3 July 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection was carried out by two inspectors and an assistant inspector on the first day and one inspector on the second day.
Service and service type
Agnes and Arthur is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at on 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection we reviewed the information we held about the service. This included the statutory notifications sent to us by the registered provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We contacted the commissioners of the service to gain their views. They shared the action plan upon which they were working with the provider on. We also contacted Healthwatch for their feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. They did not have any feedback to share. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people. We also spoke with six relatives. We spoke with six members of staff, including care assistants, senior carers, a member of the kitchen staff and the activity coordinator. We also spoke with the registered manager and deputy manager.
We looked at care records for five people, medicines records, recruitment records for two staff and other records relating to the management and quality monitoring of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who visit or have involvement with the service.
3 July 2021
About the service
Agnes and Arthur provides personal care for up to 50 people; nursing care is not provided. At the time of our inspection there were 35 people living at the home. People’s needs included those with dementia, mental health needs, older people and those with a sensory or physical disability.
People’s experience of using this service and what we found
There were some omissions in documentation that had not been identified. This had not led to anyone coming to harm, but these gaps in recording had not been identified. Infection prevention and control measures were in place; there was an omission with gloves and aprons during some tasks, but this was rectified immediately. The building needed improvement however action was being taken to address this. Medicines were mostly managed safely, and the registered manager acted on feedback about the recording of the application of topical patch medicine.
There was a positive culture in the service. People, relatives and staff felt the registered manager was approachable and felt engaged in the service. The registered manager was aware of their duty of candour. The home worked in partnership with other organisations and was continuously learning.
People felt safe in the home. People were kept safe from fire risk and staff were trained in how to respond in an emergency. Staff also understood their safeguarding responsibilities and how to recognise abuse. Staff were trained to administer medicines and stock levels matched. We have made a recommendation about the recording of topical patches. There were enough staff to meet people’s need and staff were recruited safely. Lessons were learned when things had gone wrong.
Staff received training to be effective in their roles. People had access to a range of health professionals and relatives and staff were updated about peoples’ changing needs. People enjoyed the food, had choices and food and drink was provided in line with people’s needs and preferences.
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.
People were treated with dignity and respect and supported to be as independent as possible. People had choices about their care. People received personalised care and had plans in place detailing this. People were supported to be involved in activities if they wanted to. People were also supported to keep in touch with relatives whilst there were government-mandated visiting restrictions during the pandemic. Visits were also being arranged as these restrictions were being lifted and guidance was changing.
People were supported to access information and communicate in a way that suited them. People knew how to and felt able to complain and these were responded to. People had their end of life wishes explored, where they wished to discuss this, and further work was planned to gather more information.
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 (last report published 27 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found many improvements had been made however the provider remained in a breach of a regulation about good governance and some other improvements were needed.
Why we inspected
We had concerns about the provider’s other services and there were previous breaches at the last inspection at this service. This was an inspection to follow up on our concerns and check on the previous breaches of regulations.
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.
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 have identified breaches in relation to oversight and governance of the service. We will continue to monitor the service. Please see the action we have told the provider to take at the end of this report.
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 also 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.