Archived: Arncliffe Court Care Home

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.

Arncliffe Court is registered to provide care for 150 individuals. The service is situated in Halewood, Merseyside. The service is owned and operated by BUPA Care Homes Ltd. The property is a large purpose built residence that has five separate units for people with varying needs. Woolton, Paisley and Childwall units provide residential and personal care for people. Speke unit provides residential and nursing care to people and Gatacre unit provides residential and nursing care to people with enduring mental health illness.

At the time of this inspection a registered manager was 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.

During this inspection we found breaches in Regulations 10, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

People living on Gatacre Unit were not always treated with dignity and respect. We identified task based care and support during one day of our inspection. People were not always offered choices and there was a lack of communication and social interaction within the unit.

Staffing levels on all units were assessed on a monthly basis. However, visitors and staff told us and we saw that staff were frequently moved around to other units within the service throughout the day. Due to the movement of staff it was difficult to establish where staff were working throughout the day.

The quality assurance systems in place were not effective. We identified a number of issues relating to staff deployment, health and safety, training, care planning documents and supplementary recording charts that had not been identified or addressed by the registered provider. This also included a lack of person centred care delivered to people living on Gatacre Unit.

The registered provider had systems and policies in place in relation to the Mental Capacity Act 2005. Staff practice during one day on Gatacre Unit demonstrated that people were not given choices as part of their daily routine. We identified two applications for Deprivation of Liberty Safeguard authorisations that did not consider all of the current restrictions in place for both people.

People had access to regular drinks and food. Where people’s fluid intake was being monitored we saw that no action had been taken when two people had not consumed their recommended daily fluid over a period of a few days. This put the individuals at risk of dehydration.

Each person had their own personal care plan. However, not all of the care planning documents to support people’s needs contained detailed up to date information. This put people at risk of not receiving the care and support they may require.

The registered provider had a comprehensive staff training programme. Records demonstrated that not all staff had received up to date training for their role in line with the registered provider’s training schedule.

People’s access to communal areas on Gatacre Unit was restricted as the conservatory area was being used to store equipment for the unit. A number of paving stones required attention as they posed a tripping hazard. The risk of tripping around the outside areas that people accessed on a regular basis had not been considered. The registered provider had failed to ensure that the fire risk assessment had considered and mitigated any risks in relation to the main gates of the service being locked through the night.

The majority of people and their family members felt that the service was safe. Staff were aware of the policies and procedures in place to safeguarding people.

People’s medicines were managed safely and appropriate storage facilities were in place.

The registered provider had good recruitment procedures in place that ensured that appropriate checks were carried out prior to a new member of staff beginning their role.

A comprehensive complaints procedure and recording system was in place. People and their relatives 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six month if they do not improve. This service will continue to be kept under review, and if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration.