Argyles Care Home

We found the following examples of good practice:

¿ The outbreak was effectively controlled by the service. The manager and staff had worked with support from the provider’s own specialist staff, as well as collaboratively with external social and healthcare professionals.

¿ The service had increased testing for people, staff and essential visitors. This included both on the spot testing as well as swabs sent away for laboratory testing.

¿ The service had already designed and constructed a specialised visiting pod by converting a bedroom which connected with the outside of the building. This was not in use at the time of the inspection but had allowed safe visiting following government guidelines.

¿ There was increased vigilance of staff practice by the management team to ensure that correct infection prevention and control measures were being followed.

¿ Any areas for improvement were identified through good governance, auditing and reporting. Actions were promptly taken to address any risks that could lead to the continued transmission of infection.

¿ People who were at risk of experiencing loneliness or social isolation had additional interaction with staff and where possible remotely with their family and friends.

¿ The service contacted relevant healthcare professionals if they identified a person’s psychological or emotional wellbeing was impacted by increased isolation.

¿ Staff were provided additional support to help prevent fatigue and ensure a good work life balance. This included having a work ‘buddy’ and access to remote support from employee assistance programmes.

Argyles Care Home is a residential care home providing personal and nursing care to a maximum of 50 people aged 65 and over. At the time of the inspection the service were supporting 30 people. Needs varied, with some people living with dementia, whilst others required nursing support.

The home offers bedrooms across two floors, with communal dining areas, living rooms, bathrooms and quiet rooms available on each floor. The service has an in-house chef who prepares a menu based on people’s preferences, offering three course meals in the dining rooms or in people’s bedrooms. Activity co-ordinators work closely with all departments to focus on how the premises can be more “user friendly”. Signage is used to highlight where different areas are within the home to enable people to maintain independence.

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

People were treated with compassion, care and kindness. People, their relatives and visiting professionals commented on the staff approach and thoughtfulness to go beyond the call of duty for people. Staff often came in on days off, spending large amounts of time engaging with people. The management team and staff had created lasting and meaningful relationships with people. These relationships enabled the service to provide good care, which achieved positive outcomes for people. The provider’s ethos was embedded in the culture of the home and demonstrated a caring approach. People were treated with respect and their dignity was continually upheld. This was confirmed by people and their relatives who provided positive feedback about the service. People's diverse needs were identified and met and their right to confidentiality was always protected.

The staff and management team showed great skill and thinking when looking for ways to reduce risks for people, whilst encouraging and enabling their independence. People were protected from the risks of abuse and reported feeling safe living at the service. Staff recruitment and staffing levels supported people to stay safe. Medicines were managed correctly and safely. People were fully involved in all elements of their care, and the provider was open and transparent when things went wrong.

People received effective care and support from staff who knew them well and were well trained. People's rights to make their own decisions were protected. Staff worked well together for the benefit of people and were completely focused on meeting the personal, health and social care needs of people living at the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The company policies and procedures supported this practice.

People received person-centred care which promoted positive outcomes for them and which included supporting their independence and having control over their lives. People received care and support that was personalised to meet their individual needs. Staff worked well together for the benefit of people practising the ethos of the service: to focus on the needs of the people and their wellbeing.

People benefitted from staff who were happy in their work and felt well managed and supported. The management team and staff were highly motivated and proud of the service they delivered to people. One member of staff said, “There’s a buzz here, we’re all just happy to be at work.” There were consistently high levels of engagement with people, families and professionals. There was a strong commitment to ensure the service was inclusive and that people had the opportunity to extend their lives including community engagement.

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 and update

The last rating for this service was requires improvement (published 29 January 2019) and there were multiple breaches of regulation. 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.

Follow up

We will continue to monitor information 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.

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

This comprehensive inspection took place on the 10 December 2018 and was unannounced.

At the last inspection on the 25 and 26 May 2016 we found the overall rating of the home to be Good. The service was found to be Requires Improvement in effective with all other domains rated Good. At this inspection we found that the service was rated Requires Improvement in the domains of safe, effective, responsive and well led. The service remains Good in caring. Therefore, the overall rating of the service has changed to Requires Improvement.

The service had a registered manager in post. However, they were not in the service at the time of inspection and it was not clear whether they would be returning. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people’s safety, health and welfare were not always managed in line with their care plan. We could not be assured that people were receiving the care and treatment they required in relation to managing skin integrity. Personal emergency evacuation plans were in place but did not clearly identify people’s needs in the event of an emergency. People’s personal information contained in the home's “fire box” that would be used in the event of an emergency evacuation was conflicting and did not reflect current residents living in the home. The management team were unaware this was not up to date but promptly updated this on the day of inspection. There were procedures in place in relation to safe recruitment. However, we found that records did not always have all the information as required under schedule three of the Health and Social Care Act. We could not be assured that staff were recruited to ensure they were safe to work with people. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Processes were not always followed in line with the Mental Capacity Act 2005 to ensure decisions were made in people's best interests. Care records lacked information around people's ability to consent and where authorisations placed restrictions on people to keep them safe, they were not understood by staff. This is a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Records showed people's needs were assessed and regularly reviewed. However, we found that some people’s records had conflicting information in relation to their needs. People told us and records indicated that they were not being engaged in a range of activities according to their interests and preferences. People told us and records indicated they did not always receive care that they wished for or needed such as regular bathing. Records supported this. This is a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. However, we found that these were not always effective and some concerns highlighted in the body of this report had not been identified through the quality assurance monitoring system. We saw where people had provided feedback through a survey these had not always been reviewed or responded to appropriately. Incidents and accidents were recorded but had not always been investigated or reviewed to identify patterns and trends to prevent recurrence. This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Policies and procedures were in place to ensure people were protected from the risk of abuse and avoidable harm. Staff told us they had safeguarding training, and they were confident they knew how to recognise and report potential abuse.

Steps had been taken to help protect people from the risks associated with infections. Staff understood and followed infection prevention and control measures.

Staff spoke highly of the training that they were offered and undertook. People were being supported with catheter care by staff who had not always received the necessary training, however, no harm or risk of harm had occurred. Specialist training required by staff supporting people with catheter care was arranged by the provider following the inspection.

People's medicines were managed in a safe way. Medicines were stored in a locked trolley and staff who administered medicines had received the appropriate training.

We found people who lived at the home were treated with respect and their privacy and dignity was consistently promoted. People looked happy and comfortable in the presence of staff. We observed some positive interactions by staff members with those who lived at the home.

People received support with eating and drinking and their healthcare needs were met. Appropriate referrals were made to community health and social care professionals, to ensure that people received appropriate support. People told us they were generally happy with the meals provided to them. Choices were available to people and where specialised meals were required these were provided.

We saw the complaints policy was available to people and visitors. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

People using the service and their relatives said the home was well kept and clean. The building was well maintained and regular safety checks were carried out on equipment and utilities used at the service and a record of the checks were maintained.

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

Argyles Care Home is a detached purpose-build Tudor style home built in 1991. The home is situated in the centre of Newbury within West Berkshire, close to local shops and other amenities. People have their own bedrooms and use of communal areas that includes an enclosed private garden. The people living in the home need care and support from staff at all times. Some of the people live with dementia and other health related conditions. The service is registered to provide care and nursing care for up to fifty-seven people. There were forty-two people in residence during our visit.

There is a registered manager running the service. 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. The registered manager was not available on the first day of our visit, but was present on the second day.

There were systems to regularly assess and monitor the quality of service people received that were used effectively to ensure people’s safety and well-being. Staff had received health and safety training with refresher training scheduled to promote people’s safety. They were supported with their development needs.

People, their relatives and staff told us they felt listened to by the registered manager and deputy manager who had promoted a positive culture within the home putting people first, whilst supporting and developing the staff team.

People’s care plans were up to date to reflect their care needs and identify individual risks. For example, to promote falls prevention and person centred care. These were being further developed and there were some gaps within daily records. These were being reviewed and improved by the registered manager who recognised the need for further improvements. Staff were receiving support to change the ethos of the home to promote person-centred care and improve communications.

There were enough staff to meet people’s needs safely. The registered manager had taken action on the second day of our visit to ensure the hairdressing service did not impact on the dining experience of people who needed support from staff over the lunchtime period on a Wednesday.

People’s nutritional needs were met with meals that were appetising and cooked to meet individual needs. Staff treated people with respect and kindness and embraced the support they needed to improve the quality of services to promote person centred care. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

There were robust processes in place to monitor the safety of giving people their medicine. The recruitment and selection process helped to ensure staff of good character supported people. Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse.

The service had taken the necessary action to ensure they were working in a way that recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and consent issues, which related to the people and their care.

There were various formal audits and quality monitoring visits by one of the organisation's area managers and by external professionals to promote people well-being and safety.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

People's care plans were person centred and detailed how the person wanted their needs to be met. Risk assessments identified risks associated with personal and specific health related issues, and recorded guidance for staff to minimise those risks. However, people whose fluids were being monitored were at risk of dehydration because staff could not be sure that the records for the purpose of assessment were accurate. The provider had taken immediate steps to ensure this area of non-compliance was resolved immediately.

Medicines were prescribed and given to people appropriately and were kept safely.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people's needs throughout the day. However, we had found there was not enough staff to support people at mealtimes. The provider took immediate action to be compliant so that people received a consistent and safe level of support.

We saw that the home was clean and well maintained. All the people we spoke to told us that this was always the case. Equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People were involved in their care planning and knew what actions would be taken to support them.

People we spoke with who lived in the home told us: 'there's always something to do' such as 'coach trips and quiz nights'. One-to-one activities were provided for people who remained in their room due to ill health or choice.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People's individual interests were identified and used to enhance people's lifestyle.

Is the service caring?

People we spoke with who lived in the home told us they were supported by kind and patient staff. We saw that care staff interacted positively with people who used the service. We saw that they were sensitive to people's moods and needs and mostly approached them in a respectful and appropriate manner.

We told the provider that staff had not been respectful to a person's calls for assistance in the dining room. The provider had taken immediate action to improve staffing levels at meal times. This meant that staff were less hurried and were able to respond and respect people's wishes at all times.

People we spoke with who lived in the home told us staff were considerate and kind. They told us: 'staff are marvellous' and 'staff are good, they try hard without exception'.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Each person had an individual weekly activities plan, which met their current needs.

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. People told us they knew who to complain to and that the manager and staff were approachable. The home recorded four complaints during the last 12 months and these were investigated.

Is the service well-led?

The service had a robust quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was being maintained or improved.

Staff told us that they had the support of a manager and could get assistance from senior managers, as necessary. We saw that the home had a stable staff group who had worked in the home for a number of years. However there had been some recent staff and management changes with the home. Staff told us that they worked well as a team and were provided with guidance and support in line with the provider's policies and procedures.

People we spoke with who lived in the home, their relatives and staff told us that some changes had taken place following the resignation of the registered manager and deputy manager. The reason for their resignation was unrelated. They told us that although the new manager was very approachable they also missed the previous manager and their style of management. The new manager told us that they would be submitting an application to the commission to become the registered manager of the home.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

We found that people's needs were met and care was delivered as described in their individual care plan. People told us that they were 'happy living in the home' and relatives felt their family members were 'happy and content'.

We found that people's health and care needs were well met. People told us that they could see doctor if they chose to and relatives told us that their family member's health was 'looked after very well'.

We saw that people had a varied and nutritious diet. People told us that the food was 'very good and there is plenty of it'.

We saw that the home was well maintained and comfortable. People told us that the home was always kept 'clean and is nice and comfortable'.

People told us that staff were friendly and respectful. People told us that the best thing about living in the home 'is the way the staff treat you'.

We found that the home had ways of looking at the care they offered so that they could make sure they maintained and improved it. People told us that the manager was 'very approachable'. They said that they would tell him if they had any concerns or complaints and were confident that he would ' take action to put things right'.

We saw that the home kept accurate records and stored them appropriately.