Archived: Arranmore Park Rest Home

Arranmore Park Rest Home is a care home providing accommodation for up to 35 older people, including people living with dementia. At the time of the inspection there were 33 people living at the home.

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

People were not adequately protected from the risks of infection from COVID-19. We inspected the home to see how staff were following national and local COVID-19 guidance including the correct use of personal protective equipment (PPE) and observe how people were cared for. We found people were not adequately protected from the risk of acquiring infections because systems for preventing the spread of infections were not implemented effectively. The provider had not followed the latest guidance on COVID-19 testing for staff and people and latest guidance on allowing visitors in care homes. Infection prevention and control practices needed to be improved in a number of areas. People were safely supported to receive their medicines as prescribed however, some improvements were required in relations to medicine administration records and the monitoring of time specific medicines. We made a recommendation about medicines management.

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. The registered manager had robust and safe recruitment procedures. The provider monitored the safety of the premises.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People’s consent in relation to COVID-19 testing and allowing visitors in the home had not been adequately sought. Staff had received regular training in a number of areas however, we found shortfalls in a number of areas. The registered manager took immediate action to address this and had started booked some of the training before the inspection.

While the provider had arrangements to check the quality of the service we found they had not complied and implemented best practice guidance in relation to infection prevention and control in line with government policy. The registered manager regularly checked the quality of the care provided and people’s experiences however the provider had not established formal oversight on the registered manager. People spoke positively about staff and the registered manager. There was a positive culture throughout the service which focused on providing care that was individualised and promoted independence.

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 05 June 2018).

Why we inspected

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.

We inspected and found there was a concern with infection prevention and control measures to prevent the spread of COVID-19, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the concerns raised about infection prevention and control, staff training seeking consent and good governance. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arranmore Park Rest Home on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following our last inspection we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of safe to at least good. At this inspection we found the provider had made the improvements required in accordance with their action plan, so the key question of safe was found to be rated as good.

Arranmore Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Arranmore Park provides accommodation in single and shared rooms over three floors for up to 35 adults, who require help with personal care needs. The home is situated in a residential area of Burscough, with the village centre and local amenities being nearby. Some rooms have en-suite facilities and a passenger lift is provided for access to the first and second floors. Some parking spaces are available at the front of the building and there is easy access to public transport links and the motorway network.

There was a registered manager in place. The registered manager assisted throughout the inspection. 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.

We found the premises to be well maintained, clean and hygienic throughout. However, the extension beyond the manager’s office on the ground floor was tired looking and in need of freshening up.

We noted one mattress to be longer than the bed base and could pose a risk to people if they sat on the end. Personal Emergency Evacuation Plans (PEEP’s) were in place. However, these could have been more informative. We made a recommendation about this.

We found a wide range of risk assessments had been conducted in relation to the environment and people’s health and social care needs. However, these had not always been updated at regular intervals. We made a recommendation about this.

People told us they felt involved in their care and making decisions. The plans of care we saw supported this information. We found people’s care plans varied in quality. Some were very informative and were written in a person centred way. Others provided basic details only. We made a recommendation about this.

At this inspection, we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We found areas covering the mental capacity act and consent to be satisfactory. People’s decisions had been made in their best interests and good information was provided around Lasting Power of Attorney. This helped to ensure people received care and support in a way which was best for them.

During our inspection we observed staff transferring people. Each manoeuvre was conducted in a safe and competent manner with people’s privacy and dignity being protected. Systems were in place to ensure accidents and incidents were recorded appropriately

Medicines were being managed safely, although there were some minor areas where improvements could have been made. The registered manager addressed these at the time of our inspection.

People had access to external health care professionals including dieticians, occupational therapists and the speech and language team. We noted meals to be presented well and these were well balanced and nutritious.

On the day of our inspection we found that recreational activities were provided in the morning and also in the afternoon. People were happy with the activities provided and were seen to be enjoying these.

Systems and equipment within the home had been serviced in accordance with the manufacturer’s recommendations and clinical waste was being disposed of in the correct manner.

We looked at how the service protected people against discrimination, bullying, harassment, avoidable harm and abuse. We found staff had received training in safeguarding adults and demonstrated a good understanding about the meaning of abuse. We found the service had made safeguarding referrals in line with the home’s policies and procedures.

We looked at the personnel records of three members of staff and found recruitment practices adopted by the home to be robust. This helped to ensure that only suitable people were appointed to work with this vulnerable client group. We found there were sufficient numbers of suitably qualified staff employed to meet people’s needs and to promote people’s safety. Staff told us they felt supported in their roles and had received training to help them understand their role and responsibilities. We looked at the training records and found that staff were provided with a wide range of training courses, as well as regular supervision sessions and annual appraisals.

Audits and quality monitoring systems were in place and these were completed regularly. Meetings were held for those who lived at the home, their relatives and staff members. People with an interest in the home had been asked, in the form of surveys about their views of Arranmore Park and the care and support provided.

The provider submitted documented evidence, as we had requested, which demonstrated that the home's action plan had been followed and that training in relation to The Mental Capacity Act had been rolled out to the staff team. This helped to ensure those who lived at the home and who lacked capacity to make decisions were appropriately supported.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with those who used the service, their relatives, support staff and the managers of the home. We also looked at a wide range of records and documents. Many of those who used the service were able to communicate with us. They all gave us positive responses to the questions we asked. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People we spoke with said they felt safe living at Arranmore Park. They told us their independence was promoted and their dignity was always respected. This was observed several times whilst we were at the home and we saw people being helped to mobilise in an appropriate manner. People's needs were taken into account enabling them to move around the environment freely and safely. Equipment was well maintained and serviced regularly. We noted a bath hoist had been deemed unfit for use. However, a new one had recently been installed. Therefore, people were not put at unnecessary risk. Those who lived at the home (or their relatives) were involved in making decisions about the care and support provided.

Evidence was available to demonstrate that, when necessary disciplinary procedures were followed in day to day practice and relevant health and safety training was provided. The home had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, although staff had received DoLS training, no learning had been provided in relation to the MCA and staff spoken with had little knowledge of this important area. The manager of the home informed us the day after our visit that she had arranged this training for the staff team.

Is the service effective?

Information was readily available about the local advocacy service, if people needed it. This meant that people could access additional support, when required. The health and personal care needs of those who used the service had been thoroughly assessed and a wide range of external professionals had been involved in their care and support.

Systems were in place to ensure the home was effectively assessed, so the quality of service provided could be consistently monitored. We saw the staff team delivering effective care and support for those who lived at Arranmore Park. Visitors confirmed they were able to see people in private and visiting times were flexible. This was observed at the time of our visit to this location.

Is the service caring?

We asked those who lived at the home about the staff team. Feedback from them was very positive. They said staff were considerate and friendly towards them and helped them to meet their needs. When speaking with staff it was clear they genuinely cared for those they supported and were observed speaking with people in a respectful and empathetic manner. People's preferences and interests had been recorded and care and support was provided in accordance with their wishes.

We talked to people about the staff team. One person told us, "They are smashing." Another commented, "They will do anything for us. They really are a lovely lot. I don't think we could be in a better place."

Is the service responsive?

People participated in a range of activities in accordance with their interests and wishes. Some people enjoyed outdoor activities, which helped to keep them involved with their local community.

Staff were seen to be responding to people well by anticipating their needs appropriately.The service worked well with other agencies and services to make sure people received care and support in a consistent way. Evidence was available to show the

home responded well to any suggestions for improvement and appropriate action was taken to rectify any shortfalls identified.

Is the service well-led?

The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result, the quality of service provided was continuously monitored. Staff were confident in reporting any concerns and they felt well supported by the managers of the service. People who lived at Arranmore Park and their relatives completed annual satisfaction surveys. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately.

You can see our judgements on the front page of this report.

We found staff to be well supported and those living at Arranmore Park looked comfortable in their presence. We also spoke with several relatives who were all very complimentary about the staff team and the managers of the home.

Comments from those living at Arranmore Park and some relatives included:

" This is a very well managed home."

"I have been so impressed with Bev (manager) and Pam (deputy manager). They are so responsive and always act on any issues immediately."

"Staff do respond well to Bev. She is marvellous. She is very much on the ball."

"There are some excellent carers, who anticipate mum's needs extremely well."

During our inspection we assessed standards relating to consent, care and welfare. We also looked at cleanliness and infection control. Standards relating to recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We found staff to be well supported and appropriately trained and those living at Arranmore Park looked comfortable in their presence. People we spoke with were very complimentary about the staff team and the managers of the home.

Methods for monitoring the quality of service provided had been established, although these could be extended in some areas. Systems had been developed, in order to protect the health and safety of those living at the home.

Comments from those living at the home included:

'It is very comfortable here. The staff are very kind to me. I can do what I want. For instance it was 9am when I got up this morning, because I fancied a lie in. I can go to bed when I want, too.'

'The staff are marvellous. We are well looked after, but we sometimes have to wait a long time for our 'buzzers' to be answered.'