Archived: Arborough House Limited

Updated 3 February 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 2 August 2017 and was unannounced.

Two inspectors carried out the inspection with the support of an expert by experience. The expert by experience had personal experience of caring for a person with dementia. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law. This information helped us to identify and address potential areas of concern. We also attempted to gain feedback from social care professionals involved in the service.

During the inspection we spoke with five people and two relatives. We also spoke with eight staff, including the acting manager. We also spoke with both directors of the provider company. We sought feedback from two visiting professionals; however neither said they knew the home well, having not visited for some months, so were unable to make any comment.

We looked at care records for five people and the medicines records for all 12 people living in the home. We looked at recruitment records for three staff, supervision and appraisal records for 13 staff and all staff training records. We also looked at a range of records relating to the management of the service such as activities, accidents and complaints, as well as quality audits.

It was not always possible to establish people's views due to the nature of their communication needs. To help us understand the experience of people who could not talk with us, we spent time observing interactions between staff and people who lived in the home.

Following the inspection visit we spoke with the registered manager and also requested they send us information related to health and safety, fire safety and governance systems. At the time of this report we had not received all the information we had requested as the registered manager was not able to locate it all.

Updated 3 February 2018

This unannounced inspection took place on 2 August 2017. The inspection was bought forward due to information of concern we had received about staffing levels, the management of the home and the care provided to people.

Arborough House is a care home that does not provide nursing care. It provides support for up to 14 older people, some of whom live with dementia. At the time of our inspection there were 12 people living at the home. Accommodation is over three floors and stair lifts were available for all except one, the lower floor.

At the time of our inspection visit there was 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.

At the last inspection in July 2016 the service was rated Requires Improvement. We found a breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 because the management of medicines was not safe. At this inspection we found the management of medicines remained unsafe. Storage of medicines was not secure because medicines were not always locked away and the keys were left on top of the trolley. Temperatures of medicines storage were not checked. Creams were unlabelled, undated and the wrong creams were left in people’s rooms. There were unexplained gaps in the recording of medicines and the stock and recording of antibiotic medicines did not tally. Where medicines were administrated covertly there were not clear support plans in place.

Risks associated with people’s needs and support were not always understood or assessed and plans were not developed to guide staff to reduce risks. Up to date fire safety information was not available. Staff were unable to find Personal Emergency Evacuation plans for everyone living at the home. No health and safety checks were carried out and some window restrictors were broken.

The recruitment of staff did not always ensure the appropriateness of potential applicants to work with vulnerable people because checks which would help the provider assess their character did not always take place effectively. Most staff had been trained to understand their roles and responsibilities in safeguarding, although their knowledge varied. Whilst care plans had been developed to guide staff about how to respond to the management of allegations made by on person, this was not followed. Allegations made were not investigated and were not reported to the local authority safeguarding team or to the Commission.

Staff did not receive regular supervisions or appraisals and training received was not effective. Some training that would support staff to work effectively with people had not been provided and staff lacked an understanding of these needs.

Staff sought permission before providing personal care however where this was required for the use of equipment it had not been sought. Staff lacked an understanding of the Mental Capacity Act 2005 and where this needed to be applied in full, it had not. Staff did not have knowledge of those people subject to DoLS or understood what this was for.

Staff were not consistently kind or caring in their interactions with people. At times their communication was abrupt or dismissive. They did not always demonstrate they respected people’s dignity and privacy.

Audits to assess the quality of service provision were not completed regularly and were ineffective in identifying improvements needed. Action plans were not developed to ensure improvements were made. The registered manager did not understand their responsibilities in line with duty of candour. The provider had not ensured a policy was in place. Notifications required by CQC were not submitted.

During our visit staffing levels met the needs of people, however we were not confident this was always the case and have made a recommendation. The recruitment of staff was safe but records held in relation to this required improvement.

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.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. Following the inspection we requested the provider send an action plan telling us how they would take action to address our immediate concerns. In addition we referred our concerns to the Local authority. We are now considering our regulatory response.