Arncliffe Court Care Home

Arncliffe Court Care home provides accommodation, personal and nursing care to people some of whom were living with dementia. At the time of the inspection there was a total of 63 people accommodated in three of the five units, the other two units were closed.

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

Risks to people were assessed, monitored and managed. Staff provided people with the care and support they needed to minimise the risk of harm. They monitored people’s health safety and wellbeing where this was required and completed records to reflect the care and support people received.

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 now supported this practice. Decisions made on behalf of people who lacked the mental capacity to make particular decisions for themselves were made in line with the Mental Capacity Act (MCA).

The systems for monitoring and improving the quality and safety of the service were used effectively. They brought about the required improvements to the quality and safety of the service following the last inspection. The manager promoted a culture of continuous learning and improvements.

Medicines were in the main safely managed. Medication for one person was not given at the right time and the procedure for ensuring one person received their medicines whilst out was not followed. These were isolated incidents and the manager addressed them immediately. Staff with responsibilities for managing medicines had completed the required training and their competency was regularly checked. Regular audits of medicines and records were completed.

Regular safety checks were carried out on the environment and equipment and records of the checks were maintained. Improvements were made during the inspection to secure some rooms which contained hazards.

Safe infection prevention and control (IPC) practices were followed. Staff completed IPC training and were kept up to date with current national IPC guidance. There was a good stock of PPE and staff used and disposed of it safely. Safe visiting arrangements were followed.

People received care and support from the right amount and skill mix of staff. Safe recruitment processes were followed. Applicants underwent a range of pre-employment checks to assess their suitability and fitness for the job. Induction training for agency staff had improved and staff were provided with further training in relation to the MCA which helped improve their knowledge.

There were processes for protecting people from the risk of abuse. Staff knew the signs and symptoms of abuse and the safeguarding reporting procedures. The manager worked with local authority safeguarding teams to minimise risk to people and others. People told us they felt safe with staff and they were treated well. Family members told us they were confident their relative was kept safe.

The manager had applied to CQC to become the registered manager of the service. They understood their role and responsibilities and regulatory requirements. We received positive feedback about the manager and the way they managed the service.

There was good partnership working and communication with external health and social care professionals and good communication with people, family members and staff.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 August 2021).

Why we inspected

We carried out an unannounced inspection of this service on 16 and 19 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve, safe care and treatment, consent to care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Arncliffe Court Care Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arncliffe Court Care home is a 150 bedded care home providing personal and nursing care to people aged 65 and over. At the time of the inspection, 77 people lived in the home.

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

Improvements had been made to the service with regards to infection control, medicines and to the culture of the home. We identified additional improvements were needed however with regards to the governance of the home, the monitoring and management of risk and the need for consent.

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.

Care plans and risk assessments were in place, however these did not always reflect the needs of the people and were in need of review. We also identified that monitoring information in relation to people’s needs and care was not always properly completed.

Improvements were needed to the recruitment processes as we found issues with pre employment checks such as references. On the day of inspection there appeared to be sufficient staff on duty to deliver care safely. However, feedback from staff, people living in the home and family members indicated that this was not always the case and that staffing was an issue. Staff were in receipt of induction and supervision however issues we found during inspection indicated that training in some areas such as mental capacity was not effective.

The majority of feedback received from staff indicated that there had been an improvement in the communication between management and staff within the home. A high number of the people and family members we spoke with however told us that communication was insufficient from the management of Arncliffe Court in regard to the care being provided. This was discussed with the provider during the inspection.

Infection control in regard to COVID-19 processes had significantly improved and the home appeared clean. Accidents and incidents were managed appropriately, and the management notified CQC of significant incidents when it was appropriate.

We observed support being provided in the home and saw that this was done in a caring, responsive and patient manner. We saw that people were comfortable in the presence of staff.

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

Rating at last inspection and update: The last rating for this service was inadequate (published 28 April 2021) 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 enough improvement had not been made and the provider was still in breach of regulations, but we noted the improvements that had been made.

This service has been in Special Measures since 28 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, the provider is still in breach of Regulation 12 (Safe care and treatment), Regulation 11 (Need for consent) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to management of risk, and governance and an additional breach in relation to the need for consent.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Arncliffe Court Care home is a care home providing personal and nursing care to 97 people aged 65 and over at the time of the inspection. The service can support up to 150 people over five separate units each of which has separate adapted facilities. At the time of inspection four units were being used. Two of the units specialised in providing care to people living with dementia and one unit is specifically for nursing care.

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

The majority of people we spoke with told us that they felt safe living in the home. However, we identified concerns in relation to people’s safety and the leadership of the home.

The management of medicines was unsafe. People were placed at risk because they did not always receive their prescribed medicines due to them being out of stock. Staff had failed to report these omissions to managers and medication audits had failed to identify them.

Staff did not follow safe medication guidelines and infection prevention and control procedures despite evidence which showed they had completed training and had undertaken competency checks in both areas.

Checks carried out on the quality and safety of the service failed to identify a lack of effective planning and monitoring of people’s care. Monitoring records were incomplete and did not always reflect the care people received or needed.

We identified that there was a lack of cohesive working and poor communication across the home. This led to risks not being recognised and mitigated.

Safe recruitment processes were in place, however these were not always followed by the provider. People we spoke with and relatives indicated there were issues regarding staffing levels. We saw that there was a high use of agency staff and that this had not had robust oversight. We also received feedback from families that communication with them was poor.

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

Rating at last inspection (and update) The last rating for this service was requires improvement (published 05 December 2019). At this inspection improvements had not been made and the service had deteriorated to inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about care delivery and governance. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider is taking action to mitigate the risks and is closely working with the local authority and others.

Ratings from previous comprehensive inspections for the key questions we did not inspect were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arncliffe Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medication, risk management and overall governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Arncliffe Court Care Home is a care home that provides personal and nursing care for up to 150 older people and people living with dementia in five buildings. Accommodation was on ground level. At the time of this inspection only four buildings were in use and 99 people were living at the service.

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

At this targeted inspection we found that systems and processes to protect people from the risk of abuse or neglect were robust. There were safe and effective ordering and delivery systems in place. Risk was assessed appropriately and subject to regular review. Systems for recording incidents and accidents were extensive and effective.

The building and equipment were well-maintained in accordance with regulations. Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. Effective measures were in place to manage the risk of infection. Staff were given adequate stocks of cleaning materials and personal protective equipment (PPE) to ensure the risk of infection was minimised.

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 requires improvement (published 8 May 2019).

Why we inspected

The inspection was prompted due to concerns received about the provision of care people received. We undertook this targeted inspection to ensure that the service was meeting legal requirements. To do this we examined risks relating to systems and processes, areas of risk management and safety monitoring and provisions that were in place to ensure people were living in a safe and well-maintained environment. This targeted inspection only focused on specific concerns and did not cover all key lines of enquiry, as a result the ratings for this service have not been changed. The ratings for this service will be reviewed as part of our next comprehensive inspection.

We found no evidence during this targeted inspection that people were at risk of additional harm from the concerns we had received since we last inspected.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Arncliffe Court Care Home on our website at www.cqc.org.uk.

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.

Arncliffe Court Care Home is a care home that provides personal and nursing care for up to 150 people in four buildings. Accommodation was on ground level. At the time of this inspection 92 people were living at the service.

Improvements had been made since the last inspection so that people’s rights under the Mental Capacity Act 2005 were managed appropriately and that care was planned and managed in a way that promoted people’s health, safety and well-being. In addition, improvements had been made to the overall governance of the service.

We have made two recommendations in relation to the management of medicines and the quality monitoring systems in place within the service.

People’s experience of using this service:

Peoples' needs and wishes were assessed and planned for. Care plans identified the intended outcomes for people and how their needs were to be met. This was an improvement from our previous inspection. People received care and support from appropriately trained staff. People were offered a nutritious and balanced diet and their healthcare needs were understood and met.

Systems for assessing and monitoring the quality and safety of the service were not fully effective in identifying areas of improvement within the service. However, there had been improvements from our previous inspection. People and their family members described the staff as approachable and supportive. Systems were in place to gather people’s views on the service.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Risks to people and others were identified and measures put in place to minimise harm. Good infection control practices were followed to minimise the risk of the spread of infection, this was an improvement from our previous inspection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and how they were to be met. People and their family members knew how to raise a concern or make a complaint about the service. People were treated with kindness by staff. Staff provided care and support with positive outcomes for people.

Details are in the key questions below.

Rating at the last inspection: The service was rated as Inadequate on 25 September 2018 and was placed into Special Measures.

Rating from this inspection: Requires Improvement. The service is no longer in Special Measures.

Why we inspected: This was a planned inspection to assess what improvements had been made by the registered provider following its previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our 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

This was the first inspection of the service under the registered provider Advinia Care Homes Limited.

Arncliffe Court 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. Arncliffe Court accommodates up to 150 people across five separate houses, each of which have separate adapted facilities. Two of the houses specialises in providing care to people living with dementia. At the time of this inspection 91 people were living at the service.

A registered manager was not 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.

At this inspection we identified breaches of the regulations in relation to the need for consent and the implementation of the Mental Capacity Act 2005, safe care and treatment and good governance.

Risks to people’s health, safety and welfare were not always fully considered. Not all identified risks to people and others had been fully assessed and where possible, minimised. This related to infection control practices and the management of medicines.

The service had failed to ensure that appropriate action was taken quickly to assess and mitigate any risks in relation to the telephone system within the service not working. For a period of four days, no calls could be made to or from the service. No risk assessment had been completed to inform others of the current situation. After a four day period we contacted the registered provider who took immediate action to ensure that phones were accessible to staff.

The service had failed to informed others of any potential risk in relation to the identification of a water bacteria being present in the service. Although the bacteria had been assessed as a low risk, and was being regularly checked, no information had been made available to advise people of its presence.

Systems were in place for the recording and monitoring of accidents and incidents. However, effective reports were not always maintained.

Systems and procedures were in place in relation to the Mental Capacity Act 2005. Records demonstrated that more knowledge was required around the implementation of the Act to ensure that people’s rights were promoted and maintained.

Each person had their own individual care plan. However, not all of the care planning documents to support people’s needs contained detailed, up to date information. In addition, alternative approaches to how to support people were not always considered. This could put people at risk of not receiving the care and support they required.

The quality assurance systems in place were not effective. The provider failed to identify and act upon a number of issues which we identified during the inspection. These were in relation to health and safety, care planning and supplementary care records.

Personal records relating to people were not always stored to protect people privacy.

We have made a recommendation about the environment. The environment lacked wayfinding and orientation for people living with dementia.

People had freedom of movement around the service and told us that they had a choice where they spent their time, and what time they went to bed and got up. However, people’s personal choices and preferences were not always respected in relation to their planned care.

Policies and procedures were in place and available to all staff. The new registered provider had a service level agreement with the previous provider to continue to utilise the policies and procedures in place for a period of 12 months. Within this timeframe the registered provider would develop and implement their own procedures and guidance.

People using the service felt safe and told us that they knew who to speak with if they had any concerns. A complaints procedure was in place and people knew who they would speak to if they wanted to raise a complaint.

Systems were in place to ensure that people’s medicines were safely stored. People told us that staff supported them with their medicines.

People told us that staff delivering their care and support were caring and knew what their needs were.

People had a choice of menu during mealtimes and regular drinks and snacks were available. People told us they were happy with the food they were served.

Weekly visits were made to the service by a GP and nurse practitioner to support people with their health needs. People told us that they felt they received the health care they needed.

People had access to representatives from local churches to assist them with maintain their worship and faith.

A number of social and recreational activities took place within the service to offer people with physical and mental stimulation.

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.”