Argyle Residential Home

Argyle Residential Home is a residential care home providing personal care to up to 28 people. The service provides support to younger adults and older adults, including those with dementia. At the time of our inspection there were 27 people using the service. The home is split over a number of floors, with people’s bedrooms located on each. People have access to communal spaces and a dining area.

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

The providers governance systems did not always ensure effective oversight of the service. Audits were not completed for some key risk areas within the service. Quality assurance checks that were completed did not always identify improvements required to ensure people’s safety.

Some aspects of the environment and equipment used were not always safe. People’s main risks were identified and assessed, but some improvements were required to ensure consistent detail was recorded in relation to specific health needs. Overall medicines were managed safely, but some minor improvements were required to ensure room temperature checks and medicine profiles were in place. There were enough suitably trained staff to meet the needs of people using the service. The home was clean and well maintained, with staff adhering to current COVID-19 guidance. People told us they felt safe and staff understood how to protect people from the risk of abuse.

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.

A positive culture was promoted within the home. People told us they liked living at Argyle Residential Home. Staff and leaders promoted person centred care, knew people well and respected their equality characteristics. Feedback was actively sought and used to improve people’s experience at the home. There were positive working relationships with a range of different professionals and stakeholders.

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 2 December 2017).

Why we inspected

We carried out a focused inspection due to the age of the previous rating.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. We are assured the registered manager has taken action following the inspection to address our concerns.

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

Enforcement and Recommendations

We have identified a breach in relation to 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.

At our last inspection on 28 July and 14 August 2015 the service was found to be fully compliant and was rated ‘Good’ in all areas.

A registered manager was in post and present on the day of the 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.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Is the service safe?

The three people we spoke with told us that they felt safe and that they liked the staff. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm. People were also protected from the risk of abuse as staff showed that they had received training and were clear about their responsibilities to recognise and report any concerns.

The provider was taking appropriate action to ensure that practices to protect a person from the risk of harm were lawful and in keeping with the Mental Capacity Act(MCA) and the Deprivation of Liberty Safeguards. The MCA ( 2005) is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes and preferences have affected the decision and how they were involved in the decision making process.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for recording and handling medicines.

Is the service effective?

People we spoke with told us, and our observations confirmed, that people were happy living at Argyle Residential Home. The staff who we spoke with told us that they enjoyed their job. One person said, “It’s great. I love working here. The staff work together really well.” It was clear from our observations and from our conversations with staff and the deputy manager that staff knew people’s needs well. We saw care plans in people’s records which provided staff with detailed guidance about the ways in which each person preferred to be supported.

We saw that people were supported to eat and drink sufficient amounts to meet their needs and were provided with a choice of suitable and nutritious food and drink.

Is the service caring?

We saw that people using the service enjoyed a good relationship with the staff who treated them with kindness and in a friendly manner. One of the staff we spoke with said, “The people who live here are fantastic. We really enjoy caring for them.” We observed that people’s individual requests were listened to and that staff spoke to people and responded to them in a respectful way. People who used the service spoke highly of the staff. One person said, “Everyone here is fantastic. Nothing is too much trouble.”

Is the service responsive?

People’s care and support needs were regularly re-assessed by the management team and the staff at the service. Care plans included people’s preferences and their likes and dislikes to ensure that care and support were provided in a way they wanted them to be. We saw and heard that the provider offered support in a very kind and caring manner to people who were approaching the end of their life.

Staff received mandatory training in areas such as moving and handling, safeguarding of vulnerable adults, food hygiene and infection control. Staff also received a range of additional training including how to meet the needs of people living with dementia.

Is the service well led?

There was effective leadership in place, which ensured that people’s needs were met and the service provided was of a good quality. One member of staff said, “We have good support from the management team.” We saw that staff received supervision support from the manager and that appraisal meetings offered them the opportunity for professional development. The provider had put a range of quality assurance systems in place to ensure that all aspects of the service were monitored and improvements made where necessary.

We found that the provider was compliant with the regulations in four of the areas which we assessed. The provider was non-compliant with regulation 13, management of medicines. If you wish to see the evidence supporting our summary please read the full report.

We returned on the 12 July 2013, and also asked the provider to send us information relating to Outcome 2.

We did not on this occasion (12 July 2013) speak with anyone who lived at the Argyle Residential Home.

During the inspection visit, we we taken on a tour of the building and grounds, reviewed documentation, including care plans, spoke to people who live at the care home and spoke to staff.

We spoke with three people who live at the Argyll Residential Home. They told us that: “I am very happy here, the staff are marvellous, nothing is too much trouble and they are all wonderful.” Another person said: “I don’t think I could be looked after any better, the staff work very hard, and they are fantastic.” A third person said: “I’ve got a lovely room, big, bright and a wonderful view out.” They also said: “I’ve got everything I need, and I am very satisfied here.”

We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This involved us sitting in the lounge and dining room and observing for an hour over the lunch period. This enabled us to see how the staff spoke with people who live at the home, and how they offered help and support. This observational technique is also very useful for identifying issues relating to privacy, dignity and respect. Our observations showed that people were treated with respect, and that staff had good relationships with the people who live at the care home. We saw staff offering support and encouragement in a pleasant, friendly and helpful manner.