Archived: Arthur House

Arthur House is a residential care home providing personal care to five people who are living with a learning disability at the time of the inspection. The service can support up to six people.

Arthur House also provides a supported living service for six people and in addition offer domiciliary care for people living in their own homes within the community. At the time of the inspection one person was accessing the supported living service who received the regulated activity of personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not consistently receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

At this inspection in October 2019 we found serious concerns about the safety of the residential service. People were at risk of and at times had been subjected to unsafe and inadequate care and support. Risks to people relating to the management of people’s mental healthcare needs were not always identified, recorded and known to staff. The failure to mitigate against known risks had exposed people to actual harm. Staff lacked knowledge of those at risk of ligature and self-harm and measures were not in place to minimise this risk. People did not live in a safe environment. Environmental risks had not been considered that were associated with ligature, self-harm and arson. People were not safeguarded from abuse as allegations of abuse were not always recognised, investigated or referred to external agencies. Systems for the management of people's medicines had not always ensured they were managed correctly

Pre-assessment processes were inadequate and as a result one person was living at the home whose needs could not be met effectively. Staff had not received the training and support they needed to support people effectively. People told us they were supported to prepare food which they enjoyed. People were supported to access health professionals when needed. Professionals told us their recommendations to improve people’s health and well-being were not consistently followed. We saw people were supported to have maximum choice and control of their lives. However, staff did not know how to support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice as staff did not know which people were subject to a Deprivation of Liberty Safeguards.

People did not experience kind and compassionate care as we found numerous examples where people had experienced harm and were exposed to the on-going risk of harm. Although we saw individual staff were caring in their approach, the systems and processes implemented by the provider had not always supported staff to display their caring values. People were not always treated with dignity. People's independence was promoted, and people were supported to maintain friendships and contact with families.

People did not receive responsive care which met their needs. Care plans did not reflect people’s current needs, and they were not an accurate or helpful tool for staff providing care. Staff did not know what people’s needs were and how support should be provided. Relatives and health professionals that provided feedback raised concerns about the responsiveness of the service. There was no evidence that people and their relatives had been actively encouraged to be involved in discussing or reviewing their own care on a regular basis. People told us who they could go to if they wished to complain or share a concern. Relatives told us whilst they knew how and who to complain to their concerns were not always listened to or acted upon. Care records showed that people and their relatives had not been consistently asked about their wishes at the end of their life.

Serious shortfalls identified at this inspection, had not been identified by the provider's quality assurance system. Management staff had not effectively identified and managed risks and incidents, therefore, people were placed at risk of harm. The provider failed to learn lessons to ensure risks associated with individuals were identified, planned for and monitored effectively. The provider had not acted on their duty of candour and shared information where incidents had occurred.

We received positive feedback from the one person and their relatives who used the supported living service in relation to the care and support they received.

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 05 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to keeping people safe, responding to allegations of abuse, staffing and monitoring the care provided at this inspection.

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

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Arthur House is a residential care home providing personal care for up to six people who live with a learning disability. At the time of the inspection four people were living in the home.

Arthur House also provides a supported living service for up to six people and in addition offers domiciliary care for people living in their own homes within the community. At the time of the inspection one person was accessing the supported living and domiciliary service who received the regulated activity of personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, people using the service did not consistently receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

At our last inspection in October 2019 we found serious concerns about the safety of the residential service. People were at risk of and at times had been subjected to unsafe and inadequate care and support. Risks to people relating to the management of people’s mental healthcare needs were not always identified, recorded and known to staff. The failure to mitigate against known risks had exposed people to actual harm. Staff lacked knowledge of those at risk of ligature and self-harm and measures were not in place to minimise this risk. People did not live in a safe environment. Environmental risks associated with ligature, self-harm and arson had not been considered. People were not safeguarded from abuse as allegations of abuse were not always recognised, investigated or referred to external agencies. Systems for the management of people's medicines had not always ensured they were managed correctly.

At this inspection in January 2020 we identified that known risks to two people’s safety had not been adequately assessed and mitigated against. The assessments in place continued to lack robust detail about the risks posed to people and how these should be managed. Practice at the service continued to place people at risk of harm and did not protect them from actual harm. At the time of the inspection we observed enough staff on duty to support people, when necessary. The provider had a safeguarding process in place and had made improvements to ensure safeguarding alerts where escalated to the appropriate authority when necessary. The management of medicines had improved, and further improvements were planned. There had been one serious incident in January 2020, however the provider had learnt from the incident and had put measures into place to reduce the risk of re-occurrence.

The provider had not ensured that their systems and processes were effective in enabling staff to provide safe and good quality care for people. Professionals told us their recommendations to improve people’s health and well-being were not consistently followed. The management arrangements currently in place had demonstrated some improvements and this was reflected by people and staff in their comments. Systems in respect of the monitoring of the service remained in development. The provider sent us additional information following our inspection to demonstrate plans for future monitoring and audit systems.

Members of the management team had not effectively identified and managed risks and incidents, therefore, people had experienced harm and were placed at on-going risk of harm.

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 05 May 2017)

Why we inspected

This focused inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks. In addition, we received a notification of a specific incident. Following which a person using the service self-harmed. The inspection examined the circumstances of the incident. We undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No new 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.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

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

Enforcement

We have identified continued breaches in relation to keeping people safe, and monitoring the care provided at this inspection.

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

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Arthur House provides accommodation for a maximum of six adults who are living with autism and learning difficulties and who require support with personal care. There were four people living at the home at the time of the inspection. Arthur House also provides a supported living service and at the time of the inspection eight people were accessing this service.

There is a registered manager at the service who was present throughout the 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.

People felt safe living at the service. Staff were aware of safeguarding procedures and how to recognise possible signs of abuse. We saw there were sufficient staff available to support people promptly.

People received safe support with their medicines although the management of prescribed creams needed to be improved.

People were happy living at the service and we observed staff supporting people in a kind, respectful manner. People were able to say how they preferred to be supported which was recorded in their care plan. People were encouraged to be as independent as possible in many aspects of their lives.

People were involved in making daily choices about their care and staff told us how they ensured consent was sought from people. Systems in place did not always follow the principles of the Mental Capacity Act (2005).

People were involved in planning and preparing meals of their choice. People had regular access to healthcare professionals to maintain their health.

Staff felt supported in their roles and told us they had received training in areas specific to people’s needs to ensure they supported people safely.

People had the opportunity for daily activities based on their interests. People regularly accessed the local community for activities.

Care was reviewed with people at regular intervals to ensure it continued to meet their needs.

The provider had ensured that there were processes in place for people to raise concerns and complaints. We saw concerns and complaints were responded to in a timely manner.

People and relatives were happy with how the service was managed. We found that improvements had been made following our last inspection and the service had quality monitoring systems in place.