CQC report explained · a residential care home
What the CQC found at Agnes and Arthur
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were mostly managed safely and there were enough staff, but some topical patch records were not accurate enough and staff did not always use gloves and aprons during observed tasks. Building safety work was still ongoing.
- Effective?
- Good
- Staff training, support and monitoring had improved. People had access to health professionals and received food and drink that matched their choices and needs.
- Caring?
- Good
- People and relatives described kind care. People were treated with dignity, supported to stay independent and involved in decisions, although inspectors saw one lapse in privacy during a discussion about care needs.
- Responsive?
- Good
- Care was personalised and plans described people's preferences and routines. People had activities, communication support, help to keep in touch with relatives and a complaints process.
- Well-led?
- Requires improvement
- The manager was approachable and there was a positive team culture. However, quality checks had not found important errors and gaps, so the home remained in breach of Regulation 17.
What inspectors found, July 2021
Agnes and Arthur was rated Requires Improvement; care was kind and responsive, but safety records and management oversight were not reliable enough.
This was an unannounced follow-up inspection on 15 and 21 April 2021. Inspectors spoke with people, relatives, staff, managers and health professionals. They reviewed care, medicines, recruitment and management records.
People generally felt safe and were treated kindly. Staff supported people's choices, personal care needs, food, activities, communication and contact with relatives. Training, consent arrangements and personalised care had improved since the previous inspection.
Some records were incomplete or inaccurate. These included care plans, medicine allergy records, weight-loss follow-up and mental capacity assessments. The building also needed work. The home was still in breach of Regulation 17 about good governance, so the overall rating remained Requires Improvement.
Kind and respectful care
People and relatives described staff as kind and understanding. People were supported with dignity and encouraged to remain independent.
“People were treated with dignity and respect and supported to maintain as much independence as possible.” from the report
Personalised support
Care plans included people's preferences, routines, social histories and cultural choices. Staff were said to know people well.
“Care plans detailed people's preferences and daily routines.” from the report
Improved staff training
Training completion had risen to 96%, and staff received supervision and support for their roles.
“Staff received training to be effective in their role and felt the training they received was positive.” from the report
Food and drink choices
People were offered choices at mealtimes, alternatives and second helpings. Staff monitored support with eating and drinking.
“People were supported to have enough to eat and drink of their choice and in line with their needs.” from the report
Incomplete safety records
seriousSome care plans needed more detail, and medicine records did not always show people's allergies accurately. The report says no one was found to have been harmed by these gaps.
“Some allergies had not been accurately recorded in people's medicine records.” from the report
Weak management checks
seriousQuality checks failed to identify a wrong name in a mental capacity assessment and did not fully follow up one person's weight loss.
“One person's mental capacity assessments accidentally mentioned a different person's name.” from the report
PPE was not always used
needs fixingInspectors saw staff without gloves and aprons during some tasks. The manager acted immediately after this was raised.
“We were not always assured that the provider was using PPE effectively and safely.” from the report
Building work still needed
needs fixingParts of the building were damaged or run down, although improvement work was underway. Further work, including to the fire alarm panel and some bedrooms, was planned.
“The physical environment of the home needed improving.” from the report
Topical patch records
needs fixingRecords did not always show that patches were applied in sufficiently different places. The manager changed the medicine records after inspectors raised this.
“The place they had been applied were not always varied enough so there was a risk some patches were being applied in the same place.” from the report
- 01What has been done to make sure care plans, allergy records and mental capacity assessments are checked and corrected promptly?
- 02How are you now monitoring weight loss and making sure people are referred to health professionals when needed?
- 03How do you check that staff use the correct gloves and aprons for hoisting and medicine support?
- 04Which building and fire alarm improvements have now been completed, and what remains outstanding?
- 05How will you show families the actions taken after surveys and complaints?
This was an unannounced follow-up inspection covering all five key questions, with infection prevention and control also reviewed under Safe; it checked previous concerns and breaches. This explanation was written from the published report of 3 July 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2019
Rated Requires Improvement; inspectors found fire safety, staff training, mental capacity and care planning problems.
This was an unannounced inspection on 14 May 2019. Three inspectors and an Expert by Experience spoke with people, staff and managers. They reviewed care records, medicines records, recruitment files and quality monitoring records.
The home met people's basic care needs, and people said they felt safe and treated well. However, fire arrangements were not safe enough, key staff training was out of date, and some care was task-focused rather than personal. Care plans were not always detailed or current, and records about prescribed thickeners were incomplete.
All five areas were rated Requires Improvement. This means the inspectors found shortfalls and limited assurance that care was consistently safe, effective, caring, responsive and well-led. The overall rating had fallen from Good at the previous inspection, published on 6 December 2016.
Food and drink
People were offered regular drinks and snacks, with support for specialist diets and monitoring where there was a risk of weight loss.
“People were supported to have enough to eat and drink. People were offered regular drinks and snacks.” from the report
Activities and beliefs
People could take part in activities they enjoyed, including outings and creative activities. The home also supported religious practice and personal traditions.
“People were supported to take part in activities such as playing dominoes, flower arranging, knitting and trips out to the local pub.” from the report
Recruitment
The home used references from previous employers and DBS checks as part of its recruitment process.
“A thorough recruitment and selection process was in place which included references from previous employers and a Disclosure and Barring Service (DBS) check.” from the report
Dignity and respect
Although some care was task-focused, inspectors found that people were generally treated respectfully and their dignity was promoted.
“People's dignity was promoted and people were treated with respect.” from the report
Fire safety
seriousStaff did not consistently know how to evacuate people safely. Fire risk checks, emergency lighting, gas safety and kitchen extraction work had not all been kept up to date.
“Five staff members said they did not know how to use a fire evacuation sledge.” from the report
Staff training
seriousTraining in important areas was substantially out of date. This included moving and handling, dementia care and fire safety.
“For example, out of 46 staff only 10 had completed up to date moving and handling training, seven had completed dementia training and six had completed fire safety training.” from the report
Mental capacity decisions
seriousSome decisions were not made in line with the Mental Capacity Act. One person's assessments referred to difficulty speaking English rather than their ability to make decisions, and covert medicines were used without a best interest meeting.
“The service was not working within the principles of the MCA. DoLS applications had not always been made appropriately.” from the report
Care plans
needs fixingCare plans did not always explain how to support specific health or behaviour needs. Reviews did not always reflect changes in people's needs.
“Care plans contained information about people's daily routines, but they were not always person-centred and information on people's social history was minimal.” from the report
Quality checks
seriousThe home's audits failed to identify several safety, care planning, discrimination and legal decision-making problems. Records about prescribed thickeners were also incomplete.
“The provider had a quality monitoring system, but this was ineffective in identifying and generating improvements in the service.” from the report
Limited social interaction
needs fixingStaff were busy meeting physical care needs, and inspectors did not see enough time being spent on people's social and emotional needs.
“Although people had their care needs met in a timely way, staff appeared busy and were not seen spending time meeting people's social and emotional needs.” from the report
- 01Have all fire safety problems been fixed, including the evacuation sledge training, emergency lighting, fire escape gate and fire drills?
- 02How many staff currently have up-to-date moving and handling, dementia and fire safety training?
- 03How do you make sure mental capacity assessments, DoLS applications and covert medicines decisions follow the law?
- 04How are care plans updated when a person's health, behaviour or communication needs change?
- 05How do your quality checks now identify missing medicine records and risks before they affect people?
This was a comprehensive inspection of the home, including the premises, care and all five CQC questions; it also compared the findings with the previous inspection published on 6 December 2016. This explanation was written from the published report of 27 June 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Agnes and Arthur
4 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- July 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2016Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- September 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- November 2013
Registered with the Care Quality Commission on 11 November 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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