22 Argyll Street

Updated 13 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by 1 inspector.

Service and service type

22 Argyll Street is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. 22 Argyll Street is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post, but they had recently stopped working at the service. The provider’s service manager was supporting the management of the service. The provider had appointed a new manager, but they had not yet started employment. We were assured they would submit an application to register within an appropriate timescale. The provider’s service manager supported this inspection, and we will refer to them as ‘service manager’ throughout this inspection report.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 13 April 2023 and ended on 25 April 2023. We visited the service on 13 and 17 April 2023.

What we did before the inspection

We reviewed information we had received about the service, including notifications. Notifications are information about specific important events the service is legally required to send to us. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who live in the service and 4 relatives. We spoke with 6 members of staff including the service manager, senior staff and care staff. We reviewed a range of records. This included 6 people's care records and 8 people’s medicines records. We looked at 3 staff files in relation to recruitment and induction. A variety of records relating to the management of the service, including accident and incident records, safeguarding and policies and procedures were reviewed. We received feedback from 3 external professionals.

Updated 13 May 2023

About the service

22 Argyll Street 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. 22 Argyll Street provides accommodation and support for up to nine adults, who have a learning disability, physical disability and/or Autism. At the time of the inspection, there were nine people living at the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Risks associated with people's care were not always fully assessed and some care plans lacked sufficient detail to mitigate those risks. This included safely supporting people and nutritional risks that could impact on people's health. The provider took immediate action to make the improvements needed.

Systems in place for storing and administering medicines were safe. Staff had received training and had their competency to administer medicine safely, checked. However, information about when people had ‘as and when required’ medicines required more detail. This was to ensure staff would always be able to recognise when this type of medicine needed administering.

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. However, the policies and systems in the service did not always support this practice. Mental capacity assessments (MCA) were not always in place where they should be.

People's nutritional needs were met, and they were supported to have a healthy and varied diet. However, information about known risks such as when people required a modified diet, were not always sufficiently detailed. The provider took immediate action to make the required improvements.

The provider’s governance processes in place failed to identify all the shortfalls we found. The provider took immediate action to make the required improvements.

Right Support: People were supported have choice, control and independence. They were supported to participate in activities they enjoyed and be active members of their community.

Right Care: It was clear staff knew people well and provided caring support to each person. We observed staff speaking to people with kindness and patience and using some of the agreed communication techniques described in care plans. People were supported by staff who respected their dignity, privacy and human rights and were involved in decisions about their own life.

Right Culture: The vision, values, attitudes and behaviours of the management team and care staff, supported people to be confident and empowered in living in the community. However, some care records needed to be improved to consider language used and demonstrate an improved understanding of the MCA.

There were enough staff to meet people's needs safely and provide person centred care. Staff had received appropriate training and support to enable them to meet people’s needs. They received supervision and had their competency checked, to ensure they developed and maintained their skills and were supported in their role.

People’s needs had been assessed and care plans were person centred and contained information about their life history, care needs, what and who was important to them, and how their needs would be met. End of life care plans were in place, which were person centred and captured people’s wishes well.

People told us they liked the staff and felt safe with them. Staff had received training in safeguarding and were able to describe what actions they would take should they witness or suspect abuse. Accidents, incidents and safeguarding records were made and there were processes in place to ensure these were reviewed and any lessons learnt if required. There was a complaints policy and people, and their relatives knew how to raise concerns.

The home was clean and tidy and in good repair; this meant infection control risks were managed. Staff wore PPE when needed.

A new manager was commencing work in the service and was being supported by the service manager. The senior management team demonstrated they were committed to continuous learning and improving the service, to ensure action was taken where we identified improvements were needed.

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

Rating at last inspection

This service has a new provider and was registered with us on 19 December 2022, and this is the first inspection. The last rating for the service under the previous provider was Outstanding, published on 8 March 2019.

Why we inspected

The inspection was prompted in part due to concerns received about medicines and the management of the service. A decision was made for us to inspect and examine those risks.

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 have identified a breach in relation to good governance 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.