Agnes and Arthur

Agnes and Arthur provides personal care for up to 50 people; nursing care is not provided. At the time of our inspection there were 35 people living at the home. People’s needs included those with dementia, mental health needs, older people and those with a sensory or physical disability.

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

There were some omissions in documentation that had not been identified. This had not led to anyone coming to harm, but these gaps in recording had not been identified. Infection prevention and control measures were in place; there was an omission with gloves and aprons during some tasks, but this was rectified immediately. The building needed improvement however action was being taken to address this. Medicines were mostly managed safely, and the registered manager acted on feedback about the recording of the application of topical patch medicine.

There was a positive culture in the service. People, relatives and staff felt the registered manager was approachable and felt engaged in the service. The registered manager was aware of their duty of candour. The home worked in partnership with other organisations and was continuously learning.

People felt safe in the home. People were kept safe from fire risk and staff were trained in how to respond in an emergency. Staff also understood their safeguarding responsibilities and how to recognise abuse. Staff were trained to administer medicines and stock levels matched. We have made a recommendation about the recording of topical patches. There were enough staff to meet people’s need and staff were recruited safely. Lessons were learned when things had gone wrong.

Staff received training to be effective in their roles. People had access to a range of health professionals and relatives and staff were updated about peoples’ changing needs. People enjoyed the food, had choices and food and drink was provided in line with people’s needs and preferences.

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.

People were treated with dignity and respect and supported to be as independent as possible. People had choices about their care. People received personalised care and had plans in place detailing this. People were supported to be involved in activities if they wanted to. People were also supported to keep in touch with relatives whilst there were government-mandated visiting restrictions during the pandemic. Visits were also being arranged as these restrictions were being lifted and guidance was changing.

People were supported to access information and communicate in a way that suited them. People knew how to and felt able to complain and these were responded to. People had their end of life wishes explored, where they wished to discuss this, and further work was planned to gather more information.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (last report published 27 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found many improvements had been made however the provider remained in a breach of a regulation about good governance and some other improvements were needed.

Why we inspected

We had concerns about the provider’s other services and there were previous breaches at the last inspection at this service. This was an inspection to follow up on our concerns and check on the previous breaches of regulations.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have identified breaches in relation to oversight and governance of the service. We will continue to monitor the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Agnes and Arthur care home provides personal care for up to 50 people; nursing care is not provided. At the time of our inspection there were 43 people living at the home who received personal care, some of whom were living with dementia.

People’s experience of using this service

Practices in the home required improvement. People were not adequately protected from fire risks. People’s care needs were met, but their social and emotional needs were not always met. We have made a recommendation about this. Medicines were mostly managed safely, although people’s prescribed thickeners had not been recorded as administered.

Safe recruitment procedures were in place. People said they felt safe.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff training in key areas was not up to date. People were supported to have enough to eat and drink.

People received a service that was not always caring as some staff were task-focused. Information about the service was not available in formats appropriate for people’s individual communication needs. People said they were happy with the care provided and staff treated them well.

Care plans reflected people’s daily routines, but they were not person-centred and not always up to date. People were supported to engage in activities they enjoyed. People knew how to make a complaint.

Systems to monitor the quality of the care provided were ineffective. The provider had failed to mitigate risks to people. Staff had mixed views whether they were supported and listened to. People’s feedback was sought and acted upon.

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

Rating at last inspection

Good (last report published 6 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified four breaches of regulation regarding safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing at this inspection. Please see the 'action we have told the provider to take' section towards the end of the report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme based on the current rating. If any concerning information is received we may inspect sooner.

This inspection visit was unannounced and took place on 16 November 2016. At our last inspection on 30 June 2015 we asked the provider to make improvements to the level of staffing, assessments when people lacked capacity and the management of the home. The provider sent us an action plan in August 2015 explaining the actions they would take to make improvements. At this inspection, we found improvements had been made although further improvements were needed when assessing capacity. The service was registered to provide accommodation for up to 50 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 30 people were using the service.

There was a registered manager in post. 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.

People were supported to make choices, however the assessments did not always reflect the person’s level of understanding in different situations. The home had enough staff to support people’s needs. Any staff who had been employed had received a range of checks to ensure they were suitable to work in the home. The manager and provider had established a range of audits to support the improvements within the home. We saw feedback was sought from people, relatives and professionals and any areas raised had been considered and responded to.

We found staff had established positive relationships with people. Staff showed respect for people’s choices. They ensured they maintained people’s privacy and dignity at all times. People were able to choose the meals they wish to eat and alternatives were provided. We saw that medicines were managed safely and administered in line with people’s prescriptions. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff obtained information from the person and family or relatives to support the completion of the care plan. People were encouraged and supported with activities they wish to engage in. Any complaints had been addressed and resolved in a timely manner. There was a whistle blowing policy which was responded to in confidence and any concerns raised investigated.

Staff felt supported by the manager and there was a clear process in place to cascade information about the service and the needs of people. Staff had received training and the provider had invested in further training to expand the staff knowledge in dementia.

The Home is situated in its own grounds on the edge of a small, modern housing estate which overlooks the North Staffs moors. We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

To understand people's experiences of care, we always ask the following five questions of every service and provider;

Is the service safe?

The home provided adequate staff to meet the needs of all the people living in the home. One relative told us, " I feel my X (the person who used the service) is looked after safely here".

We saw that staff reported adverse incidents which occurred and these were investigated, however the provider did not always provide management plans to reduce the risk of incidents reoccurring.

Staff were aware of the categories of abuse that people might be subjected to and felt confident to report safeguarding concerns internally or directly to the local authority. Staff were also aware of the process for whistleblowing if they had concerns which they would not want to raise directly with the provider.

People's individual risks and specialised equipment needs, such as assistive technology were assessed and reviewed on a regular basis.

People had access to specialist health care professionals to maintain their physical and mental health.

There were established health and safety procedures in place to ensure the food served to people was stored and cooked safely. One person told us, 'We get good, down to earth food here. Just what I like'.

Is the service effective?

The people who used the service had detailed care plans which provided staff with the information they required to care for people. People's individual preferences on care, for instance the time they liked to wake in the morning, were recorded and respected.

There were effective processes in place to regularly review and update the care records to ensure they remained current.

Is the service caring?

During our inspection we observed people receiving kind and respectful care from staff. All requests for personal support were met in a timely manner with discretion.

Staff knew people well and were able to support them in the way they preferred.

One person told us, 'There's nice company here. It's a lovely calm atmosphere'. Another person told us, 'They're (the staff) very good here'.

Is the service responsive?

We saw the provider responded to changes in people's well-being which might affect their health, for instance, weight loss was reported to the person's GP.

There was a complaints system in place and people felt supported to raise concerns. One person told us, 'If I wasn't happy I'd go into the office and tell them'. Another person said, 'The girls are really good but if I wasn't happy I'd tell them'.

Some people were able to participate in activities but these did not always meet the needs of all the people.

Is the service well-led?

The provider was regularly monitoring and assessing the quality of service provided through a range of audits so that, if necessary, improvements could be made. People's care records were audited to ensure they were completed correctly and contained up to date information. Staff signed to confirm they had made the required amendments.

There was a contingency plan in place to provide additional staff, if required, during an emergency.