Archived: Arncliffe Court Care Home

Updated 21 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection site visit activity started on 31 October 2017 and ended on 14 November 2017. It included speaking with people who used the service, their relatives, staff and visiting healthcare professionals. We spent time with people throughout the inspection to gather people’s experience of living at Arncliffe Court. An assessment of records took place which included how people’s care was planned for and delivered and systems in place for the registered provider to check that people were receiving the care and support they needed safely.

The inspection team included four adult social care inspectors, a nurse specialist advisor and two experts by experience in relation to older people and dementia. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Records looked at during the inspection included assessments of risk and care planning documents, medicines, policies and procedures; recruitment records of seven recently recruited staff, and rotas. In addition we spent time looking around people’s living environment and spent mealtimes with people using the service.

We spoke with 30 people using the service, seven visiting relatives, 26 staff members, the manager of the service and three members of the service recovery team. The service recovery team are a group of managers employed by the registered provider to work with services that require improvements. The team offer support, guidance and coaching throughout services to assist them in improving the service delivered to people.

Prior to the inspection we assessed all of the information held about the service. This information included concerns and complaints received from people, their relatives and members of the public and information sent to us by the registered provider. We spoke with the local authority who commissioned services and the local fire and rescue service to gather any information they had about the service. In addition, we contacted Health Watch Knowsley.

Updated 21 December 2017

This inspection took place on 31 October 2017, 1, 2, 8 and 14 November 2017. The visits on 31 October and 8 November were unannounced. The visit on the 14 November was unannounced and commenced at 0:600 hrs in the morning.

Arncliffe Court is a ‘care home’. 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. Arncliffe Court accommodates up to 150 people across five separate units, each of which have separate adapted facilities. Three of the units specialises in providing care to people living with dementia.

The last inspection of the service was carried out in June 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We asked the registered provider to take action to make improvements in relation to people’s safety, dignity and respect, planning people’s care and quality monitoring systems. We received an action plan outlining actions completed to date and those that were on-going. At this inspection we found that the provider had made improvements however we found further improvements were required to become fully compliant with the Fundamental Standards of Quality and Safety.

A new manager had been appointed at the service since the last inspection, however they were not registered with CQC. The new manager had put in an application to CQC to become the registered manager and this was being processed at the time of this 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.

Improvements had been made in the area of fire safety of the environment. A review of the fire risk assessment had taken place and training had been provided to staff in relation to fire procedures and equipment. Broken paving stones had been replaced to reduce the risk of people tripping and falling. Risks people faced had been reviewed and their care plans updated where required. Staff had received updated training in relation to safeguarding people.

During this inspection we identified other areas which required improvement that resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Water pipes, radiators and water shut off points were exposed and accessible to all. An electric cupboard was open with access to an electricity meter and privacy locks were missing from bathroom and toilet doors. The management team addressed these issues when they were raised to their attention. Laundry and soiled continence products were transported out of one unit using a wheelchair which posed an infection control risk.

Improvements had been made so that people had more opportunity for freedom of movement around the environment. People’s mealtime experience had improved. Dining tables were attractively set and people had a choice of drinks and condiments during mealtimes. People were supported at mealtimes in a dignified and respectful way.

We identified further areas of improvement that resulted in a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Task orientated practice resulted in people sitting in communal areas without any conversation or stimulation. Records did not always to reflect person centred care.

Improvements had been made as to how care and treatment was planned and provided in a safe way. Care plans and assessments relating to people’s needs had been reviewed and updated and further monitoring records had been developed. We identified further areas of improvement were required that resulted in a breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because care records and documents were not always completed in full or consistent.

Improvements had been made as to the effectiveness of the registered provider's quality assurance audit systems. The providers monitoring systems were being used and further checks had been implemented to measure the quality and safety of care people received. However, we identified further areas of improvement that resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because the current checks in place had not identified or actioned areas of improvement needed in relation to a safe environment for people, improvements needed in relation to care planning and records and a task based approach to care.

Improvements had been made as to how staff were deployed around the service. Rotas had been developed to clearly demonstrate on what unit staff were working. In addition, action had been taken to ensure that any gaps in the rota due to sickness or holiday were filled in advance.

Improvements had been made as to how Deprivation of Liberty (DoLS) were applied for. Following the last inspection all application for DoLS on behalf of people had been reviewed and when required a new application had been submitted.

Improvements had been made to the availability of training to staff to ensure they received up to date awareness for their role. A review of training had taken place and where required staff had undertaken refresher training.

We have made a recommendation about improvements to people’s living environment. Improvements were needed help people orientate their way around the units. No signage was available to help people identify which bedroom was theirs.

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People and their family members felt that the service was safe. Staff were aware of the policies and procedures in place for safeguarding people. Where required staff had received refresher training in relation to safeguarding people.

People's medicines were managed safely and appropriate storage facilities were in place. The registered provider had procedures in place that ensured the safe recruitment of staff.

A comprehensive complaints procedure and recording system was in place. People and their family members knew who to speak to if they wanted to raise a concern about the service.

The CQC were notified as required about incidents and events which had occurred within the service.

People were cared for by staff who had received appropriate training. Staff completed a variety of training relevant to people’s needs and their role and responsibilities. Staff completed online training and classroom based training which took place in a dedicated training room at the service. Competency checks were carried out following each training session to make sure staff understood and benefited from the training undertaken.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.