Background to this inspection
Updated
4 July 2019
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.
Inspection team:
The inspection team consisted of two adult social are inspectors, a CQC pharmacist specialist and two Experts-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:
Arnold House 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 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.
Notice of inspection: The inspection took place on 13 May 2019 and was unannounced.
What we did:
Before the inspection, we reviewed information we held about the service, including previous reports and notifications sent to us at the Care Quality Commission. A notification is information about important events which the service is required to send us by law. We looked at the information sent to us by the provider in the Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We also checked the action plan submitted following the last inspection.
During the inspection:
We looked at the environment and the cleanliness of the service. We spoke with five support workers, the registered manager and the maintenance co-ordinator. We checked three staff files, including induction, training, supervisions and appraisal, and recruitment. We looked at training and supervision logs and three people’s care records.
We talked with 12 people and two relatives on the day of the inspection. We also talked with a visiting health professional.
We checked complaints, accidents and incidents, CQC evidence folder, building and fire records and the safeguarding file. We also looked at staff and residents’ meetings and residents’ surveys.
During the inspection we reviewed three medicines administration records, three topical medicine administration charts and four medicines support plans. We observed medicines administration and looked at medicines storage and governance arrangements.
We looked at audits covering medicines, infection control, call bell and care and environmental audits.
Following the inspection the registered manager sent us additional auditing information and we received feedback from two additional health and social care professionals and three relatives.
Updated
4 July 2019
About the service:
Arnold House is a care home registered to provide residential care for up to 23 people with a physical disability. Some people have additional needs due to a cognitive impairment or mental health needs. At the time of the inspection there were 19 people living at the service. People were aged from 20 to 65 years of age.
People’s experience of using this service:
At the last inspection there were two breaches of the regulations relating to dignity and respect and governance of the service. We issued a Warning Notice in relation to the governance of the service.
We found improvements in the way the service was managed at this inspection. Quality audits took place covering a wider range of areas including out of hours care and they were more detailed.
We found the service was in breach of the regulations related to the management of medicines. Although people were supported to take their regular medicines regularly, the systems for offering ‘as and when required’ medicines and applying creams did not reflect current best practice. We could not be sure that people were always getting their medicines as prescribed.
There was still a mixed view from people as to the kindness and caring nature of some members of staff. We could see the registered manager was working with people at the service to encourage them to speak openly regarding any concerns they had. Residents’ meetings took place regularly for people views to be considered in how the service was run. The registered manager had also moved their office to the ground floor, so they were available for people to talk with easily and could routinely observe care.
Supervision and training was taking place regularly for staff and staff told us they felt supported in their role.
Care plans were up to date and contained up to date information; medicines care plans required more personalised information . There were risk assessments in place but for some people we found these needed reviewing to ensure they were accurately completed, in particular, in relation to eating and drinking. The registered manager acknowledged the service would benefit from a summary document to guide new or agency staff in how to meet people’s needs, and completed these after the inspection.
Complaints, accidents and incidents, including safeguarding were dealt with appropriately and we could see lessons learnt were shared across the service.
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.
Rating at last inspection: The last inspection took place on 6 and 19 September 2018 and was rated ‘Requires Improvement’. The report was published on 21 November 2018.
Rating at this inspection: The service remains rated as ‘Requires Improvement’. The requirements of the Warning Notice had been met at this inspection.
Why we inspected: This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up: You can see what action we have asked the provider to take at the end of this full report.
We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.