Archived: Arthur House

Updated 24 June 2020

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 was carried out by two inspectors and one assistant inspector on day one and two and two inspectors on day three.

Service and service type

Arthur 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.

This service also provides care and support to people living in six ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. This service is also a domiciliary care agency. It provides care and support to people living in their own houses and flats.

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 announced. We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.

Inspection activity for the supported living service started on 17 October 2019 and ended on the 17 October 2019. We visited the supported living service office location on the same date. We conducted the residential service inspection over a period of three days.

What we did before the 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. We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority, professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We met all five people who lived at Arthur House (residential service) and we spoke with four people who used the service about their experiences of the care provided. In addition, we communicated with one person who used the supported living service. We spoke with fourteen members of staff including directors of operations, registered manager, deputy manager and support workers from both the residential and supported living services. In addition, we spoke with a visiting health professional.

We reviewed a range of records across the two services provided. This included five people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service (s), including policies and procedures were reviewed.

After the inspection

Following our inspection, we spoke with three relatives about their experiences of the care provided from the residential service and one relative from the supported living service. We also spoke with two healthcare professionals who regularly visit the residential service. We continued

Updated 24 June 2020

About the service

Arthur House is a residential care home providing personal care for up to six people who live with a learning disability. At the time of the inspection four people were living in the home.

Arthur House also provides a supported living service for up to six people and in addition offers domiciliary care for people living in their own homes within the community. At the time of the inspection one person was accessing the supported living and domiciliary service who received the regulated activity of personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. However, people using the service did not consistently receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

At our last inspection in October 2019 we found serious concerns about the safety of the residential service. People were at risk of and at times had been subjected to unsafe and inadequate care and support. Risks to people relating to the management of people’s mental healthcare needs were not always identified, recorded and known to staff. The failure to mitigate against known risks had exposed people to actual harm. Staff lacked knowledge of those at risk of ligature and self-harm and measures were not in place to minimise this risk. People did not live in a safe environment. Environmental risks associated with ligature, self-harm and arson had not been considered. People were not safeguarded from abuse as allegations of abuse were not always recognised, investigated or referred to external agencies. Systems for the management of people's medicines had not always ensured they were managed correctly.

At this inspection in January 2020 we identified that known risks to two people’s safety had not been adequately assessed and mitigated against. The assessments in place continued to lack robust detail about the risks posed to people and how these should be managed. Practice at the service continued to place people at risk of harm and did not protect them from actual harm. At the time of the inspection we observed enough staff on duty to support people, when necessary. The provider had a safeguarding process in place and had made improvements to ensure safeguarding alerts where escalated to the appropriate authority when necessary. The management of medicines had improved, and further improvements were planned. There had been one serious incident in January 2020, however the provider had learnt from the incident and had put measures into place to reduce the risk of re-occurrence.

The provider had not ensured that their systems and processes were effective in enabling staff to provide safe and good quality care for people. Professionals told us their recommendations to improve people’s health and well-being were not consistently followed. The management arrangements currently in place had demonstrated some improvements and this was reflected by people and staff in their comments. Systems in respect of the monitoring of the service remained in development. The provider sent us additional information following our inspection to demonstrate plans for future monitoring and audit systems.

Members of the management team had not effectively identified and managed risks and incidents, therefore, people had experienced harm and were placed at on-going risk of harm.

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 05 May 2017)

Why we inspected

This focused inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks. In addition, we received a notification of a specific incident. Following which a person using the service self-harmed. The inspection examined the circumstances of the incident. We undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No new areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained 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 Arthur House on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to keeping people safe, and monitoring the care provided at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

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.