Archived: Arborough House Limited

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.

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 11 people living at the home. Accommodation is over three floors and stair lifts were available for all except one, the lower floor.

Our last inspection at Arborough House took place on 20 January 2015 and we found that improvements were required in the monitoring of the quality of the service provided at the home. We made a requirement for action and we received an action plan telling us that the improvements would be in place by October 2015.

At this inspection whilst we found that improvements had been made, we found not all actions had been taken by the provider to ensure the service was fully compliant with all the Regulations.

A registered manager was in place. 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.

Medicines were not managed safely because there was lack of proper recording of medicine administration and important information relating to some medicines was not complete.

People’s care had been appropriately assessed and plans had been developed to ensure that staff met people’s needs and reduced and identified risks. However, food and fluid charts, which although were in place did not always contain sufficient information to understand any relevant risks. We have made a recommendation about this.

People confirmed they felt safe and that staff involved them in making decisions and staff knew people well.

Observations demonstrated people’s consent was sought before staff provided care. However, we also observed people having their medicines crushed and staff had not offered them the medicine beforehand to see if they would have it without it needing to be disguised in food.

People described staff as lovely and caring. Staff treated people with respect and recognised the importance of promoting independence, dignity and privacy.

Staff demonstrated a good understanding of safeguarding people at risk. They were confident any concerns raised would be acted upon by management and knew what action to take if they were not. However they were unsure about the Mental Capacity Act and Deprivation of Liberty Safeguards.

Recruitment checks were carried out and the provider ensured there were enough staff on duty to meet people’s needs. Staff received an induction when they first started work which helped them to understand their roles and responsibilities. They felt supported through supervision, appraisal and training.

People and their relatives knew how to make a complaint and these were managed in line with the provider’s policy. Systems were in place to gather people’s views and assess and monitor the quality of the service. However, this had not effectively identified and addressed the concerns around medicines administration.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

The inspection team was made up of a single inspector. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a Summary of what we found.

Is the service safe?

People were treated in a kind, dignified and respectful manner. Staff were clear they would report concerns to the manager and these would be actioned. There was a system in place to record incidents and accidents, however we could not always see that learning from incidents or accidents took place and measures were implemented to reduce the recurrence of these.

The home did not always recognise potential safeguarding matters and did not always make appropriate referral to the local safeguard authority. This meant safeguarding risks for people were not identified and actions taken to prevent these risks were not in place.

CQC monitors the operation of the Mental Capacity Act and Deprivation of Liberty

Safeguards (DOLS) which applies to care homes. Management we spoke with had a good understanding of DoLS and their responsibility in this.

Is the service effective?

Before people received care they were asked for their consent. Staff supported people to make day to day decisions. Staff were observed to respect the decisions people made. Where people lacked capacity to make decisions the provider was not able to demonstrate they had applied the Mental Capacity Act 2005. There were no capacity assessments in place and there was no evidence of best interests decisions having been made. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set out by law in relation to consent to care and treatment, care planning and safeguarding.

Is the service caring?

The staff that we spoke with knew people well. Our observations demonstrated that staff had a good understanding of people's needs and the support they required. We saw staff were kind in their approach to people when they supported their needs. All people we spoke with expressed their satisfaction with the service provided and told us staff were kind and caring.

Is the service responsive?

Care plans had been developed for people based on an assessment of their needs. However, we found these did not always reflect people's current needs and risks of harm had not always been assessed or support planned.

Is the service well led?

The home had no policy in place to support the safeguard of vulnerable people. There was no clear guidance for staff about what constitutes a safeguarding concern or what action they should take.

We saw people who lived at the home and their relatives/representatives were asked for their views. However, we found no evidence actions were taken by the management as a result of people's feedback. The provider had no systems in place to audit and monitor the service provided. We have asked the provider to tell us what they will do to meet the requirements set by law in relation to the monitoring and assessing of the quality of the service they provide.

At the time of our inspection there were 10 people using the service who were all living with dementia. We spoke with all of them. We also spoke with four members of staff, including the manager, and two healthcare professionals who visited the service during our inspection. We left comment cards at the service for a week between our visits, but none were filled in during that time.

All the people we spoke with were satisfied with the support they received. They told us staff were caring and responsive to their needs. One said, 'I'm as happy here as it is possible to be. I never expected to be here, but it's better than at home.' Another person said, 'I think it was the right decision.' People told us they were given choices and staff respected their privacy and dignity. They said they were listened to and were involved in decisions about their care. Visiting healthcare professionals said they found people to be well cared for and looked after.

We found people were supported to access other healthcare services to ensure their needs were met. We observed that people living with dementia experienced responsive care which met their needs and was delivered by caring staff. Processes were in place to monitor and assess the quality of the service. Staff were supported to provide care to the required standard.

We visited the home following concerns that we had received that indicated that people's privacy, dignity and that staffing levels may not be appropriate to meet people's needs. We observed people throughout the day and used our SOFI tool to observe a 40 minutes period. Throughout all of our observations we saw that people were treated with dignity and respect. Staff were observed to be supporting people at a pace they needed. Staff were observed to be encouraging and engaging with people. Staff we spoke with were aware of the importance of promoting dignity and respect and could describe to us what they would do to ensure this. People who used the service gave us examples of how people supported their dignity and respect such as, shutting the door and curtains when supporting with personal care.

We found that people's needs were assessed and care plans were developed that included people's needs and personal wishes. These were individualised and told staff how people wanted to be supported. We found that for one person more detail was needed about how the person could react to certain aspects of their care. We discussed this with the acting manager and these were amended at the time of our visit.

People that we spoke with told us they were happy with the care and support being provided. Comments included, 'I like living here', 'staff treat me well, they are kind. I don't have to wait long if I need someone'. Another person told us 'They do all they can for me, they look after me well'.

We found that the home had sufficient numbers of skilled and experienced staff to meet the needs of people. One person told us 'I don't have to wait long for someone to come if I need them'. We observed call bells being responded to immediately. We observed people's requests being responded to promptly and staff had time to sit and talk or do activities with people. Staff we spoke with told us they felt there was always enough staff on shift to meet people's needs.

At out last inspection we identified concerns in relation to supporting workers. The provider sent us an action plan detailing how they would work to improve this. At this inspection we reviewed the progress the provider had made in taking action to ensure compliance in the area of concern. We found that whilst some improvements had been made, we found that the acting manager had not received supervision or appraisal and that no staff had received an appraisal.

We found that people were involved in their care and were supported to make choices.

We looked at four people’s care records and found that care was planned in accordance to people’s needs, wishes and preferences.

We spoke to two relatives and three staff. Staff were able to describe to us the support people needed. Relatives we spoke to told us the staff were “brilliant”. One relative told us “they really know people well and the staff go over and beyond”. “The home is tailored to people’s needs and the care is without fault”. Another relative told us “the carers do a brilliant job, they know how {the person} wants to be looked after”.

We spoke with a social worker who told us that they have found the home quite relaxed with good continuity of staff. They told us that communication from staff is good.

We found that people were safeguarded against the risk associated with medicines because the home had effective systems in place for managing these.

Staff we spoke to told us they felt supported and we found that staff received appropriate professional development. However we found that staff were not receiving supervision meetings and had not received appraisals.

We found that provider had some systems in place to monitor the quality of the service, however these were not followed.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan, and in a way which ensured their safety and welfare.

People were provided with a choice of suitable and nutritious food and drink.

The food appeared to be appetising and staff supported people to eat and drink in a dignified way.

People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

Medicines were kept safely and safely administered. However, appropriate arrangements were not in place in relation to the recording of medicines. Medicines were disposed of appropriately.

There were effective recruitment and selection processes in place. People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system available. The comments and complaints people made were responded to appropriately.