Archived: Arundel House - Paignton

We found the following examples of good practice.

Robust systems were in place to help manage the risks and prevent the spread of COVID-19.

Visitors to the service had been restricted. There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. Instructions were easily accessible on arrival at the service to ensure visitors understood the infection prevention and control protocols they needed to follow to keep people safe.

Visitors to the service were asked to wear PPE, have their temperature checked, wash their hands and use the hand sanitiser provided, before they would be allowed to enter the main part of the building.

People were encouraged and supported to maintain contact with their relatives through use of mobile phones and video calls.

Staff had received additional training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser. There were sufficient stocks available and staff were seen to be wearing PPE appropriately.

The provider had converted one bedroom to a staff room to ensure staff could change their uniforms at the start and end of their shift.

People and staff took part in regular COVID-19 "whole home" testing. People and staff who tested positive followed national guidance and self-isolated for the required amount of time.

Staff helped people to socially distance by spacing out tables and chairs in communal areas. People were given their own PPE and hand gel to use if they wished and staff supported people with their hand hygiene.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches. A daily Covid 19 compliance check for had been introduced to ensure all required actions were being completed.

The management team had been open and transparent and worked closely with the Local Authority and infection prevention and control teams throughout the outbreak. All practice and procedures had been reviewed, updated and where necessary, changed in line with the latest guidance.

We were assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

Arundel House is a residential care home providing personal care for up to 12 adults who have learning difficulties and/or a physical disability. At the time of the inspection there were nine people living at the home.

The service has been developed 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 receive planned and coordinated person-centred support that is appropriate and inclusive for them.

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

People were supported by staff who had relevant training, skills and experience to understand the needs of the people they were supporting. Since the last inspection the provider had introduced a fully comprehensive induction training programme that all new staff completed within the first week of their employment.

Improvements had been made to the provider's quality assurance system to effectively identify any shortfalls. There was a variety of audits completed to ensure the quality of the service provision was maintained.

We were assured the service were following safe infection prevention and control procedures to keep people safe.

There was an open and transparent person-centred culture within the service. Staff were clear about their responsibilities told us they felt well supported, appreciated and valued.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff closely monitored people's health and supported them to access appropriate healthcare services. Staff followed professional advice and helped people to improve their health and wellbeing. People's dietary needs were catered for and people told us they enjoyed the food.

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 requires improvement (published 21 August 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 14 and 17 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance and staffing training.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions 'Effective' and 'Well-led' which contain those requirements.

As part of this inspection we also looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. 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 Arundel House - Paignton on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service and take any necessary regulatory action, this may include carrying out another inspection of the service.

Arundel House is a care home providing personal care for up to 12 adults who may have learning difficulties and/or a physical disability. At the time of the inspection there were 11 people living at the home.

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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Eleven people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People and their relatives were positive about the service. A person said, "I like it here." A relative told us, “The staff are exceptional. [Relative’s name] calls it home and that says a lot.”

Staff, new to the service, completed an induction. However, we found the induction process did not provide staff with the necessary training to meet people's needs and keep them safe. This was immediately addressed, and a full induction training programme was purchased by the provider ensuring new staff would receive training in subjects considered as essential for the role.

People were supported by enough staff, however, people had mixed views on the staffing levels. Some people told us the service was short staffed. We discussed these comments with the management team who told us this was due to a temporary reduction in their staffing levels which would be resolved in a matter of weeks. Prior to this, people were happy with the staffing levels and were having all their needs met. When the situation was resolved, people would receive the same level of support again.

There was an open and transparent culture within the service. Quality assurance and governance systems were in place to assess, monitor, and improve the quality and safety of the services provided. However, systems and processes had not been fully effective to ensure staff had been provided with the necessary training to keep people safe.

People told us they felt safe living at Arundel Hose. People looked comfortable with staff and staff were friendly, respectful and attentive to people's needs. People who could not tell us, showed in their expressions and behaviours, they enjoyed the company of staff. Staff respected people's privacy and protected their dignity.

There were appropriate systems in place to protect people from the risk of abuse. Staff knew how to safeguard people and were confident to raise any concerns. The provider had effective systems in place to ensure safe recruitment practices.

Risks to people were well known and there were robust assessments to address concerns. People received personalised support centred around their support needs, preferences and choices. This was regularly reviewed with people, their relatives and professionals.

People received the support they needed to stay healthy and to access healthcare services. People's nutritional needs were consistently met, and guidance given by professionals followed by staff. People were offered choices at mealtimes and supported with a specialist diet where appropriate.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People living at Arundel House participated in activities and were actively involved in their local community.

People knew how to complain, and any complaints had been resolved to people's satisfaction. People were asked their opinions on the service by attending meetings and completing surveys and suggestions had been acted upon.

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 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. Please see the ‘action we have told the provider to take’ section towards the end of the report.

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 may inspect sooner.

Arundel House provides accommodation and care for up to twelve people. People living at the home have a learning disability. On the day of our inspection, twelve people were living at the home. People have their own bedrooms, some with their own lounge areas. Some bedrooms had en-suite facilities. Communal space consisted of a large lounge area, kitchen and dining room.

The home was managed by the registered manager who was also the registered provider. 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 and associated Regulations about how the service is run.

There was a warm, friendly, family style atmosphere in the home and people were relaxed and comfortable in the company of staff. The home was well decorated and adapted to meet people's needs. The home had a homely feel and reflected the interests and lives of the people who lived there, with photos of people and staff.

The focus of the home was on promoting people's rights and independence so that people live fulfilling lives. People followed activities they enjoyed and were given opportunities to gain new skills and to increase their independence. Support was planned and provided to take account of each person's needs, interests and preferences. People received personalised care that took account of their abilities and needs.

We saw people had a good relationship with staff. Key workers worked closely with people to help build a rapport, and supported people to contribute to their care plans. Care plans were comprehensive and contained detail specific to each person, showing how their care and support should be delivered according to their preferences. We saw care plan information was available in different formats appropriate to the needs and preferences of people who lived in the home.

People were supported by staff who knew how to recognise and respond to abuse and systems were in place to minimise the risk of harm. Risks associated with people's care and support were effectively assessed and managed.

Staff were competent and skilled and had a good understanding of people's individual needs and preferences. Staff had developed warm and caring relationships with people living in the home. They treated people with respect for their dignity and privacy and promoted their independence.

There were sufficient numbers of staff available to meet people's needs. Safe recruitment practices were followed and staff were provided with regular supervision and support.

People were supported to make informed decisions and where a person lacked capacity to make certain decisions they were protected under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported in the least restrictive way possible and staff were insightful about how to support people who presented behaviours which may challenge others.

Support was provided to enable people to have a balanced diet and to have enough to eat and drink.

People and staff planned weekly menus together and pictures of food or meals were used to support some people's understanding and to help them make choices.

People were supported to access a range of healthcare services to promote their health and in response to any changes in their health. These included GP's, dentists, opticians and hospital specialists.

There were effective systems in place for monitoring the safety and quality of the service. Audits viewed had identified any areas which were in need of improvement and action was taken to address these shortfalls.

Complaints were encouraged, investigated and responded to in good time. People we spoke with were aware of how to raise concerns, should they need to do so. Systems were in place to ensure that any complaints received were responded to in a timely manner and a thorough investigation was conducted.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire. A range of internal checks were conducted and environmental risk assessments were in place to ensure the safety of the premises and equipment. Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer's recommendations. Infection control procedures were being followed in day-to-day practice.

We found that people's consent had been obtained for care and treatment provided to them by the service. Records showed that people had regular opportunities to be involved in and discuss how they wished to have their care provided. Where people did not have the capacity to make significant decisions their rights had been protected.

People's health and social care needs had been assessed and care had been planned and delivered in line with their individual care plan. People had access to community and specialist health services.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by suitably qualified, skilled and experienced support workers.

People who live at the home were aware of how to make it known to support workers if they were unhappy.

During our observations we saw staff were respectful and treated people with dignity. For example, staff offered help with personal care in a discreet manner.

We found that staff supported people to make choices and decisions about their daily lives. For example, throughout the day we heard staff asking people what they wanted to do.

We found care files to be comprehensive and detailed. Care plans were called 'A key to me' a name which had been chosen by people who lived at the home. The plans were kept in a box in people's rooms and focused on the person as an individual.

When we asked one person if they felt safe at the home they told us "Yes, yes". One person told us "If I get upset or sad I go and speak to the staff".

We saw that good training records were maintained. We saw a list of what training had been supplied and when training needed updating. We saw and staff confirmed that the home provided them with a thorough induction and ongoing training programme.

We saw that the home had an annual development plan. This contained details of the returned questionnaires that had been sent to staff, families, and health and social care professionals as well as people who lived at the home. We saw that people were very happy with the service provided.