Arlington House

Arlington House is a residential care home providing the regulated activity of accommodation and personal care to up to 6 people. The service provides support to adults with learning disabilities and/or on the autistic spectrum. At the time of our inspection there were 3 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Medicines were not always managed in a way that was safe and the provider had not taken sufficient steps to ensure the premises were safe. Care plans did not cover people’s needs in relation to developing independent living skills. Quality assurance and monitoring systems were not always effective.

Right Support: People were able to choose where they lived. The service was able to assess people's needs before they began living at the service, so they knew whether they could meet their needs. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. Systems were in place for dealing with complaints. People were supported to maintain relationships with family and friends, and to engage in meaningful activities.

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.

Right Care: People were protected from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them. Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity.

Right Culture: People were supported with care that was person-centred. Relatives and staff told us there was an open and positive culture at the service. The provider was aware of their legal obligations and worked with other agencies to develop best practice and share knowledge.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 October 2017).

Why we inspected

We had not inspected this service for over 5 years and we needed to assess whether or not it still provided good standards of care.

Enforcement and Recommendations

We have identified breaches in relation to the physical environment, medicine, care plans and quality assurance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection in November 2015, the service was rated Good.

At this inspection we found the service remained Good.

The service had a registered manager 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.

The service had systems in place to safeguard people from the risk of abuse. Each person had a risk assessment which identified possible risks and how to manage them to ensure people were safe. The staff recruitment process was robust which meant that staff were employed only after they were successfully checked to determine they were suitable to work with people. We observed that there were enough staff to meet people’s needs. Staff managed medicines in a safe manner.

Staff received on-going training and supervision to enable them to support people effectively. They had knowledge of the Mental Capacity Act 2005 and were able to demonstrate that people’s capacity to make decisions about their care required assessment if necessary. People were provided with meals that reflected their choices, preferences and culture. Staff supported people to have access to healthcare. This showed staff worked with healthcare professionals to ensure people received appropriate health and medical care.

Relatives told us staff were kind and caring. They treated people with respect and had knowledge and experience of how to promote people’s privacy and dignity. Each person had a care plan which was regularly reviewed.

Staff supported people to engage in different activities. Relatives were aware of the service’s complaints procedures. The registered manager audited various aspects of the service. Relatives were satisfied with the quality of the service and how it was managed.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary describes what the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Each person using the service had a risk assessment. Staff had attended training in areas such as safeguarding and first aid. They were also aware of Deprivation of Liberty Safeguards which required them to apply for authorisation, as needed, by the Local Authorities.

Is the service effective?

People's needs assessments and care plans had been completed. However, the care plans had not been regularly reviewed and information relating to changes in people's support plans had not been recorded.

Is the service caring?

Staff treated people with respect and dignity. People who used the service were dressed appropriately and were supported to access activities based in the community.

Is the service responsive?

People had received care and treatment from specialist services such as psychologists and arrangements were in place to make referrals for people other specialist healthcare services. Staff who had suitable experience and knowledge had been employed to meet people's needs.

Is the service well-led?

There was a registered manager for the service. However, the service had been managed by persons who had not been registered with the Care Quality Commission. The provider has not notified the CQC about the management arrangements of the service.

We found that there were enough suitably trained and experienced staff to meet people's needs. We also found people were protected from the risk of abuse and there were systems in place to monitor the quality and safety of the service that people received.