Ardent Residential Care Home

Ardent Residential Care Home is a care home without nursing registered to provide accommodation and care for up to 23 people. People living at the service are mostly older people, some of whom may be living with dementia. At the time of our inspection there were 14 people using the service.

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

People told us they were happy with the care they received. Comments from people included; “They always bring me a cup of tea and chat with me.” Another said; “I like it here.” People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

The environment was safe and there was equipment available to support staff in providing safe care and support. However, the registered manager discussed the environment with us, which required updating and attention, with some areas found to be neglected and in a poor state of repair. A tour of the premises showed areas in need of improvement. Previous inspections had noted the need for improvement works and we had made a recommendation. We found that not all repairs and updates had been completed as stated on the services action plan, sent to us after the last inspection.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met. However, we observed times when there was not much going on for people on the day of the inspection. The registered manager said they were actively looking to employ an activity coordinator to focus on this. Staff knew how to keep people safe from harm.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Medicines were ordered, stored and disposed of safely.

People were protected from abuse and neglect. People's care plans and risk assessments were clear. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

People were supported by staff who completed an induction and received appropriate training and support to enable them to carry out their role safely. This included fire safety and dementia care training.

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; the policies and systems in the service supported this practice.

People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the registered manager was available, assisted them daily and helped cover shifts when some staff had been absent with COVID-19. They went onto say how the registered manager was approachable and listened when any concerns or ideas were raised. One staff member said; “Very supportive.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 December 2022).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service, care provider and staffing.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains requires improvement. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Effective and Well led sections of this full report.

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

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 breaches in relation to Premises and Equipment. The service remains in breach of Good Governance and Notification of other Incidents.

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

Ardent Residential Care Home is a residential care home providing personal care to up to 23 people. The service provides support to older people living with dementia, mental health needs, and/or physical difficulties. At the time of our inspection there were 14 people using the service.

At the last inspection the service was called St Anne's Residential Home. Since the last inspection the provider has changed the name of the service to Ardent Residential Care Home.

The service is situated in a residential area in the centre of Plymouth. There are three floors at various levels accessed by stair lifts.

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

Improvements had been made to the environment and further improvements were planned. We made a recommendation about the way the environment was used to meet people’s needs.

People’s needs had not all been assessed. Information about how people preferred to spend their time or how staff could provide them with meaningful opportunities had not been sought or recorded. Quality assurance processes did not review this aspect of the service which meant any improvements were not identified or acted upon.

People were not offered a range of opportunities tailored to their interests and preferences. People spent a significant amount of their time not engaged. Staff did not regularly engage with people beyond offering food, drink or care tasks.

People were not always encouraged to eat a balanced diet and one person who required a modified diet had sometimes been given food that increased their risk of coughing or choking.

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 sometimes made decisions for people; however, there was no record showing the individuals didn’t have the capacity to make the decisions themselves.

Where areas for improvement had been identified, action had been taken; however, quality assurance systems had not monitored all the areas for improvement we identified. Where systems to seek feedback about the service were not successful, alternatives had not been considered.

Statutory notifications had not been submitted to the commission, as required by the regulations.

People told us they were given choices throughout the day and staff asked for consent before providing care or support.

Staff had received training relating to their roles. Where improvements or changes were identified, the registered manager allocated further training to staff to help keep their skills and knowledge up to date.

People and staff said they were happy with the service and knew how to raise any concerns.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 07 June 2022) and there was a breach of regulations. The service remains rated requires improvement. The service has been inspected three times since 22 September 2021. Each inspection was a focused inspection and has been rated requires improvement.

At this inspection we found some improvements had been made, however we found further breaches of regulations.

At our last inspection we recommended that the provider made significant improvements to the environment. At this inspection we found action was ongoing.

Why we inspected

We carried out an unannounced focused inspection of this service on 14 May 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when, to improve the environment.

We undertook this focused inspection to check they had followed their action plan, to confirm they now met legal requirements and to provide a rating for the responsive key question. This report only covers our findings in relation to the Key Questions effective, responsive and well led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

At this inspection we have identified breaches in relation to mental capacity, person centred care, statutory notifications and the governance of the service.

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.

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

At the previous inspection we found fire retardant furniture had not been considered for one person, who at times, smoked in their bedroom. At this inspection we found improvements had been made. The registered manager had liaised with the fire service. They had replaced furniture with government approved fire retardant furniture and updated risk assessments. Smoking was only allowed in the external area of the home.

At the previous inspection we found there was no method in place, such as the use of a staffing dependency tool to ascertain whether staffing levels met with people's individual needs. At this inspection improvements had been made.

At the previous inspection we found governance systems were in place to help capture where improvements were needed, however they had not always been implemented robustly. At this inspection improvements had been made.

The homes environment required more improvement to make it a comfortable place for people to live. We have made a requirement for the provider to address this.

Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow.

There were processes in place to prevent and control infection at the service, through regular COVID-19 testing, additional cleaning and safe visiting precautions.

There were enough staff to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the service.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training, and this ensured all staff received the training and updates needed to provide safe consistent care.

Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by senior staff and the manager.

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; the policies and systems in the service supported this practice.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals.

The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities as a registered manager.

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

Why we inspected

We undertook this inspection to check a previous breach of regulation had been met.

The last rating for this service was requires improvement (published 6 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 monitor the service and will take further action if needed.

We have found a breach in relation to the condition of the environment. The provider had not ensured the premises used by people were suitably decorated and had the necessary adaptive equipment to improve people’s quality of life and promote their wellbeing. This was a breach of Regulation 15 (Premises and Equipment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

St Anne’s Residential Home provides residential care for older people living with dementia, mental health needs, and/or physical difficulties. The service is registered to accommodate 23 people. At the time of our inspection there were 15 people living at the service.

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

People told us they felt safe living at the service, and were cared for by kind staff, however at times they felt they waited too long for support. People were involved in the development of the service. For example, people were part of the interviewing process for new staff and were invited to staff meetings.

People’s families were welcome at the service, but the registered manager was understandably cautious in ensuring people remained safe, (during the Pandemic) in respect of COVID-19.

People lived in a service where infection, prevention and control was being managed safety. However, aspects of fire safety had not always been considered in respect of smoking. Immediate action was taken at the time of the inspection to protect people.

Overall, people's medicines were being managed safely however the system to administer medicines across the service required improving. The registered manager took prompt action following our inspection to make the necessary improvements, and also contacted the clinical commissioning group (CCG) medicines optimisation team for further support and guidance.

People lived in a service, whereby there was a culture of learning and reflection which meant when things went wrong, action was taken to make improvements and to help reduce re-occurrences.

People's care records were individualised, detailed and reflected their needs in line with the Equality Act 2010. People’s individual beliefs and cultural diversity were known and respected.

People told us social engagement and stimulation did not always meet with their likes, preferences and wishes. The registered manager had already recognised this as an area requiring improvement and explained action had been taken to recruit an activities person who would be commencing employment in the coming weeks.

People, relatives and staff told us they felt the service was well managed and we observed a warm and friendly atmosphere, whereby staff spoke with people in an inclusive manner. The provider was in the process of strengthening the management team, by recruiting a deputy manager.

Systems designed to monitor the quality of the service were in place to help capture where improvements were needed, however they had not always identified when improvements were required.

The registered manager was a member of the Skills for Care outstanding managers network and attended local authority care home forums. This helped to enhance their ongoing knowledge, share new ideas and become aware of innovation occurring within the sector. The registered manager worked in partnership with key organisations such as local authorities, health, and safeguarding teams to ensure service development and joined up care for people.

We have recommended that the provider strengths its governance processes to ensure systems in place to monitor the safety and quality of the service are more robust.

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

Rating at last inspection (and update)

The last rating for the service under the previous provider was Good published on 01 August 2018. At this inspection the rating has deteriorated to Requires improvement.

Why we inspected

We received an increasing number of whistleblowing concerns in relation to the leadership of the service, the safe management of people’s needs, staffing levels, training, medicines, and environmental safety. As well as infection, prevention and control, prompting people’s social wellbeing, dignity and respect.

As a result, we undertook a focused inspection to review the key questions of Safe, Caring and Well-led.

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 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.

We found one breach of regulation and made a recommendation for the provider to improve their governance arrangements in respect of fire safety.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe 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 St Anne’s Residential Home on our website at www.cqc.org.uk

Follow up

We will request an action plan for 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.