Armstrong House

We found the following examples of good practice.

Systems were in place to help prevent people, staff and visitors from catching and spreading infection.

Staff and people were tested regularly for COVID-19. A COVID-19 vaccination programme had been implemented.

Staff worked hard to ensure people’s well-being was maintained.

Visitors to the home underwent the appropriate checks to reduce the risk of spreading COVID-19 to others.

Further information is in the detailed findings below.

Armstrong House is a purpose-built nursing home providing care for up to 71 older people, some of whom are living with dementia.

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

The service was exceptional at placing people at the heart of the service. The registered manager and staff had a strong focus on demonstrably showing people were valued and respected. Staff were exceptionally caring. They focused fully on the goals and aspirations of the people who used the service. They all shared the same hopes and wishes for people to continue to live the lifestyle of their choice. The staff provided, as many opportunities, as possible for people to develop their confidence, regain skills and become as independent as they could.

We found that staff were totally committed to delivering a service which improved people’s lives in fulfilling and creative ways. 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. The staff drive and passion had created a dynamic and vibrant service. Relatives and other professionals we spoke with during our inspection highly praised the service and the impact it was having on people.

Staff were making a difference to people’s wellbeing by working well as a team, in harmony with one another and by sharing the same values and principles.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe. People's health needs were thoroughly assessed and external professionals were involved in individuals care when necessary.

Staffing levels met people’s needs. Staff had received a wide range of training including working with people who may display behaviours that challenge. Checks were made on the ongoing competency of staff. Appropriate checks were completed prior to people being employed to work at the service.

People who used the service came from diverse backgrounds. To enable individual's communication the registered manager had looked at the skill mix within the service and employed staff who were bi-lingual. They had also ensured staff had access to telephone translator services and was making sure staff recorded key phrases and words in people's care records.

The cook had received a range of training around meeting people's nutritional needs. Staff were encouraging people who were under-weight to eat fortified foods. A range of menu choices were available.

The registered manager had acted on concerns and complaints and had taken steps to resolve these matters. All incidents were analysed, and lessons were learnt and embedded into practice. The registered manager and deputy manager constantly looked for ways to improve the service. People’s voices were of paramount importance in the service.

The service was well run. The senior managers and registered manager carried out lots of checks to make sure that the service was effective. The registered manager continually researched information about best practice and ensured staff practice remained at the forefront in introducing new guidance.

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

Rating at last inspection

Good (report published 29 December 2016).

Why we inspected

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

Follow up

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

Armstrong House is a purpose built care home providing accommodation and nursing care for up to 71 older people, some of whom have dementia. The service is provided over three floors and is separated into four individual units.

The service had a registered manager in place. 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 the premises to be clean and tidy. Areas had been re-decorated and new furniture had been purchased. There was an on-going plan for re-decoration. There were some signs of odours in a couple of bedrooms we inspected but we saw that the registered manager was addressing this with confirmed orders for replacement flooring.

There were systems and processes in place to protect people from the risk of harm. The care staff understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the right action to take if they were concerned that abuse had taken place.

Staff told us that they felt supported and had regular and productive meetings with the management team. Staff told us that they were up to date with their mandatory training and had completed training that was relevant to the service. We saw staff were supported to develop professionally by taking additional qualifications and roles of responsibility.

Staff and management had an understanding of the Mental Capacity Act (MCA) 2005. The senior management had a good knowledge of the principles and their responsibilities in accordance with the MCA and how to make ‘best interest’ decisions. We saw that appropriate documentation was in place for those people who lacked capacity to make best interest decisions in relation to their care. We saw that a multidisciplinary team and their relatives were involved in making such a decision and that this was recorded within the person’s care plan.

We looked at the arrangements that were in place to ensure that staff were recruited safely and people were protected from unsuitable staff. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. We saw that medicines had been given as prescribed.

There were positive interactions between people and staff. We saw that people were supported by staff who respected their privacy and dignity. Staff were attentive, showed compassion, were encouraging and caring.

People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. We saw people from different cultural and ethnic backgrounds were supported to ensure their needs were met and respected by all staff within the service.

People told us they had good access to their GP, dentist and optician. Staff at the service had good links with healthcare services and people told us they were involved in decisions about their healthcare. This meant that people who used the service were supported to obtain the appropriate health and social care that they needed. Nursing care at the service was provided by a consistent core team who were motivated and supported by the registered manager.

Assessments were undertaken to identify people’s health and support needs. Care plans reflected people’s individual needs, wishes and choices. People’s independence was encouraged and there were activities taking place in the service that included evenings and weekends.

The provider had a system in place for responding to people’s concerns and complaints. People and the relatives that we spoke with during the inspection told us they knew how to complain and felt confident that staff and registered manager would respond and take action to support them. People and relatives told us they felt confident in the registered manager and our observations confirmed they knew the staff and all people within the service very well.

Records looked at during the inspection informed that audits were in place to monitor and improve the quality of the service provided. The service had responded to requirements and recommendations from the previous CQC visit in October 2015 and a clear record of actions was recorded and reviewed on a weekly basis by the management team.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. These related to breaches of regulations regarding safe administration of medicines, supporting staff, consent to care and treatment, person-centred care, complaints and governance.

We undertook a focused inspection on 3 May 2016 to check the progress the provider had made in implementing their action plan. During the course of the inspection we also followed up on some concerns that had been raised with us. This report only covers our findings in relation to those requirements and the concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Armstrong House on our website at www.cqc.org.uk.

Armstrong House is a care home providing accommodation and nursing care for up to 71 older people, some of whom have a dementia-related condition. At the time of the inspection 64 people were living at the home.

The registered manager had left in the period since our last inspection. A new manager was in post at the time of this inspection who informed us they were in the process of registering.

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 provider had made improvements to the management of medicines and introduced a new system to improve the recording of topical medicines. However, records did not demonstrate that topical medicines were being consistently applied.

The provider had reviewed the provision of staff training and made the necessary arrangements for staff to undertake training within specified timescales. The provider had taken action to ensure all staff members were scheduled to receive six supervisions and an annual appraisal in line with their policy and procedure for supporting staff.

The provider had improved the process for acting on complaints and updated the service user guide to ensure people were made aware of the complaints procedure.

Although some improvements had been made to further personalise care records, people’s consent to care and treatment was not always being obtained to uphold their rights.

We concluded that the provider was making good progress towards their action plan and will check whether the improvements have been sustained at our next comprehensive inspection.

In this report the name of a registered manager appears who was not in post and not managing the regulatory 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.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. Staff personnel records contained all the information required to demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place.

We found that improvements had been made to the cleaning of the building and of equipment used to care for people. This meant that people were protected from the risks of poor hygiene and cross-infection. People living in the home told us they felt safe and protected from harm by the staff.

Is the service effective?

People told us that they were happy with their care, and they and their relatives felt their needs had been met. Staff demonstrated they had a good understanding of the people's care and support needs and knew them well. One person told us, 'We are all very happy, here. This is a nice place.' Staff had received training to meet the needs of the people living at the home.

A social care professional told us the manager and staff were 'on the ball', and that the home was 'doing very well, at the moment.' Health care professionals who visited the home were also positive about the quality of the care being delivered. One professional told us, 'There's a good stable staff team, who are competent and professional, and know their patients well.' We were given examples of significant improvements to people's condition, including the complete healing of serious pressure ulcers, and marked reduction in behaviours that challenged the person and others around them.

Is the service caring?

We observed that staff were kind, caring and attentive to people living in the home. They were calm and unhurried in their approach to people's care, and there was a relaxed and settled atmosphere in the home. We saw people were able to do things at their own pace and were not rushed. One person said, 'I have no worries at all about my care. It's lovely here.' People's care plans showed that they were treated as individuals, and their care was tailored to their needs and wishes.

We spoke with relatives visiting the home. They told us they felt their relatives' needs were being fully met. One spoke of the 'kind and caring staff' and another relative said, 'We are very happy with the care.'

Is the service responsive?

People's needs had been assessed before they moved into the home. People were asked for their views in meetings and in surveys, and their views were taken seriously. One person told us, 'They always listen to what I say.' Staff had a very good knowledge of people's likes and dislikes, interests and preferences, and gave care and support that reflected this. People's care was delivered in line with their individual care plan, and adjustments were made to the person's plan if their needs changed.

Staff described the new manager as being 'positive and responsive' to both staff and people in the home. People had good access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and took a pride in their work. Effective quality assurance processes were in place. People who used the service and their relatives were asked for their views about their care and treatment in regular meetings and in annual surveys, and their views were acted upon.

Staff spoke highly of the manager, and said she always took their views into consideration. One care worker told us, 'The manager listens, and is very supportive and helpful.' Staff told us they were clear about their roles and responsibilities, and could easily access company policies and guidance. Visiting professionals told us the manager was leading improvements in the home.

We found people living in the home had not been given the quality and consistency of care their needs required, and that their safety and welfare had not always been protected. Their care had not always been adequately planned to meet their needs.

Appropriate standards of hygiene had not been maintained, in that there was unpleasant and pervasive odour in the unit providing care to people with dementia, and people's wheelchairs had not been kept clean.

Staffing levels had been increased and new care staff and domestic staff had been employed, to improve consistency of care and avoid the need to use agency staff.

Some staff had not been properly trained or supported, and had not been given the necessary supervision or appraisal.

Records in the home were poorly maintained. Records of people's care and treatment were not always accurate, nor were staff records kept up to date.

People's care needs and wishes had been assessed before they came into the home, and care plans had been put in place to guide staff in meeting those needs.

Appropriate systems were in place to make sure people had their prescribed medicines delivered, recorded, administered and safely stored.

Effective processes were in place to recruit new staff, and appropriate checks were carried out before they started working in the home.

A range of systems was in place to check the quality of the service being delivered. This included asking the views of people living in the home and their relatives. The provider acted upon the feedback received.