Archived: Ardgowan House Residential Care Home (Mrs Annie Jobson)

Ardgowan House Residential Care Home is the only location owned and run by Mrs A Jobson and is based in a residential area of Blyth in Northumberland. It provides accommodation for up to 10 people living with mental health issues, who require assistance with personal care and support. At the time of the inspection there were seven people living at the home.

This report only covers our findings in relation to the Safe, Effective and Well Led domains and the details around previous concerns and breaches of regulations. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ardgowan House’ on our website at www.cqc.org.uk

The home is not required to have a registered manager because it is under the day to day supervision of the registered provider, Mrs A Jobson. A previously employed registered manager had recently left the service, although they had not formally deregistered with the CQC. Consequently their name appears on this report. Because of the organisational safeguarding concerns the provider had voluntarily agreed not to visit the home at the present time.

Because the registered provider had not been at the home a number of management issues, raised at the previous inspection in January 2017, had not been able to be addressed.

Issues regarding the safe management of medicines had improved. Maintenance of records had improved, with all entries now double signed and appropriate codes entered when medicines were not given. A local pharmacy adviser had recently visited the home and whilst highlighting some issues, felt the systems in place were adequate.

The home was clean and tidy. Communal towels, previously in use, had been removed from bathrooms and showers. Appropriate staffing levels were in place, including the addition of a sleep in care worker at night. Agency staff were used to support permanent staff, where appropriate.

Safety checks continued to be undertaken and fire systems were tested on a weekly basis. We checked with the home’s outside fire safety contractor that systems where still within appropriate checking dates.

The home was in organisational safeguarding and was regularly visited by the safeguarding team and other local authority staff. An update of all staff’s DBS certificates, previously started, had not been completed.

There was not always evidence staff had up to date training in the safe handling of medicines, although safety systems had been instigated by the deputy manager to manage the situation. Staff had received some additional training and most staff had received first aid and moving and handling training within the last two years.

The quality of food available at the home and choice of meals continued to improve. People were able to have breakfasts at whatever time they got up in the morning. People continued to be supported to attend health and social care appointments to maintain their health and wellbeing.

The day to day running of the home was being undertaken by the deputy manager. Staff and outside professionals felt the current situation was being managed well on a day to day basis. Other management issues, identified at the previous inspection had not been able to be addressed or progressed because the provider had not been at the home.

Whilst there had been improvements to the delivery of care at the home, we have not changed the current rating of the domains we looked at, or the service overall, because we wanted to be sure changes were sustained and the outstanding actions undertaken in due course.

Ardgowan Residential Care Home is the only location owned and run by Mrs A Jobson and is based in a residential area of Blyth in Northumberland. It provides accommodation for up to 10 people living with mental health issues, who require assistance with personal care and support. At the time of the inspection there were eight people living at the home, including one person who was there on a temporary basis.

The home is not required to have a registered manager because it is under the day to day supervision of the registered provider, Mrs A Jobson. However, the provider had employed a manager, who had formally registered with the CQC in September 2016. 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.

People told us they always felt safe living at the home. Staff had received training on understanding safeguarding issues and said they would report any concerns. Regular checks were carried out on the premises. Windows had restrictors fitted that now met Health and Safety Executive guidance.

The provider told us all day shifts were covered by two staff; a senior care worker and a care worker. Nights were covered by one waking night staff. Staff we spoke with confirmed this was the case and told us there were sufficient staff at the current time. Proper recruitment procedures and checks had been in place at the previous comprehensive inspection. No new staff had been recruited since the last inspection.

We found issues with medicines management at the home. We found gaps in medicine administration records sheets, no “as required” care plans in place, inappropriate storage of incoming medicines and a failure to monitor the temperature of the area where medicines were stored.

Staff told us they had undertaken training in recent months, and records confirmed this. The registered manager had instigated a new training programme to ensure training was kept up to date. Regular supervision sessions had been undertaken and annual appraisals were in the process of being arranged.

People told us they enjoyed the food provided at the home. Staff told us people had been involved in developing new menu choices. If people did not like the main menu choice on offer they could request an alternative. We observed there was an improved range of food available for people and people had access to regular drinks.

The registered manager told us no one at the home was subject to any restriction under the DoLS guidelines, although there were no detailed assessments of people’s capacity to confirm DOLS applications were not required. Staff supported people to make choices and said those living at the home had capacity to make their own day to day decisions.

People told us they were happy with the care and support they received. We observed there were good relationships between staff and people living at the home. Staff were aware of people’s individual needs and personal preferences. People had access to general practitioners, dentists and a range of other health professionals. Specialist advice was sought, where necessary. People said they were treated with dignity and staff respected their individual preferences and decisions. The home was generally clean and tidy, although some flooring in toilet areas and showers was in need of replacing.

People had individualised care plans related to their specific needs. The detail in the care plans varied and reviews of care plans was often limited. Staff told us people often preferred to manage their own time rather than participate in organised activities, although some activities and trips were organised by the home. There had been no recent formal complaints. People said they would speak with staff or the provider if they had a complaint, but were happy with the care at the home.

The provider told us she personally checked around the home at least weekly, but did not formally record any issues found in audit format. Records were not always completed or up to date, particularly around medicines and care plan reviews. There were two instances where a person had suffered an injury and the provider had not notified the CQC, as legally required to do so. A recent staff meeting had taken place to discuss changes to the running of the service. The provider was not displaying their current rating from the CQC, as legally required to do so.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to Safe care and treatment and Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We undertook a focused inspection on 11 and 17 April 2016 to check that they had followed their plan and to confirm that they now met legal requirements. We only considered the areas we had highlighted in the warning notice at this inspection. We will return and further inspect the home in relation to other breaches we found at the inspection in November 2015, in due course.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ardgowan House’ on our website at www.cqc.org.uk’

Ardgowan Residential Care Home is the only location owned and run by Mrs A Jobson and is based in a residential area of Blyth in Northumberland. It provides accommodation for up to ten people living with mental health issues, who require assistance with personal care and support. At the time of the inspection there were ten people living at the home.

The home is not required to have a registered manager because it is under the day to day supervision of the registered provider, Mrs A Jobson.

A member of staff who had previously not undertaken training on the safe handling of medicines had now completed this training. At the last inspection we found that regular supervision sessions and annual appraisals had not been undertaken. A basic appraisal of staff members had been undertaken by the provider immediately following the previous inspection. The deputy manager and a senior care worker told us they were completing more in depth appraisal review process.

Some staff had undertaken additional distance learning training since the previous inspection. The provider told us that further face to face training was planned and showed us the sessions logged in the home’s diary. The training was confirmed by the person providing the training.

At the last inspection we noted there was no central record of staff training needs. We noted there was now some record of training that staff had undertaken, although it was not always well maintained. A senior care worker at the home was taking on responsibility for drawing together a fuller record of current and required training.

Updating training on diabetes had not been undertaken because the individual previously supported with this condition had now moved away from the home.

This meant the provider had met the requirements of the warning notice issued. We have not changed the rating we gave in this domain as we wish to be assured that the changes instigated will be sustained in the long term.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found:

Is the service caring?

We saw that people's needs were assessed and care delivered in line with their assessed needs. We saw that people had access to outside professionals such as doctors, dentists and opticians.

We observed that staff responded in a caring and compassionate way to people's needs and had a good understanding of people's individual likes and dislikes.

People we spoke with told us they were happy with the care they received. One person told us, 'I like this place very much, you get well looked after.' Another person told us, 'I have no concerns about living here. It is okay.'

Is the service responsive?

People's needs were assessed and their care plans reviewed and revised in line with the changing needs. One person told us, '(Key worker) sits down and goes through the plan so I always know what's in it.' Another person told us, '(Key worker) sits down with us once a week and checks that everything is still ok.'

People we spoke with told us that they generally liked to do things for themselves but that there were activities, if they wished to join in. One person told us about trips to the theatre and how they had been to a local church to participate in an event. One person told us, 'There are trips out, if you want to go; but I'm not a group person, I'm a bit of a loner.'

Is the service safe?

Audits of safety systems were in place and the building was clean and tidy.

We found that windows on the upper floor of the building did not have restrictors in place or the window restrictors had been disconnected. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We saw that night shifts were covered, on some occasions, by only one member of staff. The manager told us that no risk assessment had been undertaken in relation to this, to ensure people could be effectively cared for or supported in the event of an emergency. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no applications have needed to be submitted and people's care plans reflected that the issue of capacity had been assessed and considered. All people using the service were assessed as having the capacity to make decisions about their life in line with the Mental Capacity Act 2005.

Is the service effective?

People we spoke with told us they were happy with the care they received. They told us that staff were always available if they had any concerns. People told us, 'I do chat to (care worker) if I am worried. She is a nice understanding person' and 'If I am worried about anything then I would chat to someone.'

We saw that care issues were discussed at staff meeting and changes to care implemented on the back of discussions. We saw one person was being helped to manage their smoking through changes suggested by staff.

Is the service well led?

The home had a range of quality assurance systems in place to monitor the quality and consistency of care and the environment of the home. We saw copies of documents regarding checks on medication, fixtures and furnishings, smoke alarms, water temperatures and electrical systems.

People who used the service confirmed that there were regular residents' meetings and we saw copies of notes from these meeting.

Staff confirmed that staff meetings took place and we saw minutes from these meetings. Staff we spoke with told us there had been no recent supervision sessions and that they had not been given an annual appraisal within the last twelve months. The manager confirmed that these had not taken place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff received appropriate professional development and training relevant to their working environment and had the correct knowledge and information to recognise health issues and to take the appropriate action should people require medical help or intervention.

People's personal records were accurate and fit for purpose because they were up to date and included good detail of people's activities, presentation and involvement from other care professionals.

People who used the service looked comfortable in the home, well cared for and told us they were happy with the service. One person told us, "I've lived here for 25 years and the staff are superb." Another person told us, 'The staff look after me very well." We concluded care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff were unsure about the presentation of certain conditions and side effects of medications that people who used the service were taking. We concluded staff had not received appropriate professional development or additional training.

The provider had systems in place to monitor and assess the quality of the service and took account of people's views and wishes.

We found people's personal records were not up to date, accurate or fit for purpose.

We saw needs were assessed and plans in place to support individuals. A care manager told us, "I am really impressed by the way they have supported X. I have got no concerns. I know his family are happy."

One person's diabetic condition was controlled by medication. This person also took Warfarin. We saw there were no specific plans regarding the care for these conditions. This meant there was a risk they may not receive the correct care.

We established there was a schedule to ensure the home was clean and tidy. We noted an up to date Food Hygiene Certificate and confirmed staff had undertaken a basic food hygiene course.

We saw effective recruitment and selection processes in place. We confirmed appropriate checks were undertaken before staff began work and files contained a copy of their job description, so people had a clear understanding of their role.

We noted care plans should be reviewed every three or six months. We saw reviews had been undertaken in March 2012, but with no further reviews since then. This meant there was a risk plans may not be up to date and staff may not have access to the correct information.