Arthur Court

Arthur Court is a residential care home providing personal care to up to 19 people. The service provides support to people with a variety of mental health conditions, and some people were autistic or had a learning disability. At the time of our inspection there were 16 people using the service, with 4 people being in receipt of personal care.

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

People, relatives and healthcare professionals gave positive feedback about Arthur Court. However, we found that guidance was not always in place to inform staff how best to support people. When people moved into the service staff completed assessments, however the written assessments were not robust. Accident and incident oversight was not always documented and used to inform and update care plans. Checks and audits were not effective in identifying and making improvements identified during the inspection.

Medicines were managed safely. People told us they felt safe living at the service. The service was clean and well maintained.

There were sufficient staff in place, who received training and support to meet people’s needs. Staff worked with healthcare professionals to provide joined up care to people. People told us the food was good at the service, and people were encouraged to maintain a healthy balanced diet. The service was homely, and people’s rooms were personalised.

There was a positive culture within the service. Staff interactions with people were kind and compassionate. People told us they had positive relationships with staff. People were supported to be as independent as possible. Staff, people and their relatives felt involved in the service, and were committed to make improvements.

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 however did not always this practice.

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.

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 outstanding (published 6 October 2016).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement and Recommendations

We have identified breaches in relation to risk mitigation and 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.

When we inspected on 9 April 2019 we found that people were not in receipt of ‘personal care’ and the regulated activity was therefore not being provided. As a result we are not able to report in the usual way in respect of the five domains Safe, Effective, Caring, Responsive and Well led and the associated Key Lines of Enquiry or issue a rating.

Because of finding that no regulated activity was being provided, the location may be removed from the CQC register because CQC can only regulate locations where a regulated activity is being provided.’

There was a registered manager in post who was available in the service Monday to Friday and included in a telephone on call rota at weekends to advise staff if needed. A registered manager is a person who is 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.

People were provided with a safe, clean environment that was maintained to a high standard, with all safety checks and tests routinely completed. There were enough skilled staff to support people and provide continuity, and the provider implemented recruitment procedures quickly when staff left, with an emphasis on recruiting skilled qualified staff. New staff were inducted appropriately into their role and given opportunities to meet regularly with members of the management team individually and in staff meetings, they said that they felt well supported and listened to.

Staff understood how to keep people safe and protect them from harm, they understood how to respond to emergencies that required them to evacuate the building quickly and safely. It was recognised that some restrictive practices were necessary although there was a clear culture of least restrictive practice and positive risk taking embedded across the service. Risks were appropriately assessed to ensure measures implemented kept people safe.

People were encouraged by staff to make everyday decisions for themselves, but staff understood and were working to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so. The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for themselves.

There was a strong rehabilitation focus helping people to regain a meaningful life. Staff worked in partnership with people to promote and encourage their rehabilitation and skills development and included them in every aspect of their support. People were placed at the centre of the service and their involvement and empowerment was clearly embedded. They were able to contribute to their own care records through regular meetings with their key workers (in this service the keyworker was involved in planning with the person how their care needs were met, and agreeing with them the amount of assistance they required) this may also involve participating in discussions about the persons support with professionals and attendance for example at reviews. They were treated with dignity, respect and kindness and their relationships with staff were positive. People understood how to complain and felt confident of approaching staff with any concerns.

Medicines were well managed. People were encouraged to eat healthily and chose from a selection of food provided for them, they had opportunities to self-cater. Their health and wellbeing was monitored closely and specific staff had the responsibility for doing this each month as a preventative measure; any issues arising from these checks were quickly alerted to health professionals.

People were supported to develop relationships and maintain those that were important to them, there was excellent support for them to use new technology to do so and free access to telephone and internet was available to them, many were supported to purchase tablets and smart phones and given support in how to use them. Video link facilities were available so that people could more easily maintain their relationships with the people close to them, staff also used video link with external care co-ordinators who might otherwise be unable to attend care programme meetings locally due to distances so that everyone could contribute to care decisions.

Staff worked closely with their mental health team partners in the local teams and allocated care co-ordinators to ensure that peoples changing needs were identified and solutions found and also to celebrate achievements.

People told us they were happy, they enjoyed the freedoms the service provided and the variety of activities offered in house and in the community, they were supported to access educational and voluntary work opportunities. Professionals held the service in high regard and thought the service was effective in working with people with complex mental health needs and supporting, motivating and preparing them for life in the community.

People were routinely asked to comment about the service and their views were analysed and action taken where improvements could be made. People could join in at the end of management meetings which were open to all. The providers took an active interest in the service and were present several times each week, speaking with staff and the people supported, they attended weekly management meetings and ensured identified shortfalls were addressed.

People had had their needs assessed, and care plans developed to meet these. People's physical healthcare needs were responded to. The service worked with other health and social care professionals to ensure that people's needs were met.

People were satisfied with the food provided by the service. Some of the people using the service cooked their own food.

The service was adequately maintained, and was undergoing refurbishment at the time of the inspection.

Staff received adequate training and supervision.

The interactions we saw between staff and people using the service were friendly and respectful. The people we spoke with said they liked the staff and found them supportive. One person said 'they're very good' and another 'we're well looked after here.' One person told us 'it's a good place' and that 'the people who work here have a lot of respect for me.' The people we spoke with told us what they liked to do, and said they were able to make choices about their lives and pursue their interests.

The service had effective systems in place for the handling of medication. We saw that there were processes for the safe ordering, storage, administration and disposal of medicines.

There were effective recruitment and selection processes in place. The service had processes in place for the recruitment and management of staff, and the staff working there had had the necessary recruitment checks.

Records were kept of people's care and both these and staff records were updated and kept securely by the service.