We carried out an unannounced comprehensive inspection on 12 and 14 July 2018.

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.

Arguam House provides care for people who are living with Acquired Brain Injury and those with Neurological Disorders. It provides care and accommodation for up to 8 people. On the day of the inspection 8 people lived in the home. Arguam House is owned by Waters Park House Limited.

Waters Park Limited also owns another care home in the same area and the registered manager managed both of these services. The registered manager was also the provider. 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 registered manager was supported by a clinical lead, who also worked across both services. There was a house manager in place at Arguam House who took responsibility for the day to day running of the service.

During the last comprehensive inspection in June 2017 we found the areas of safe, effective and well led required improvement with breaches of Regulation. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good.

At that inspection we found at that time that people did not always have risk assessments in place to guide staff how to mitigate risks associated with people's needs. Information received about new staff through recruitment procedures had not always been acted upon to ensure the staff member was suitable to work with vulnerable adults. People who were deemed not to have the capacity to make certain decisions had no assessments in place to show how this decision had been made.

People's rights were not always protected when they were restricted of their liberty. Quality assurance systems were not sufficiently effective to identify the gaps in quality found during this inspection.

This inspection was a comprehensive inspection that looked at all areas of the service again to check the service had addressed the concerns from June 2017. We found people's care at Arguam House had significantly improved in all areas. They have been judged to be Good overall.

Why the service is rated good:

We met and spoke to six people during our visit and observed the interaction between them and the staff supporting them. People were able to tell us about the care and support they received.

People were now safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. Staff had completed safeguarding training and further updates were arranged. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff confirmed there were sufficient staff to meet people’s needs.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapists. People who required additional input, for example from Community Psychiatric Nurse’s (CPN) had this clearly recorded into their care plans.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines.

People continued to receive care from staff who had th

The inspection took place on 5 and 7 June 2017 and was announced. We announced the inspection due to the needs of the people living at Arguam House. Arguam House provides care for people who are living with Acquired Brain Injury and those with Neurological Disorders. It provides care and accommodation for up to 8 people. On the day of the inspection 7 people lived in the home. Arguam House is owned by Waters Park House Limited.

Waters Park Limited also owns another care home in the same area and the registered manager managed both of these services. 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 registered manager was supported by a clinical lead, who also worked across both services. There was a manager in place at Arguam House who took responsibility for the day to day running of the service. They were supported by a deputy manager.

The service was registered in December 2015 and this was its first inspection.

Recruitment practices were carried out on new staff members before they started working at the service, to help ensure they had the correct characteristics to work with vulnerable people. However, where concerns were raised about staff’s previous conduct through references or Disclosure and Barring Service (DBS) checks, or where there were gaps in their career history; there was no record that these had been discussed with the staff member, or any actions recorded to show how the provider would ensure people were not put at undue risk. Following the inspection, the manager confirmed this had been done.

There were risk assessments in place to help reduce any risks related to people’s care and support needs. However, these did not always reflect all of people’s risks. Staff knew people’s risks well but were not always clear exactly how they should act to protect people from these risks. The manager told us they would update people’s records to ensure all risks stated what steps staff should take to help mitigate risks to people.

Staff were knowledgeable about which people had the capacity to make their own decisions and how to support those who didn’t. However, where people were deemed to lack the capacity to make decisions for themselves, records did not show how this decision had been reached. This meant people’s rights may not have been protected. Where people’s liberty was restricted, the Deprivation of Liberty Safeguards (DoLS) applications had not always been made to help ensure this was being done in their best interests. People were involved in planning their care and staff sought their consent prior to providing them with assistance.

The manager and staff monitored the quality of the service by regularly talking to people about whether they were happy with the care they received. The registered manager and clinical lead also carried out spot checks of the service which they recorded and used to improve the service. However, there was no clear system in place to ensure all aspects of the service were regularly monitored. This meant concerns highlighted through the inspection had not been previously identified or acted upon.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. People told us there was a homely atmosphere within the service and the staff were committed to helping people feel ‘at home’. The registered manager told us, “I want people to have the same things I would have at home.” A compliment received by the service stated, “The house looks so cosy, just what we wanted for [….]”

People received support from staff that knew them well and had the knowledge and skills