We inspected this service on 6 and 19 September 2018. The inspection was unannounced.

We last inspected the home on 19 and 22 February 2018. At the inspection in February 2018 the service was rated as ‘Inadequate’ and two Warning Notes were served on the registered provider and due to lack of safety of care and poor governance at the service.

Arnold House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide residential care for up to 23 people with a physical disability. At the time of the inspection there were 19 people living at the service. People are aged from 20 to 65 years of age. Everyone at the service has a physical disability and some people have additional needs due to a cognitive impairment or mental health needs.

At this inspection, the service did not have 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. Since the last inspection the registered manager was no longer in post and an acting manager had been employed on a temporary basis. The new permanent manager started work between the first and second day of the inspection, but at the time of writing this report had not yet applied to be the registered manager.

The overall rating for this service is ‘Requires improvement’. However, the service will remain in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. Information on special measures is detailed at the end of this summary.

At this inspection we found there were improvements with medicines management, but staff were still not fully competent or confident using the new electronic medicines management system. The provider had taken some remedial action by the time of the inspection to support staff better so they gained confidence and competence.

At the last inspection we found not all people at the service were treated with dignity and respect and although some improvement had been made, we had similar concerns at this inspection. In the interim period, from February 2018 to the inspection in September 2018, the service and provider had taken some remedial action, but there were still issues of dignity and respect at the service.

Care records, in particular, person-centred plans (PCP’s) had improved significantly since the last inspection, although some needed refining to be fully person-centred and the service was in the process of updating medicine care plans at the time of the inspection. There were risk assessments in place on care records, but the information did not always align with information on PCP’s.

There had been improvements made to the décor to some areas of the service since the inspection in February 2018.

At this inspection we found the staff roster reflected the number of people working, but on the first day of the inspection we were aware that call bells were not always answered in a timely manner. We were not confident staff were deployed effectively on shift to meet people’s needs.

Staff recruitment was safe at the service will all pre-employment checks taking place prior to people starting work.

The majority of people living at the service told us they felt safe, and staff knew what to do if they had concerns regarding the care of people. Since the last inspection the providers local management team had notified the relevant bodies of any

We inspected this service on 19 and 22 February 2018. The inspection was unannounced.

We last inspected the home on 28 June 2016 to carry out a focused inspection due to a breach of the regulations related to medicines management as stock records did not tally with medicine receipt and administration records, and people’s allergy status had not always been recorded or updated. Prior to the focused inspection, the last comprehensive inspection took place on 15 September 2015. The overall rating for the service prior to this inspection was Good.

Arnold House is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide personal care for up to 23 people with a physical disability. At the time of the inspection there were 23 people living at the service of all ages.

The care home accommodates 21 people in one purpose built building. There is a bungalow situated in the garden which accommodates two people. This is viewed as ‘move on’ accommodation.

The service had 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.

We found multiple concerns with medicines management at the service. Concerns ranged from medicines not being available for people as per their prescription, inaccurate recording of medicines administration and discrepancies when tallying medicine stocks versus records. This placed people at risk of unsafe care.

There were not always risk assessments in place to provide guidance to staff in their caring role, including key areas such as choking, bathing, and moving and handling risks. This increased the risk of accidents occurring and placed people at risk of harm.

We found that the number of staff rostered to work was not always reflected in the number of staff working. This impacted on the care provided to people. With the exception of one person, people were not restricted to leave the service. However, the staff shortages impacted on people having the opportunity to go out as many people required staff support to leave the building. We found there were insufficient staff to provide personalised care to people.

We did not find comprehensively completed care records in place that set out in detail people’s likes and dislikes nor their needs or how these were to be met. The service could not evidence they provided person-centred care.

We had mixed views from people living at the service regarding their experience of living there and the care provided by the staff. Whilst some people told us staff were caring and kind, other people told us some staff fell short in this area, and this impacted on the dignity and respect shown to them by the service.

We found that staff were able to tell us what they would do if they had safeguarding concerns, but refresher training was not taking place in line with the provider policy in key areas such as safeguarding and moving and handling. Supervision was not taking place as regularly as the provider policy stipulated. These failures to support staff appropriately increased the risk of unsafe care being provided to people.

The provider had quality assurance systems in place. However, these were largely ineffective in the areas of safe medicines management, or with ensuring people’s risk assessments and care records provided staff with up-to-date information on how to care for people. Although the provider had identified these concerns in autumn 2017, there had been few improvements to the service in these areas at the time of our inspection.

We could see from r

At our previous inspection of this service on 15 September 2015, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the management of medicines. The provider sent us an action plan after the inspection detailing how they would address the breach. At this inspection we found that progress had been made, medicines were managed safely and the provider was no longer in breach of this regulation.

This inspection took place on 28 June 2016 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Arnold House on our website at www.cqc.org.uk

Arnold House provides accommodation for up to up to 23 people with physical disabilities. On the day of the inspection there were 17 people residing at the home.

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 and associated Regulations about how the service is run.

We were assisted during our inspection by the registered manager.

All of the issues we found with medicines at the last inspection had been addressed. The records of the receipt and administration of tablets matched with the amount of tablets left in the medicines trolley. We saw that the allergy status had been updated and recorded in peoples’ medicines administration records (MAR) and care plans.

The provider was no longer in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

This inspection took place on 15 September 2015 and was unannounced. At our last inspection in July 2013 the service was meeting all the standards we looked at.

Arnold House provides accommodation and support with personal care for up to 21 people with physical disabilities. On the day of the inspection there were 20 people residing at the home.

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.

People told us they felt safe and had no concerns about how they were being cared for at the home. They told us that the staff were kind and respectful and they were satisfied with the numbers of staff on duty so they did not have to wait very long for assistance.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

We saw that risk assessments, audits and checks regarding the safety and security of the premises were taking place on a regular basis and were being reviewed and updated where necessary.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) Including the associated Deprivation of Liberty Safeguards (DoLS) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

Systems to audit medicines were not always accurate and it was difficult to account for all the medicines each person had been given and how much was left in stock.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the registered manager took their views into account in order to improve service delivery.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with people who use the service. They told us they were happy living in the home and described a wide range of activities they took part in both inside and outside the home, including arts and crafts and a flower arranging group. Staff understood the needs of the people they cared for and supported. We saw staff interacting with people compassionately and responding to their needs during our visit.

Staff received appropriate training and support to enable them to provide the care that people needed. They demonstrated the knowledge and skills needed to protect people from possible abuse. Medicines were stored appropriately and administered safely. Systems were in place to assess and monitor the quality of service that people received and ensure care and support was provided appropriately and in a safe environment.

We spoke with four people who use the service. Everyone told us they were happy with the service provided. People told us staff asked them how they liked care to be provided. They said staff were “friendly” and “kind” and knew how to meet their needs. For example, one person said, “I get on very well with staff, they treat me very well.” Three people described the quality of care as “excellent”.

Staff received appropriate training and support to enable them to deliver the care to people that they needed. The equipment used to support people was checked regularly to ensure it was safe to use. Complaints about the service were managed effectively.

We observed that people were involved and consulted about decisions affecting their care. A person said, “I get very good care here". People were treated well by staff. We saw that staff understood their needs. People spoken to confirmed that they trusted staff and felt safe. They could discuss their concerns with the staff. We saw that staff understood peoples’ needs. A person said, “Staff are very good. They know what they are doing”. People told us and we observed that they felt that staff listened to them. Staff responded to any suggestions they made about the home.