Archived: Arnold House - Care Home Physical Disabilities

Arnold House is a care home registered to provide residential care for up to 23 people with a physical disability. Some people have additional needs due to a cognitive impairment or mental health needs. At the time of the inspection there were 19 people living at the service. People were aged from 20 to 65 years of age.

People’s experience of using this service:

At the last inspection there were two breaches of the regulations relating to dignity and respect and governance of the service. We issued a Warning Notice in relation to the governance of the service.

We found improvements in the way the service was managed at this inspection. Quality audits took place covering a wider range of areas including out of hours care and they were more detailed.

We found the service was in breach of the regulations related to the management of medicines. Although people were supported to take their regular medicines regularly, the systems for offering ‘as and when required’ medicines and applying creams did not reflect current best practice. We could not be sure that people were always getting their medicines as prescribed.

There was still a mixed view from people as to the kindness and caring nature of some members of staff. We could see the registered manager was working with people at the service to encourage them to speak openly regarding any concerns they had. Residents’ meetings took place regularly for people views to be considered in how the service was run. The registered manager had also moved their office to the ground floor, so they were available for people to talk with easily and could routinely observe care.

Supervision and training was taking place regularly for staff and staff told us they felt supported in their role.

Care plans were up to date and contained up to date information; medicines care plans required more personalised information . There were risk assessments in place but for some people we found these needed reviewing to ensure they were accurately completed, in particular, in relation to eating and drinking. The registered manager acknowledged the service would benefit from a summary document to guide new or agency staff in how to meet people’s needs, and completed these after the inspection.

Complaints, accidents and incidents, including safeguarding were dealt with appropriately and we could see lessons learnt were shared across the service.

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.

Rating at last inspection: The last inspection took place on 6 and 19 September 2018 and was rated ‘Requires Improvement’. The report was published on 21 November 2018.

Rating at this inspection: The service remains rated as ‘Requires Improvement’. The requirements of the Warning Notice had been met at this inspection.

Why we inspected: This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

We last inspected the home on 19 and 22 February 2018. At the inspection in February 2018 the service was rated as ‘Inadequate’ and two Warning Notes were served on the registered provider and due to lack of safety of care and poor governance at the service.

Arnold House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide residential care for up to 23 people with a physical disability. At the time of the inspection there were 19 people living at the service. People are aged from 20 to 65 years of age. Everyone at the service has a physical disability and some people have additional needs due to a cognitive impairment or mental health needs.

At this inspection, the service did not have 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. Since the last inspection the registered manager was no longer in post and an acting manager had been employed on a temporary basis. The new permanent manager started work between the first and second day of the inspection, but at the time of writing this report had not yet applied to be the registered manager.

The overall rating for this service is ‘Requires improvement’. However, the service will remain in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. Information on special measures is detailed at the end of this summary.

At this inspection we found there were improvements with medicines management, but staff were still not fully competent or confident using the new electronic medicines management system. The provider had taken some remedial action by the time of the inspection to support staff better so they gained confidence and competence.

At the last inspection we found not all people at the service were treated with dignity and respect and although some improvement had been made, we had similar concerns at this inspection. In the interim period, from February 2018 to the inspection in September 2018, the service and provider had taken some remedial action, but there were still issues of dignity and respect at the service.

Care records, in particular, person-centred plans (PCP’s) had improved significantly since the last inspection, although some needed refining to be fully person-centred and the service was in the process of updating medicine care plans at the time of the inspection. There were risk assessments in place on care records, but the information did not always align with information on PCP’s.

There had been improvements made to the décor to some areas of the service since the inspection in February 2018.

At this inspection we found the staff roster reflected the number of people working, but on the first day of the inspection we were aware that call bells were not always answered in a timely manner. We were not confident staff were deployed effectively on shift to meet people’s needs.

Staff recruitment was safe at the service will all pre-employment checks taking place prior to people starting work.

The majority of people living at the service told us they felt safe, and staff knew what to do if they had concerns regarding the care of people. Since the last inspection the providers local management team had notified the relevant bodies of any issues which could be considered a safeguarding matter in a timely way, with the exception of one incident.

By the time of this inspection, the provider had taken some remedial action to address issues of concern raised by another organisation regarding the safety of staff supporting people with eating and drinking. The provider was reviewing the menu for appropriateness and was providing additional training to staff in this area.

Accidents and incidents were recorded and overseen by the acting manager. Care records were not always updated as a result, but we could see from associated care documents that actions were taken.

At the last inspection staff were not receiving supervision and training in line with provider requirements. At this inspection we found there were significant improvements as most staff who worked in the day had now undertaken refresher training, and supervision was taking place with greater regularity for the majority of staff.

The majority of people were not restricted to leave the service, and the provider had systems in place and staff were aware of the process to restrict people’s liberty if required. Care records commented on people’s mental capacity.

At the last inspection we were concerned at the lack of effective management at the service and provider level. This impacted on the quality of the service and placed people at risk of harm.

Since the last inspection an acting manager had been recruited to work alongside the deputy manager.Staff, people and relatives spoke well of the local management team. We found the local management team had made many improvements and were transparent and open in the period since February 2018. However, there remained a number of areas in which the quality of the service was still of concern. We also found despite extensive support from the provider there was a lack of effective overall scrutiny of the service by the provider. We also found a lack of responsibility and leadership by the provider to ensure all areas of the service were improving and staff at all levels were held accountable for their actions.

At the last inspection we noted people did not have many opportunities for leisure or social activities. At this inspection we found there was some improvement in this area, as people were going out of the service more regularly and an activities co-ordinator had been recruited. The service had yet to complete personalised activity plans for all the people at the service.

The provider had a complaints system in place and we could see they responded to complaints within the timeframe set out by the provider.

We found the provider was in breach of two fundamental standards. These related to dignity and respect of service users and governance of the service.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

You can see what action we told the provider to take at the back of the full version of the report.

We last inspected the home on 28 June 2016 to carry out a focused inspection due to a breach of the regulations related to medicines management as stock records did not tally with medicine receipt and administration records, and people’s allergy status had not always been recorded or updated. Prior to the focused inspection, the last comprehensive inspection took place on 15 September 2015. The overall rating for the service prior to this inspection was Good.

Arnold House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide personal care for up to 23 people with a physical disability. At the time of the inspection there were 23 people living at the service of all ages.

The care home accommodates 21 people in one purpose built building. There is a bungalow situated in the garden which accommodates two people. This is viewed as ‘move on’ accommodation.

The service had 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.

We found multiple concerns with medicines management at the service. Concerns ranged from medicines not being available for people as per their prescription, inaccurate recording of medicines administration and discrepancies when tallying medicine stocks versus records. This placed people at risk of unsafe care.

There were not always risk assessments in place to provide guidance to staff in their caring role, including key areas such as choking, bathing, and moving and handling risks. This increased the risk of accidents occurring and placed people at risk of harm.

We found that the number of staff rostered to work was not always reflected in the number of staff working. This impacted on the care provided to people. With the exception of one person, people were not restricted to leave the service. However, the staff shortages impacted on people having the opportunity to go out as many people required staff support to leave the building. We found there were insufficient staff to provide personalised care to people.

We did not find comprehensively completed care records in place that set out in detail people’s likes and dislikes nor their needs or how these were to be met. The service could not evidence they provided person-centred care.

We had mixed views from people living at the service regarding their experience of living there and the care provided by the staff. Whilst some people told us staff were caring and kind, other people told us some staff fell short in this area, and this impacted on the dignity and respect shown to them by the service.

We found that staff were able to tell us what they would do if they had safeguarding concerns, but refresher training was not taking place in line with the provider policy in key areas such as safeguarding and moving and handling. Supervision was not taking place as regularly as the provider policy stipulated. These failures to support staff appropriately increased the risk of unsafe care being provided to people.

The provider had quality assurance systems in place. However, these were largely ineffective in the areas of safe medicines management, or with ensuring people’s risk assessments and care records provided staff with up-to-date information on how to care for people. Although the provider had identified these concerns in autumn 2017, there had been few improvements to the service in these areas at the time of our inspection.

We could see from records that staff recruitment was safe. References were in place and Disclosure and Barring Service certificate checks had taken place prior to people being employed. This meant staff were considered safe to work with vulnerable adults.

The provider had a complaints system in place and we could see they responded to complaints within their set timeframe.

We found the provider was in breach of five fundamental standards. These related to the safe care and treatment of people using the service, person-centred care, staffing, dignity and respect and governance of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

You can see what action we told the provider to take at the back of the full version of the report. However, 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.

This inspection took place on 28 June 2016 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Arnold House on our website at www.cqc.org.uk

Arnold House provides accommodation for up to up to 23 people with physical disabilities. On the day of the inspection there were 17 people residing at the home.

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 and associated Regulations about how the service is run.

We were assisted during our inspection by the registered manager.

All of the issues we found with medicines at the last inspection had been addressed. The records of the receipt and administration of tablets matched with the amount of tablets left in the medicines trolley. We saw that the allergy status had been updated and recorded in peoples’ medicines administration records (MAR) and care plans.

The provider was no longer in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Staff received appropriate training and support to enable them to provide the care that people needed. They demonstrated the knowledge and skills needed to protect people from possible abuse. Medicines were stored appropriately and administered safely. Systems were in place to assess and monitor the quality of service that people received and ensure care and support was provided appropriately and in a safe environment.

Staff received appropriate training and support to enable them to deliver the care to people that they needed. The equipment used to support people was checked regularly to ensure it was safe to use. Complaints about the service were managed effectively.