We inspected this service on 6 and 19 September 2018. The inspection was unannounced.We last inspected the home on 19 and 22 February 2018. At the inspection in February 2018 the service was rated as ‘Inadequate’ and two Warning Notes were served on the registered provider and due to lack of safety of care and poor governance at the service.
Arnold House is a ‘care home’. People in care homes receive accommodation and 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 is registered to provide residential care for up to 23 people with a physical disability. At the time of the inspection there were 19 people living at the service. People are aged from 20 to 65 years of age. Everyone at the service has a physical disability and some people have additional needs due to a cognitive impairment or mental health needs.
At this inspection, the service did not have a registered manager. 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. Since the last inspection the registered manager was no longer in post and an acting manager had been employed on a temporary basis. The new permanent manager started work between the first and second day of the inspection, but at the time of writing this report had not yet applied to be the registered manager.
The overall rating for this service is ‘Requires improvement’. However, the service will remain in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. Information on special measures is detailed at the end of this summary.
At this inspection we found there were improvements with medicines management, but staff were still not fully competent or confident using the new electronic medicines management system. The provider had taken some remedial action by the time of the inspection to support staff better so they gained confidence and competence.
At the last inspection we found not all people at the service were treated with dignity and respect and although some improvement had been made, we had similar concerns at this inspection. In the interim period, from February 2018 to the inspection in September 2018, the service and provider had taken some remedial action, but there were still issues of dignity and respect at the service.
Care records, in particular, person-centred plans (PCP’s) had improved significantly since the last inspection, although some needed refining to be fully person-centred and the service was in the process of updating medicine care plans at the time of the inspection. There were risk assessments in place on care records, but the information did not always align with information on PCP’s.
There had been improvements made to the décor to some areas of the service since the inspection in February 2018.
At this inspection we found the staff roster reflected the number of people working, but on the first day of the inspection we were aware that call bells were not always answered in a timely manner. We were not confident staff were deployed effectively on shift to meet people’s needs.
Staff recruitment was safe at the service will all pre-employment checks taking place prior to people starting work.
The majority of people living at the service told us they felt safe, and staff knew what to do if they had concerns regarding the care of people. Since the last inspection the providers local management team had notified the relevant bodies of any issues which could be considered a safeguarding matter in a timely way, with the exception of one incident.
By the time of this inspection, the provider had taken some remedial action to address issues of concern raised by another organisation regarding the safety of staff supporting people with eating and drinking. The provider was reviewing the menu for appropriateness and was providing additional training to staff in this area.
Accidents and incidents were recorded and overseen by the acting manager. Care records were not always updated as a result, but we could see from associated care documents that actions were taken.
At the last inspection staff were not receiving supervision and training in line with provider requirements. At this inspection we found there were significant improvements as most staff who worked in the day had now undertaken refresher training, and supervision was taking place with greater regularity for the majority of staff.
The majority of people were not restricted to leave the service, and the provider had systems in place and staff were aware of the process to restrict people’s liberty if required. Care records commented on people’s mental capacity.
At the last inspection we were concerned at the lack of effective management at the service and provider level. This impacted on the quality of the service and placed people at risk of harm.
Since the last inspection an acting manager had been recruited to work alongside the deputy manager.Staff, people and relatives spoke well of the local management team. We found the local management team had made many improvements and were transparent and open in the period since February 2018. However, there remained a number of areas in which the quality of the service was still of concern. We also found despite extensive support from the provider there was a lack of effective overall scrutiny of the service by the provider. We also found a lack of responsibility and leadership by the provider to ensure all areas of the service were improving and staff at all levels were held accountable for their actions.
At the last inspection we noted people did not have many opportunities for leisure or social activities. At this inspection we found there was some improvement in this area, as people were going out of the service more regularly and an activities co-ordinator had been recruited. The service had yet to complete personalised activity plans for all the people at the service.
The provider had a complaints system in place and we could see they responded to complaints within the timeframe set out by the provider.
We found the provider was in breach of two fundamental standards. These related to dignity and respect of service users and governance of the service.
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.
You can see what action we told the provider to take at the back of the full version of the report.