checks before staff started work.

Staff received adequate training and support to carry out their roles and staff training was up to date. Staff received regular supervisions and annual appraisals. There were processes in place to ensure staff new to the service were inducted into the service appropriately.

The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA). Staff asked people for their consent before they provided care.

People were protected from the risk of poor nutrition and had access to a range of healthcare professionals in order to maintain good health.

People were treated with kindness and compassion and people's privacy and dignity and confidentiality was respected. People were supported to be independent where possible such as attending to some aspects of their own personal care.

Staff were knowledgeable about people's individual needs. People's cultural needs and religious beliefs were recorded to ensure that staff took account of people's needs and wishes.

People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. Care plans and risk assessments provided clear information for staff on how to support people using the service with their needs. Care plans were reflective of people's individual care needs and preferences and were reviewed on a regular basis.

People knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

There were effective processes in place to monitor the quality and safety of the service and the registered manager recognised the importance of regularly monitoring the quality of the service provided.

Regular staff meetings took place and people were provided with opportunities to provide feedback about the service. People and staff told us they thought the service was well run and that the registered manager was supportive.

We took enforcement action and served four warning notices on the provider as they had failed to comply with Regulations 9,10,12, and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also issued a compliance action in respect of Regulation 18 of the Health and Social Care Act. We also referred this to the local authority safeguarding and commissioning teams.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notices and compliance action. The inspection team who carried out this inspection consisted of two adult social care inspectors. On the day of the inspection there were 22 people using the service. During the inspection, the team worked together to answer four of our five key questions; Is the service caring? Is the service responsive? Is the service safe? 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 seven people using the service, three relatives, seven of the care staff, the provider, registered manager and head of care. We used our short observational frame work for inspectors (SOFI) to give us information about the care of people who were not able to express themselves. We observed interactions between staff and people using the service in the communal areas throughout the day. We looked at 10 care plans and other records related to the service such as staff duty rosters, cleaning schedules and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People we spoke with said that they were well cared for. One person told us 'It is marvellous here; they have made me feel very comfortable.' Another person said 'The staff are very nice and I am well looked after.' Relatives we spoke with were mostly positive about the service. One person said 'I just can't fault it, there is kindness and care. I have never needed to complain.'

We observed staff to interact in a positive way with people and their visitors. They spoke kindly with people and engaged with them at times during the day. Staff checked for people's consent before delivering care.

There were now more accurate records of people's preferences for their care. People's consent to care was recorded and there was an assessment to consider if they had the capacity to make certain decisions for themselves. There were some mechanisms in place to ascertain the views of people who used the service although there was no evidence that these were actioned or taken into account.

Is the service safe?

People did not always receive the appropriate care to meet their needs. Most but not all risk assessments we looked at had been reviewed.CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. We found that the provider did not always follow the Mental Capacity Act (2005) code of practice and was unaware of recent changes to their responsibilities in relation to the act.

We found the environment was cleaner throughout and more hygienic; the smell was much improved although there was still some odour in the hallway and some bedrooms.

There were sufficient levels of staff employed at the service. New permanent staff had been employed and the provider now used agency staff at night or in the day to cover any last minute gaps due to leave or sickness.

Is the service responsive?

Care plans were improved and more accurately reflected people's current needs. Although this work was not yet fully completed. There was evidence of people's or their relative's involvement in their care.

People were supported to maintain their relationships with family and friends. We observed that people were provided with some activities to stimulate them.

People we spoke with told us they had not needed to raise a complaint. They knew how to raise informal complaints and were aware there was a complaints policy. The complaints policy was not very visible for people at the service or their visitors. The policy on display differed from that in the service user guide but neither were accurate in terms of what steps to take if someone was unhappy with the provider's response.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with six people using the service, a relative, six of the care staff supporting them, a cook and kitchen assistant, the provider partners one of whom was also the registered manager and head of care. We talked with four professionals who visited the service on the day of the inspection. We used our short observational frame work for inspectors (SOFI) to give us information about the care of people who were not able to express themselves. We also looked at ten care plans and other records related to the service such as staff duty rosters, cleaning schedules and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People we spoke with said that they were well looked after. One person told us 'It's very good here I have no complaints.' Another person told us 'The staff are good as far as it goes.' We spoke with a visitor to the service who told us they came most days. They said 'I come most days at different times and the staff here are very good. They are always smiling and happy. [My relative] is always clean and tidy and their health has improved and they have put on weight. I have peace of mind now.' We observed staff to speak kindly with people and most of the time they checked for their consent before delivering care.

There were some records related to people's preferences for their care. However, people's consent to care was not always recorded and there had not always been an assessment to consider if they had the capacity to make certain decisions for themselves. Information from other professionals was not always accurately recorded and where it had been recorded it was not incorporated into the care plan.

People told us they enjoyed the food and we saw they were provided with adequate nutrition. The service had scored the top rating of 5 on the 'Scores for the Doors' assessment at the last visit by Environmental Health on 29 November 2013.

People were able to see a health professional when necessary. Care plans were not always up to date and did not always reflect people's current needs. Risk assessments had been completed but not always regularly reviewed and where they had been completed and risks identified a care plan was not always in place.

Is the service safe?

People did not always receive the appropriate care to meet their needs. For example people identified as at high risk of falls did not have a plan in place to reduce this risk. People with pressure areas were at risk of receiving incorrect care and treatment as their care plans did not detail what care was needed to meet those needs or did not identify where the pressure area was. There was no analysis of a high number of accidents and incidents that had taken place in the first six months of this year.

We found the environment was not clean and hygienic. There was a strong smell of urine and faeces in the communal areas for much of the day. While we saw some cleaning being done by the family member of the provider who was we understand normally employed in a financial/maintenance role. We observed that the toilets were in an unclean state for much of the morning. The cleaning schedule had not been completed since the end of May as the cleaner was on leave. There was evidence that some cleaning tasks were not regularly undertaken and there were inadequate processes in place to reduce the risk of infection.

The service had a contingency plan for emergencies but lacked evacuation plans for all individuals in need of assistance. We found that adequate checks were being made on equipment at the service. Staff were being provided with essential training for their roles but there were insufficient numbers of staff on duty on some shifts according to the providers agreed staffing levels to meet people's needs adequately and safely.

Is the service responsive?

Records confirmed some people's preferences and diverse needs had been recorded and care and support was provided that met their wishes. People were supported to maintain their relationships with family and friends. There was no keyworker system in operation for people to discuss any important issues with a specific member of staff.

There was no evidence that regular meetings with people who used the service were held or that formal reviews of their care plan took place involving them or their family members. The service did not actively seek out the views of the people who used it. The complaints policy was available but or their visitors but the provider's complaint investigation tool was not being used to record any response.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. People received sufficient amounts of food and drink. We saw that people were referred appropriately to health care professionals when this was needed but instructions they gave were not always adequately recorded. Staff were provided with opportunities to complete and refresh essential training.

The service carried out an annual survey with people at the service and their relatives. However no action plan was in place to address the findings from the last survey. There was no evidence therefore that responses were being used to inform improvements.

While some audits were carried out these were limited in nature to health and safety checks and medication audits. There was no system in place to highlight inadequacies in several areas such as gaps in important areas of people's care plans, cleaning records or hygiene records.

Is the service well led?

The day to day management of the home was undertaken by the head of care. The registered manager was present on the day of the inspection but left the head of care with responsibility for the inspection.

We identified concerns across several areas of care at the inspection which had not been identified by the registered manager or provider. Or where they had, for example, the inadequate staffing levels, they had not been addressed. We found that regular staff meetings to help improve the consistency and level of care throughout the service were taking place quarterly. But seniors meetings were due to be held to provide over sight and effective management of the service on a six monthly basis. We found there had only been one seniors meeting held In November 2013 since the head of care started at the service in 2012.

At our last inspection of January 2013 we had raised concerns with the way people's care was delivered, lack of appropriate infection control practices, staff's understanding of safeguarding of vulnerable adults and staff training and supervision.

At our inspection of May 2013 we found that people received suitable care based on an assessment of their needs. Staff received regular training and supervision and improvements had been made in the cleanliness of the environment and in the infection control practices. However, although people's care plans had appropriate risk assessments and reflected people's needs, not all information was suitably and correctly recorded.

We found that the people who used the service and their relatives were involved in their care planning and received personalised care and support which was based on an assessment of their needs. Medicines were mostly managed appropriately and care records were accurate. However, we also found on the day of the inspection staff not following suitable infection control practices and appropriate moving and handling of people which meant that they had not received suitable training and support in some aspects of care delivery. Some staff could not demonstrate an understanding of safeguarding of vulnerable adults and important policies related to safeguarding and whistle blowing had not been updated and did not reflect current guidelines.