Archived: Argyle Park Care Home

Argyle Park Nursing Home is a residential care home providing personal and nursing care to 29 people at the time of the inspection. The service can support up to 31 people. The building is on three levels and is used to provide services to people with both long-term and short-term care needs.

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

Staffing levels were not always sufficient to provide safe, effective care and meet people’s needs. The over reliance on staff that were not familiar with people’s needs and preferences meant people’s needs were not always met. Call bells were not always answered in a timely manner and people were left without observation while other tasks were completed.

Processes for monitoring and improving the quality and safety of care were not robust. Audit processes were extensive and subject to review by senior managers. However, this had not always resulted in improvements to safety and quality in a timely manner. The service provided evidence of development since the last inspection, and was committed to providing high-quality, person-centred care. However, the range of concerns identified during the inspection provided clear evidence further work is required to meet regulation.

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 and in their best interests; the policies and systems in the service did not support this practice. Staff were not consistently inducted and supported to an appropriate standard. People’s needs and preferences for food and drinks were not always met. We made a recommendation regarding this.

People were not always cared for in accordance with their needs and preferences. We saw evidence people were not always treated with care and respect. Staff did not always support people in a timely manner to promote their privacy, dignity and independence. People’s privacy was not always respected by staff. For example, throughout the inspection we saw staff entering people’s rooms without knocking or checking if they were there. We made a recommendation regarding this.

Records did not always contain enough detail to instruct staff how to deliver personalised care. In some cases records had not been completed as required. We made a recommendation regarding this.

The service met the requirements of the AIS. Information was available in a range of formats to help people understand. People were encouraged to maintain relationships and take part in activities. However, people told us activities did not always take place as planned.

Medicines were managed safely by appropriately trained staff. Incidents and accidents were recorded in sufficient detail and subject to analysis to identify patterns or trends.

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 22 June 2017).

The inspection was prompted in part due to concerns received about the management of pressure wounds and issues relating to staffing levels. A decision was made for us to inspect and examine those risks. We found no concerns relating to the management of pressure wounds. Information relating to staffing levels is contained in the full report.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

Enforcement

We have identified breaches in relation to staffing levels, the quality and responsiveness of care and the management of 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 work with the 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.

This inspection was carried out over two days on 17-18 May 2017 and was unannounced.

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.

The service was last inspected in October 2016 and we found breaches of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff had been appropriately checked before they started work in the home; the home did not always support people to provide effective outcomes for their health and welfare and there was a continued failure to provided governance [management] systems to ensure appropriate monitoring of standards in the home.

At this inspection we found the home to be meeting all of the regulatory requirements. This was an improvement from our last inspection and we have revised the quality rating for the service from ‘Requires improvement’ to ‘Good’.

There were enough staff on duty to help ensure people’s care needs were consistently met. We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found recruitment to be well managed and thorough. This was an improvement from our last inspection.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed. Monitoring records and charts were updated so they provided for effective evaluation of care. This was an improvement from our last inspection.

There was now a clear organisational management structure in place. The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were effective in managing the home; there were systems based on getting feedback from the people living at the home. This was an improvement from our last inspection.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 [MCA] were followed, in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. We had some discussion, however, how this could be further improved by evidencing assessment around individual decisions; this would meet best practice and follow the principles of the MCA.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained.

Activities were organised in the home and these were appreciated by the people living at the home.

We saw written care plans were formulated and reviewed ongoing. We saw that people were involved in the care planning and regular reviews were held.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each individual person’s care needs and how they communicated these needs. People living at Argyle Park told us that staff had the skills and approach needed to ensure people were receiving the right care.

People were satisfied with living in the home and told us they felt the support offered met their care needs. People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input.

We saw people’s dietary needs were managed with reference to individual needs.

People told us their privacy was respected and maintained. When we observed staff interacting with people living in the home they showed a caring nature with appropriate interventions to support people.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

This was an unannounced inspection which took place on 9 and 10 November 2016. The service was last inspected in June 2016 and we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively monitored and evaluated. Care monitoring records such as diet, fluid and positioning charts were not completed which meant that an accurate evaluation of care needs could not be made. We served a statutory Warning Notice.

This was a comprehensive inspection and we found the service had met the Warning Notice. Care plans were being reviewed and people’s monitoring charts were [mostly] being completed.

We found further breaches of regulations, however, regarding people’s nursing care, staff recruitment and the overall management and governance of the service.

There was no 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. The new manager advised us they would be applying for registration.

We found the home did not always support people to provide effective outcomes for their health and wellbeing. We were concerned that for two people there had not been adequate monitoring and referral for medical review when they had lost excessive weight.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw not all of the required checks had been to help ensure staff employed were ‘fit’ to work with vulnerable people.

The manager was not able to evidence a full range of quality assurance processes and audits carried out internally and externally from visiting senior managers for the provider. We found the management systems for the provider were not developed and embedded to ensure the most effective monitoring.

You can see what action we told the provider to take at the back of the full version of the report.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

We saw there were good systems in place to monitor medication safety and that nursing staff were supported with updates to help ensure their competency so that people received their medicines safely.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis where obvious hazards were identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

There were two people being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The two people had been assessed and placed on a standard authorisation from the local authority and these were being monitored by the manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice. Meal time was seen to be a relaxed and sociable occasion.

People we spoke with said they were happy living at Argyle park. They spoke about the nursing and care staff positively. People felt the general atmosphere in the home had improved over the past six months. When we observed staff interacting with people living at Argyle park they showed a caring nature with appropriate interventions to support people. People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained. We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs on an individual basis and how they communicated these needs. People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care.

We found there were sufficient staff to meet peoples care needs.

We asked people how their care was managed to meet their personal preferences and needs. Most people were satisfied with living in the home and felt the care offered met their care needs.

Most people we spoke with said they were consulted about the care planning and we saw some of the care plans were signed or showed evidence of people’s input. The new manager was gradually auditing all of the care files to ensure people had had their care reviewed.

Social activities were organised in the home. People said there were now more social activities and this helped contribute to the overall feeling of wellbeing for people.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were good records of complaints made and the manager had provided a response to these.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

We asked the provider to take action to address these concerns. We served the provider with a statutory Warning Notice regarding the provision of sufficient care staff.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 8 June 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover four questions we normally asked of services; whether they are 'Safe', ‘Effective’, ‘Responsive’ and ' Well led'. The question ‘was the service caring’ was not assessed at this inspection.

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

Argyle Park Nursing Home caters for the needs of older people. It has 31 en-suite bedrooms.

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.

We found the service had made improvements and all but one of the breaches we had previously found, had now been met. We still had concerns regarding the way care was planned and monitored in the home.

At our last inspection in January 2016 we found people’s care plans evidenced an individual approach to care that was not reflected in daily care records or observations we made. On this inspection we found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively monitored and evaluated. In some instances people’s care needs was not included or updated in the care planning. Care monitoring records such as diet, fluid and positioning charts were not always completed, which meant that an accurate evaluation of care needs could not be made.

We found there was a clearer understanding of the principles of the Mental capacity Act 2005 and how this should be applied with people living in the home. We saw examples where people’s capacity had been assessed with regard to key decisions they were making and where they lacked capacity, decisions had been made in people’s best interest.

We found that staff and managers were clear on their responsibilities with reporting and investigating allegations of abuse. The registered manager had reported through incidents and allegations of possible abuse and liaised effectively with the Local Authority safeguarding team.

We had previously served the provider with a warning notice to improve the care staff numbers to ensure there was sufficient staff to carry out care effectively. We found the provider had taken action and this had improved.

We found action had been taken to improve the management and governance of the home. We found the provider was supporting the registered manager and had developed clearer and more effective systems to monitor standards in the home. This included getting information from people so that the service could be developed with respect to their needs and wishes.

You can see what action we told the provider to take at the back of the full version of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and well cared for.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents and complaints and concerns. This reduced the risks to people and helped the service to continually improve.

The home had some supporting policies and information around mental capacity and consent to support people who may not be able to make decisions about their care or treatment. The manager showed an understanding of the Mental Capacity Act 2005 which is the legislative framework for the decision making process regarding people who may lack mental capacity. A recent review had included assessment of whether the person was being deprived of their liberty. The home was therefore able to show they had acted appropriately in ensuring the person's rights were maintained and that an appropriate assessment had taken place.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with appropriate referrals being made to external professionals who could assess and support the care of people in the home. Care needs had been identified in care plans and these had been reviewed. We looked at the care of three people and the care plans reflected their current needs.

Visitors confirmed that they were able to see people at any time as visiting times were flexible. They said that staff kept them informed and they were therefore always up to date with any changes to people's care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are very kind', 'The staff have organised district nurses to attend for some of my care'', ''My care is organised really well most of the time. It depends if they have enough staff ' sometimes it can be a struggle but the staff work so hard' and 'The staff are very good and are on hand to help me with my care when I need it.'

People using the service and/or their relatives completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities. People were supported as their care needs changed. This was particularly evident with changing medical and nursing care needs.

Following our last inspection in April 2014 we had made a requirement for the provider to improve the way records were maintained. The service had responded by sending an action plan. We found that most of this had been achieved and things had improved.

During the inspection we fed back some concerns about staffing in the home. The manager acted promptly and made changes to ensure care was delivered more effectively. This showed the new management team in the home were responsive to feedback from regulatory bodies.

Is the service well-led?

The service had a quality assurance system. Records showed us that any shortfalls identified as part of this had been addressed. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The new manager of the home was in the process of applying for registration to the Care Quality Commission to become registered at Argyle Park.

We looked in detail at three peoples care records. We found improvements in that the assessment and care planning records were clearer, better organised and had been reviewed regularly.

We found some anomalies with records that supported peoples care such as charts to monitor people's daily health and welfare. Some were not fully up to date and accurate. This mean that important aspects of people's care were not being recorded and monitored in enough detail.

We looked in detail at three people's care records and found they were not up to date and accurate. Important information such as, daily records of care were not being carried out consistently and lacked necessary detail. Plans of care had not been updated effectively. Evidence of people's consent to care had not been recorded.

Records confirmed staff had received infection control training. Infection control policies and procedures were in place to support staff maintain the necessary hygiene standards.

There were systems in place for the safe administration of medication. Staff we spoke with were knowledgeable about the home's procedures to support people with their medication

The home used people's monthly assessments to provide an indication of their dependency level. This was used to help ensure the appropriate number of staff were on duty at different times of the day to meet people's needs.

Relatives we spoke with told us they would raise concerns with the manager or their relative's key worker. Three relatives told us they felt the manager listened and their concerns were acted upon.

Relatives we spoke with confirmed that records in people's rooms were not up to date and this meant they were unsure of what care had been given by the staff.

During our inspection we spent time with people who lived at the home and invited them to share with us their views and experience of the care they received. One person said 'I have settled in and like it here, I feel very safe.' Another person told us 'It is managed particularly well; it has good facilities and trips arranged for us.'

During our inspection we observed staff being attentive to the needs of the people, their tone and manner was respectful and caring; Showing dignity and respecting privacy as they delivered the care.

Staff told us that they felt supported by the new management and felt they worked well as a team with their peers.