Archived: The Regard Partnership Limited - Arrowe Park Road

At the last inspection in January 2017 the service was rated Good.

This inspection took place on the 15 and 17 July 2018. The first day of the inspection was unannounced and the second was announced.

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

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 management and leadership of the service was not effective. The provider had systems to assess the overall quality of the service which had identified shortfalls in the delivery of care and the management of the service. Action plans had been devised to address the areas of concern but had not led to improvements being made. Therefore, shortfalls had been allowed to continue. These included the completion of care records, completion of medication administration records (MARS), the provision of staff training, staff induction, staff supervision, staff appraisals, the monitoring of health and safety issues, and the recording and monitoring of accidents and incidents. In addition to these shortfalls we identified other areas of concern that the providers own systems had not identified.

People’s needs had been assessed before they began using the service and people and their relatives had been consulted about their preferences for how they wanted their care delivered. However, records had not always been updated when people’s needs had changed and some contained conflicting information. Therefore, staff did not always have access to the guidance they needed to provide safe and effective care.

The provider had not ensured that people’s capacity to make decisions and consent to their care and treatment had always been assessed. Staff told us some people lacked capacity to make some decisions and others had fluctuating capacity however capacity assessments had not always been completed. Staff told us that care was delivered to some people in their ‘best interests’ however there was little evidence to show how these decisions had been made or who had been involved in making these decisions. Therefore, the provider was not working within the principles of the Mental Capacity Act (MCA).

The provider had not ensured that procedures in place for people to receive their medicines safely were always followed. There had been many errors in 2017 and 2018 where people had not received their medication as prescribed. Care records contained conflicting information about people’s medicines and people’s MAR had not always been accurately completed.

The provider has not ensured that there were always sufficient numbers of adequately trained and competent staff on duty. Most people received the support they needed most of the time. However, the lack of effective management of the staff duty rota had resulted in some people experiencing missed calls or having to share their one to one support staff with another person. In addition to this staff had not all received the training supervision and support they needed to provide effective care.

People were not always treated with dignity and respect and their privacy and confidentiality was not always respected. One person told us senior management had entered their home without permission and we saw records containing private information was not always stored securely.

The registered manager shared their office with an administrator and other staff providing little privacy for conversations of a sensitive and private nature. Records containing people’s personal information and other records relating to the on-going management of the service were left out on desks in the office and displayed on the walls in full view of visitors.

There was a backlog of many incidents and accidents going back several months that had not been entered onto the providers own quality assurance systems. Therefore, the provider could not be assured appropriate action had been taken to prevent reoccurrence or be sure relevant external bodies such as the local authority and CQC had been informed.

The provider had not ensured that communication was effective or that complaints were always responded to promptly. Relatives told us communication with management was poor with one relative referring to the communication and administration at the service as “Shambolic”. The providers systems in place to record and respond to concerns and complaints. However, complaints and concerns received verbally had not been recorded and relatives told us they had to raise concerns multiple times before any corrective action was taken.

Most relatives felt their loved one’s regular staff were kind and caring, had a good understanding of their needs and treated them well. Staff told us and records confirmed that people were supported to maintain their independence and spend their time as they wished. Some people were also supported to go on holiday.

Recruitment practices were safe. Appropriate identity and security checks had been completed before staff started work.

We found eight breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

Initially, the inspection was unannounced. However, there was a delay in the inspection because of unforeseen circumstances, which we explained to the registered manager on 24 January 2017. We visited to complete the inspection the following day.

Arrowe Hall is a period property set in the grounds of Arrowe Park. It is a large, grade 2 listed mansion house. The house has been converted to flats, most of which are single occupancy, but one ground floor flat accommodates four people. There are communal areas, but most people enjoy the privacy of their own homes. There were 22 people living in the house all together and seven of these people have a domiciliary care package from the service to support them with their personal care. It is the personal care part of the service that is registered with the Care Quality Commission to carry out the regulated activity of ‘personal care’. This care is available 24 hours a day. The tenants of Arrowe Hall are adults with enduring mental health needs or learning difficulties, Asperger’s syndrome and/or conditions on the autism spectrum who all have various support needs.

The service required a registered manager. 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 had had a registered manager who had been registered since March 2016.

The service used safe systems for recruiting new staff. These included checking references and a criminal conviction check using the Disclosure and Barring Service (DBS) for criminal records.

People told us they were happy about all the aspects of their care and support in their own homes. We found that the service was adequately staffed, with competent and trained staff members. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the service and received on-going training. We noted that more robust training in breakaway techniques was needed and during the course of our inspection, saw that this had been addressed. Staff told us they felt supported by the senior staff and the registered manager.

The care provided was person centred and individual to each person’s needs and staff and senior managers kept accurate and up to date records of the care they delivered. Staff knew how to safeguard people from abuse and report any concerns.

Risk assessments were carried out for people and where they needed help, they were given support to administer their medication. People could choose what they wanted to eat and they often went out for meals to local cafes or pubs.

The service was monitored effectively for quality and people using the service were listened to and treated with respect and dignity. Any complaints were dealt with effectively and the outcomes were recorded.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights and were aware of the differences in the implementation of the MCA in a person’s own home. However, the recording of consent obtained was in some part, inconsistent and needed improvement. Over the course of our inspection, we found that suitable recording practices had been put in place to evidence that appropriate consent had been obtained for issues around people’s support needs.

We looked at the people's care records and found they provided assessments and guidelines for the staff to enable them to support the people in their care. However, the organisation of the files were inconsistent and difficult to understand. The manager told us a new care file system was being introduced.

All the people we spoke with told us they were part of the care planning process. We found that all staff we spoke with were knowledgeable about the Mental Capacity Act (2005) and the issues of consent and had received training.

We found that the service managed medicines appropriately and had systems in place to ensure the secure storage and safe administration of medicines.

We spoke with three members of staff who expressed no concerns regarding staffing issues and we found there were enough members of staff to support people and meet their needs.

We saw the agency had a complaints procedure which was accessible to the people at the service.