Archived: Argyle House

People’s experience of using this service:

People and relatives told us the service had improved since the new registered manager started in January 2019. Most people were satisfied with the service they received and felt previous concerns had been listened to and acted upon.

The provider, registered manager and staff were clear about improvements that had to be made at the service. They were proud of what they had achieved but understood that further improvement was needed in some areas, for example record keeping and staff deployment. Improvements already achieved needed to be sustained and embedded.

Everyone praised the registered manager who was approachable, resourceful and provided strong leadership. All staff told us they were motivated to work with the registered manager to make the improvements needed at the service.

Staffing levels had been increased and there were now sufficient staff to ensure people’s care needs were safely met. The registered manager was aware that improvements were required to ensure that staff were consistently deployed and were able to spend time with people. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

People were provided with a variety of nutritious meals, based on people’s choices and including special diets for those who needed them. Improvements continued to be required to the mealtime experience for people living in one area of the home.

Most people were happy living at Argyle House. They felt safe and liked the staff who looked after them. People received safe care and they were protected against avoidable harm, abuse, neglect and discrimination.

Improvements had been made to ensure that people’s medicines were safely managed. People’s safety was maintained because staff followed the risk management plans in place to mitigate risks to people.

The arrangements in place for food safety and infection control had improved. The environment was clean and well maintained.

External healthcare professionals supported staff to help people maintain or improve their health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff had access to the support, supervision and training they required to work effectively in their roles.

Staff were friendly and caring; they treated people with respect and maintained their dignity. Staff encouraged people to maintain their independence.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s preferences.

Information could be provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service provided appropriate end of life care to people.

The service met the characteristics for a rating of "requires improvement" in all five key questions. Therefore, our overall rating for the service after this inspection was "requires improvement".

Rating at last inspection:

Inadequate (report published 17 January 2019).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At the last comprehensive inspection, the provider was in breach of regulations 10, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed positive conditions on the provider’s registration to restrict admissions to the service and to provide monthly reports to the Care Quality Commission (CQC).

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Argyle House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Argyle House is registered to provide accommodation, nursing and personal care to up to 87 people in one adapted building. The home is set out over four floors, with each floor set up as a separate unit providing a particular type of care; these are residential dementia care, nursing care, dementia-nursing care and residential care. At the time of the inspection there were 60 people living in 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 2008 and associated Regulations about how the service is run.

At the previous comprehensive inspection on 3 and 4 April 2018 the service was rated ‘Requires Improvement’. We found concerns in relation to the governance of the service, record keeping and the measures in place to ensure that people’s personal information was stored securely. We also found concerns with staff deployment in the home. The provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the governance of the service, confidentiality, record keeping and staffing levels. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At this comprehensive inspection, we have found that the required improvements have not been made. 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.”

Many of the people using the service were extremely vulnerable, and highly dependent on the care and nursing staff supporting them. Our observations of peoples' needs, during our inspection showed that they were not always receiving the necessary support to ensure risks to their health, safety and wellbeing were being effectively managed. There was a lack of care delivered to meet people's individual needs and maintain their dignity.

We found there to be insufficient numbers of staff working at the service to keep people safe. People had experienced and were at risk of experiencing unsafe care and treatment as a result.

Care was not always planned and delivered to ensure people's safety. People at nutritional risk and those at risk of developing pressure sores had experienced unsafe care and treatment and there was a lack of monitoring in relation to people's nutritional intake. We found that medicines were not always safely managed and that medicines records were not completed accurately.

People's dignity was not being maintained at the service and their privacy was not always respected.

People's personal preferences in relation to their care was not always considered and people lacked stimulation and choices about how they spent their time. People did not feel listened to by the provider, as they had raised concerns about the service they received but no action had been taken.

There were elements of environmental safety that needed to be addressed to ensure that the environment people lived in was safe. Risks posed by the environment had not been identified and as a result had not been resolved. Where risks had been identified insufficient action had been taken to mitigate these risks. We found that some areas of the environment were malodorous and the principles of infection control were not consistently adhered to. Food hygiene measures had not been effectively implemented and this posed a risk that people would be provided with food that was not safe to eat.

There was a lack of effective monitoring in place at the service and this had resulted in poor outcomes for people using the service. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection. There was a lack of clinical leadership within the home.

We found individual staff to be caring and compassionate towards people, however, due to staffing levels at the service they lacked time to be able to spend with people. Care being delivered was often task focussed.

Staff were provided with appropriate training, however did not always put this training into practice, due to time constraints when providing people’s care.

People were supported to maintain good health. Staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

The principles of the Mental Capacity Act 2005 were followed at the service and people had assessments and best interest decisions documented when needed.

At this inspection we found breaches of five regulations of the Health and Social Care Act 2008 Activities) Regulations 2014. The breaches we identified posed a significant risk to people who used the service due to the complexity of their care needs. Full details regarding the actions we have taken are added to reports after any representations or appeals have been concluded.

Due to the breaches of regulation we identified during our inspection and the risk that these posed to people, we made a number of safeguarding referrals to the Local Authority as we were concerned about people's safety and well-being.

Argyle House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Argyle House is registered to provide accommodation, nursing and personal care to up to 87 people in one adapted building. The home is set out over four floors, with each floor set up as a separate unit providing a particular type of care; these are residential dementia care, nursing care, dementia-nursing care and residential care. At the time of the inspection there were 59 people living in the home.

At the last inspection, on the 28 and 29 June 2016, the service was rated “Good.” At this inspection we found that aspects of the service had deteriorated and we have rated the service as overall “Requires Improvement.”

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the 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. The service had been without a registered manager for twelve months, a new manager had recently been recruited and commenced work at the service in January 2018. They had applied to CQC to register as manager for the service and their application was being processed at the time of inspection.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not effective at identifying shortfalls. Where shortfalls were identified these were not addressed in a sufficiently timely manner. Health and safety checks had not resulted in sufficient action to mitigate risks to people’s health and safety.

People’s care records were not stored securely and records of care provided to people were not sufficiently detailed. Records related to people’s wishes regarding the end of their life had not been reviewed by their GP as often as necessary.

The service was not able to demonstrate that staffing levels were sufficient to meet people's needs. People sometimes had to wait for staff to support them and staff were often rushed; this negatively affected people’s experience of care.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that understood their responsibility to keep people safe. Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles. Staff had access to appropriate support and received one to one supervisions with their line manager.

There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

People received enough to eat and drink and had a choice of meals and snacks. People were supported by staff to use and access a variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service.

People were supported to access health appointments when required to make sure they received continuing healthcare to meet their needs. People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely.

People were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred. Care plans reflected how people's needs were to be met. Records showed that people and their relatives were involved in the assessment process and the ongoing reviews of their care. People were supported to take part in activities within the service and the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and were comfortable in their presence.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Argyle House is registered to provide nursing and personal care for up to 87 people who may be living with physical disability or dementia. At the time of this inspection there were 61 people living in the home.

There was a registered manager in post at the time of our 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.

Staffing levels had been calculated to reflect the dependency levels of people living in the home. However, at times the number of staff on duty did not correspond to the number of staff required and there were not always sufficient staff to ensure that people’s needs were met in the way that they chose.

People felt safe in the home and relatives said they had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were written in a person centred approach and detailed how people wished to be supported. Where possible people were involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people that lived at the house. Staff responded to complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to and acted upon. There was a stable management team and effective systems in place to assess and monitor the quality of service provided.

We spoke with 13 people who used the service and they all told us that staff were kind, one person told us “Staff listen and they are kind”, another person told us “staff treat you nicely”.

We spoke with four relatives of people that used the service, they all told us they were happy with the care their relative received. One relative told us “Staff are kind, and he gets what he needs”.

We spoke with four members of staff; they told us that there was enough staff to meet people’s needs and they described new ways of working that had provided more time to care for people who used the service.

We found that people had been treated with respect and dignity. We found that there were enough staff to provide activities to improve people’s well-being and enough staff to provide care to meet their needs.

The provider had improved the quality monitoring systems to ensure that there was enough staff to meet people’s needs.

We visited six people who could not communicate verbally. We saw that four of these people could use the call bell, but did not have access to their call bell.

We spoke with four people who had recently moved from the ground floor of the home to another part of the home. They all told us that they had not been consulted and had not had any choice about moving.

We spoke with five relatives of people who use the service they all told us that they had observed that there were not enough staff to meet their relative's needs.

We spoke with five members of staff who all told us that there were not enough staff to provide all the care that people needed.

We found that there had been improvements in the risk assessments and care planning. We found that the provider had moved people around the home without consultation or respect for their opinions. We found that people did not always have access to their call bells. We found that some people were woken early in the morning to be washed and dressed when this was not their preference. We found that there were not enough staff to meet people's needs.

We found that staff at Argyle House were not following procedures that were designed to keep people's valuables secure.

We spoke with three relatives of people who used the service. One relative described how the staff at the home had provided very good care to two of their relatives. We spoke with two relatives that visited on a daily basis to spend time with their spouse in the home. They told us they were happy with the care provided.

We spoke with five members of staff. Three of them told us that the staffing was not consistent, and at times they were short of staff. Two members of staff told us that they felt supported in their work.

We found that most people had assessments and their care was planned. However, we found that people with diabetes did not have a complete plan of care and errors had been made with the administration of their insulin. We also had concerns about the management of medicines as procedures were not being followed and errors had been made. We looked at the staffing levels and found that although there was an induction and training programme in place, there were not enough experienced and skilled staff to cover all of the shifts. We also looked at the cooperation with the GP practices and found that the provider was not receiving all the support they required.

We spoke with four relatives of the people who use the service, one told us 'the staff understand how to care for him', others said 'they keep me well informed', 'the staff have improved over the last few months and 'my mother always looks content'.

During our last inspection 1 October 2012 we found a number of concerns. During our inspection of 4 February 2013 found that the service had created and followed action plans that had led to an improvement in the service they provided.

We found that there had been a vast improvement in the care provided by staff at Argyle House since our inspection of 1 October 2012. We saw that the assessment, planning, implementing and evaluation of care were carried out and recorded and delivered in accordance with the people's needs.