Background to this inspection
Updated
31 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team included an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Argyle Park Nursing Home 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not available on either day of the inspection but was given the opportunity to provide information and evidence of compliance with regulation on their return.
Notice of inspection
The first day of this inspection took place on 23 September 2019 and was unannounced. The second day of the inspection was announced and took place on 24 September 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with seven people who used the service and seven relatives about their experience of the care provided. We spoke with nine members of staff including three clinical leads (nurses), four care staff, the quality manager and the regional manager. We also spoke with a representative of the provider. We observed the delivery or care and interactions with staff and completed a SOFI (short observational framework for inspections).
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found and confirm what action was proposed to reduce the level of risk. We looked at supervision data and quality assurance records. We spoke with two people who contacted us because they were unavailable to comment during the inspection.
Updated
31 October 2019
About the service
Argyle Park Nursing Home is a residential care home providing personal and nursing care to 29 people at the time of the inspection. The service can support up to 31 people. The building is on three levels and is used to provide services to people with both long-term and short-term care needs.
People’s experience of using this service and what we found
Staffing levels were not always sufficient to provide safe, effective care and meet people’s needs. The over reliance on staff that were not familiar with people’s needs and preferences meant people’s needs were not always met. Call bells were not always answered in a timely manner and people were left without observation while other tasks were completed.
Processes for monitoring and improving the quality and safety of care were not robust. Audit processes were extensive and subject to review by senior managers. However, this had not always resulted in improvements to safety and quality in a timely manner. The service provided evidence of development since the last inspection, and was committed to providing high-quality, person-centred care. However, the range of concerns identified during the inspection provided clear evidence further work is required to meet regulation.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were not consistently inducted and supported to an appropriate standard. People’s needs and preferences for food and drinks were not always met. We made a recommendation regarding this.
People were not always cared for in accordance with their needs and preferences. We saw evidence people were not always treated with care and respect. Staff did not always support people in a timely manner to promote their privacy, dignity and independence. People’s privacy was not always respected by staff. For example, throughout the inspection we saw staff entering people’s rooms without knocking or checking if they were there. We made a recommendation regarding this.
Records did not always contain enough detail to instruct staff how to deliver personalised care. In some cases records had not been completed as required. We made a recommendation regarding this.
The service met the requirements of the AIS. Information was available in a range of formats to help people understand. People were encouraged to maintain relationships and take part in activities. However, people told us activities did not always take place as planned.
Medicines were managed safely by appropriately trained staff. Incidents and accidents were recorded in sufficient detail and subject to analysis to identify patterns or trends.
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 22 June 2017).
The inspection was prompted in part due to concerns received about the management of pressure wounds and issues relating to staffing levels. A decision was made for us to inspect and examine those risks. We found no concerns relating to the management of pressure wounds. Information relating to staffing levels is contained in the full report.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.
Enforcement
We have identified breaches in relation to staffing levels, the quality and responsiveness of care and the management of the service. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.