We carried out an unannounced comprehensive inspection on 12 and 14 July 2018.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.
Arguam House provides care for people who are living with Acquired Brain Injury and those with Neurological Disorders. It provides care and accommodation for up to 8 people. On the day of the inspection 8 people lived in the home. Arguam House is owned by Waters Park House Limited.
Waters Park Limited also owns another care home in the same area and the registered manager managed both of these services. The registered manager was also the provider. 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.
The registered manager was supported by a clinical lead, who also worked across both services. There was a house manager in place at Arguam House who took responsibility for the day to day running of the service.
During the last comprehensive inspection in June 2017 we found the areas of safe, effective and well led required improvement with breaches of Regulation. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good.
At that inspection we found at that time that people did not always have risk assessments in place to guide staff how to mitigate risks associated with people's needs. Information received about new staff through recruitment procedures had not always been acted upon to ensure the staff member was suitable to work with vulnerable adults. People who were deemed not to have the capacity to make certain decisions had no assessments in place to show how this decision had been made.
People's rights were not always protected when they were restricted of their liberty. Quality assurance systems were not sufficiently effective to identify the gaps in quality found during this inspection.
This inspection was a comprehensive inspection that looked at all areas of the service again to check the service had addressed the concerns from June 2017. We found people's care at Arguam House had significantly improved in all areas. They have been judged to be Good overall.
Why the service is rated good:
We met and spoke to six people during our visit and observed the interaction between them and the staff supporting them. People were able to tell us about the care and support they received.
People were now safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff had completed safeguarding training and further updates were arranged. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff confirmed there were sufficient staff to meet people’s needs.
People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapists. People who required additional input, for example from Community Psychiatric Nurse’s (CPN) had this clearly recorded into their care plans.
People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines.
People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.
People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input as much as they were able to in preparing some meals and drinks.
The provider and staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.
People were supported to have maximum choice and control of their lives as much as they were able to. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were met and their health was monitored by the staff team. People had access to a variety of healthcare professionals.
People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy was respected. People or their representatives, were involved in decisions about the care and support people received.
People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care records were person centred and held comprehensive details on how people liked their needs to be met, taking into account people’s preferences and wishes. Staff understood people’s needs and responded when needed. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.
People were mostly independent and arranged their own activities however others were arranged with staff involvement and we observed people enjoying the company of the staff. Some people had their end of life wishes documented.
People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the house manager and provider were very approachable and made themselves available. Staff talked positively about their roles. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.
People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. People lived in an environment that was clean and hygienic.
People were able to make choices about their day to day lives. The provider had a complaints policy in place and the house manager confirmed any complaints received would be fully investigated and responded to.
The provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.