Archmoor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of regulations in relation to staffing levels. This is because there was insufficient staffing levels to meet people’s needs.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice. Gaps remained in the providers ability to demonstrate organisational learning, to remedy identified actions in a timely manner, and to properly embed a culture of continuous improvement. For example, the provider was not proactive in their approach to risk management, but reactive to issues, as described elsewhere in this report. This included unsafe window restrictors and an approach to falls management that did not take account of a ‘prevention first’ approach.

Staff worked with people and partner agencies to establish and maintain safe systems of care, in which safety was managed or monitored. Individual needs assessments were provided when people were referred to the service, which helped determine the suitability of placements. Staff collaborated well with health and social care professionals in response to changes in people’s needs.

The provider worked with people and partner agencies to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately. Staff told us they felt able to report any concerns or incidents of abuse and were confident managers would respond appropriately. They had also received training in safeguarding adults. People told us they felt safe, comments included, “I don't have any concerns or issues here they do their best for us all” and “The staff are caring and yes, I feel safe.”

People can only be deprived of their liberty to receive care and treatment when the correct legal authority is in place. In care homes, this is achieved through the Deprivation of Liberty Safeguards (DoLS), which form part of the Mental Capacity Act 2005 (MCA). We reviewed whether the service was operating in line with MCA principles and how DoLS were being managed. We found systems in place to record each person’s ability to consent to their care and treatment. Where individuals lacked the mental capacity to make important decisions, applications for DoLS had been submitted as required. For those with authorised DoLS, we saw evidence that any conditions attached to the authorisations were understood and being met.

The service worked with people to understand and manage risks. A variety of individual risk assessments were incorporated into the electronic care planning system. These included risks related to mobility and falls, and eating and drinking.

We reviewed the systems in place to recognise and respond to any deterioration in a person’s condition. An early warning score system integrated in the digital care plan system enabled staff to monitor and track signs of deterioration. This was done through checking vital signs such as blood pressure, temperature and heart rate. Senior care staff were able to describe this process to us clearly and effectively.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some people had been identified as being at risk of falls, particularly at night. Motion detectors had been placed in some people’s rooms, but these were not linked to the call bell system. This simply alerted staff via a chiming sound in the main lounge, which meant staff needed to be in the vicinity of the lounge to hear the chime. Additionally, the system did not identify the specific room where motion had been detected. This meant the system was not a safe nor effective method of falls detection and prevention. The call bell system worked at a basic level but needed modernisation.

Window restrictors on some upper floor windows were not compliant with safety regulations. This was because the mechanism to restrict the window was a nail and chain. The risk was lessened because people occupying those rooms were not at such risk. We raised our concerns with the provider and remedial action was taken.

The building layout and limited storage space, we were told, was an ongoing challenge for everyone. As people’s needs in residential care settings increase, so does their need for extra equipment such as wheelchairs and walking frames. For example, at the time of this assessment, the conservatory was cluttered and used as a storeroom which meant this area could not be used for the benefit of people year-round.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

There were insufficient numbers of staff deployed to meet people’s needs, particularly in the morning. During the day, there was 1 senior carer and 2 care assistants, with the senior mostly deployed to medicines administration duties. This meant the 2 remaining carers were left to support everyone else. Care staff were also expected to manage the laundry function. On several occasions we observed people asking for assistance to go to the toilet, but with only 1 member of staff present in the lounge, people were asked to wait. This meant people’s needs were not met timely. We spoke with staff who confirmed the morning period was a particular pitch-point due to number of people who needed the support of two staff for personal care. Staff described to us a task-and-time regime where care delivery is essentially focused on key times in the day and not always provided in a person-centred and responsive way.

The provider had a dependency tool in place which was meant to look at people’s individual dependency needs to help inform staffing levels. However, more weight was placed on the number of room vacancies to inform staffing levels as opposed to the needs of the existing cohort of residents. Comments from people included, “The staff are wonderful but they are overworked and I don't think there is enough of them really” and “When I first came in the carers seemed to have the knack of things more, but I think it’s probably because they are short on staff now with all the things they have to do. They don't have time to sit and chat with you.”

Most of the staff training was delivered via online e-learning modules, and staff were expected to complete this in their own time outside of work. Our analysis of the e-learning records showed staff were completing multiple modules in rapid succession. On the job competency checks to ensure underpinning knowledge was minimal for most staff. This meant we were not assured learning was properly applied and understood in practice. Furthermore, access to face-to-face learning for key areas such as moving and handling had not been provided by the provider for many years. Instead, the provider was dependant on dates becoming available for sessions organised by the local authority. This meant some newly recruited staff were waiting many months before being able access such training.

Staff were recruited safely with all pre-employment checks completed. However, at the last quality assurance visit, the local authority had provided guidance around improving onboarding of newly recruited staff and what a proper induction should like, including probationary periods. This recommendation had not been fully implemented and still work in progress.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home employed a domestic assistant to help with daily routine cleaning tasks across the home.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Since our last inspection, improvements had been sustained around the safe management of medicines, including associated documentation. The medicines fridge door was broken at the time of this assessment, but we were assured a new fridge had been ordered from the pharmacy.