Archmoor Care Home

Archmoor Care Home provides personal care for up to 20 older people in one adapted building. There were 19 people accommodated at the home at the time of the inspection.

We found the following examples of good practice.

The provider had staff who were trained and skilled to ensure people were admitted safely and continued to be supported in the service in accordance with national guidance. Infection prevention and control (IPC) policies and procedures were kept under review. We found safe processes were in place.

The registered manager was accessing testing for people living at Archmoor and staff. Records indicated safe processes were followed in response to any positive COVID tests, in line with government guidance. There were enough staff to provide continuity of support should there be a staff shortage. A staff member said, “No issues with staffing and Covid Guidance, the manager always puts residents health first and follows the rules.”

The home was clean and hygienic. One person said, “It’s very clean they seem to do extra since the pandemic.” There were designated domestic staff and cleaning schedules were followed. Environmental audits were undertaken, and any shortfalls were being addressed. In addition, a recent infection control visit had been completed. The report made recommendations and the registered manager had completed an action plan to address the issues.

There were enough stocks of personal protective equipment (PPE). We observed staff and management team were using PPE correctly and there were procedures in place to support staff with its use. Staff had received training in the use of PPE and infection control. Signage was in place to remind staff, visitors and people about the use of PPE correctly. Staff we spoke with confirmed the management team were strict when it came to using the right protective equipment to ensure the people were protected from Covid 19.

The registered manager was facilitating safe visiting in line with government guidance. They had recently updated their visiting policy to ensure the correct guidance was followed. One person said, “I have not had any issues with family visiting since the pandemic has calmed down.” In addition a relative spoken with confirmed they had no issue with visiting and felt they were accommodated by the staff to suit their needs.

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

The administration of medicines was not always safe. Safeguarding policies, procedures and staff training helped protect people from abuse. All necessary checks on staff and the environment were undertaken to keep people safe. Risk assessments helped protect the health and welfare of people who used the service.

Notifications which are required to be sent to the Care Quality Commission had not been undertaken. The manager was completing audits to improve the service. The registered manager attended meetings to discuss best practice topics with other organisations to improve the service. People who used the service and staff said the manager was available and approachable. People who used the service, staff and relatives were able to air their views about how the service was run.

People were supported to live healthy lives because they had access to professionals, a well-trained staff team and choice of a nutritious diet. The service worked with other organisations to provide effective and consistent care. 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 were treated as individuals which helped protect their dignity. Staff were trained in equality and diversity. People's equality and diversity was respected by a caring staff team and where they wanted they were supported to continue with their religious needs.

We saw the service responded to the needs of people by providing meaningful activities, having regularly reviewed plans of care and any concerns acted upon. Staff training enabled them to care for people at the end of their lives. There was a system to respond to complaints.

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 14 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection. We found evidence the provider needs to make further improvement. Please see the safe and well-led domains of this full report. The provider took action to mitigate the risks found.

Enforcement

We have identified breaches in relation to Regulation 17(2)(c) Good Governance, for a failure to maintain accurate records for the administration of medicines and a possible breach of Registration Regulation 18(2) and (4)(a) failure to notify incidents.

Please see the action we have told the provider to take at the end of the report.

Since the last inspection we recognised that the provider had failed to comply with a condition of registration (s33 Health and Social Care Act 2008) Registered Manager Condition. The provider accepted a fixed penalty and paid this in full.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Archmoor Care Home 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. The home can accommodate up to 20 older people, some of whom were living with dementia. At the time of this inspection there were 19 people using the service.

People’s experience of using this service:

People felt safe and told us that staff were kind and caring. There was a calm and relaxed atmosphere during the home during the three days that we inspected.

There was good feedback from visiting health and social care professionals about the care provided and about the friendliness of the care staff.

There were continued concerns about the quality of the recording in both care plans and in medication administration records. There were concerns about the application of the Mental Capacity Act 2005.

Quality assurance systems would benefit from a review to ensure that they are targeted, thorough and effective.

There were significant concerns reported by people and their relatives about the lack of activities and the impact this could have on people’s wellbeing. The wellbeing principle is central to the Care Act 2014.

Rating at last inspection:

This service has been rated requires improvement at the last two inspections including the last inspection (published 9 April 2018).

Why we inspected:

This was a planned inspection based on the current timescales for returning to re-inspect services rated requires improvement overall.

Follow up:

We will continue to monitor the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Archmoor Care Home is registered to provide accommodation for up to 20 older people who require personal care. There were 17 people using the service at the time of the inspection. We last inspected Archmoor Care Home on 31 January and 01 February 2017 where we found there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines not being managed safely, unguarded radiators and pipework in parts of the home that posed a risk of harm to people and records that are necessary for the management of the home were either not in place or were incomplete.

Following the last inspection of 31January and 01February 2017 we required the provider to take action to make improvements. The provider sent us an action plan informing us they had taken action to ensure the regulations had been met.

During this inspection we found that records necessary for the management of the home were in place. We found however that the provider had not addressed the issue of the unguarded radiators and pipework and although there had been some improvement in the management of medicines, the recording of medicines was not safe.

During this inspection we found there were further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The care records contained guidance for staff on how people were to be supported and cared for. They did not however reflect the person’s current care needs as they had not been updated when a person’s needs had changed. We also found that risk assessments in relation to care and health issues had not been reviewed as often as they should have been. In addition we found the provider had failed to provide the CQC with information that is required by legislation. This was in respect of the Provider Information Return (PIR). This is a form that asks the provider to give us some key information about the service.

You can see what action we have told the provider to take at the back of the full version of the report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. Full information about the CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Although systems were in place to monitor the quality of the service provided we have recommended they need to be improved, as they had failed to identify the issues of concern we found during the inspection.

We have recommended there is a more effective system in place so that information necessary for the running of the home is more easily located.

We have recommended that the induction programme in place for new staff be improved to ensure staff are prepared for their role by helping to develop their skills, knowledge and understanding.

People's rights were protected as the manager knew the procedures to follow if people were to be deprived of their liberty. There was no evidence however to show how the manager had determined that an application to deprive a person of their liberty was required.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience. People who used the service told us they enjoyed the range of activities that were provided.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People told us they enjoyed their meals. We saw that food stocks were good and people were able to choose what they wanted for their meals.

Specialised training had been provided to help ensure that staff were able to care for people who were very ill and needed 'end of life' care.

Procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. All areas of the home were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in.

We saw that equipment was serviced and maintained in accordance with the manufacturers' instructions. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

Records we looked at showed there was a system in place for recording complaints and any action taken to remedy the concerns raised. Records showed that any accidents and incidents that occurred were recorded.

We last inspected Archmoor Care Home on 16 July 2014 where we found there was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. This was in relation to the lack of systems in place to monitor the quality of the service provided. During this inspection we checked to see if the breach in regulation had been met. We found the registered provider had taken the necessary action to meet the regulation.

The home had a manager registered with the CQC who was present on the day of the inspection. A registered manager is a person who has registered with the CQC 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 there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines not being managed safely, unguarded radiators and pipework in parts of the home that posed a risk of harm to people and records that are necessary for the management of the home were either not in place or were incomplete. You can see what action we have told the provider to take at the back of the full report.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. Several of the care staff had received end of life training to help ensure that people were supported at the end of their life to have a comfortable, dignified and pain-free death.

People's care records contained enough information to guide staff on the care and support required. The records showed that risks to people's health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans. We also saw how the staff worked in cooperation with other healthcare professionals to ensure people received appropriate care and treatment.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

We saw people looked well cared for and there was enough equipment available to ensure people's safety, comfort and independence were protected. People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

We saw people were provided with clear information about the procedure in place for handling complaints.

Satisfaction surveys were given to people so they could comment on the facilities of the service and the quality of the care provided. To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided.

We reviewed the records for three people living at the home. Information provided guidance for staff about how people's needs were to be met. Records had also been reviewed and updated, where necessary.

Following our July 2013 visit, incident reports about events within the home were being forwarded to the Care Quality Commission as required.

We saw that people were offered choice in their daily routine and were able to spend their time as they wished. Information was recorded about people's individual preferences, likes and dislikes. Improvements were needed so that care plans clearly directed staff in the safe delivery of care.

We found the nutritional needs of people were being met. People told us that sufficient food and drink was provided throughout the day. One person told is 'I'll eat everything they put in front of me'.

People were provided with a good standard of accommodation, which was clean and well maintained. Plans were being considered by the provider to expand and refurbish the property.

Sufficient staff were on duty to meet the assessed needs of people. The team had been very stable with many staff having worked at the home for some considerable time.

Systems were in place to monitor and review the service provided so that people received a good standard of care and support.

During our visit we spoke with three people living at the home and the relative of one person. People spoke positively about the care and support provided. We were told; 'They are lovely carers, they always help us' and 'I'm happy with the care, they are all very helpful'.

One visitor told us their relative enjoys the singer who comes to the home on some weekends. However, two visitors told us there was a lack of daily activities taking place at the home for their relatives.

One visitor said 'There is a severe lack of activities and stimulation.'

All the visitors told us they felt the meals provided by the home were not good quality.

One visitor said 'The food is not good; it is appalling and poor quality.'

Everyone was complimentary about the staff and commented on how helpful they were. However, all the visitors told us they felt there was a shortage of staff during some busy periods.