Arden Park

People’s experience of using this service:

¿People felt safe because there were enough staff to support their needs and to protect them from avoidable harm.

¿Recruitment checks were completed prior to staff working at the home but records of checks were not completed in sufficient detail to demonstrate staff were safe to work with people.

¿Staff received on-going support and training to be effective in their roles.

¿Staff knew people well and knew about risks associated with their care. Risk management plans mostly contained clear instructions for staff to follow.

¿The environment was clean and staff followed good infection control practices.

¿People received their medicines as prescribed and people were supported to access healthcare professionals when needed.

¿People’s needs were assessed before it was agreed for them to live at the home to ensure their needs could be met safely and effectively.

¿Work was to be completed in regards to the Accessible Information Standards to help ensure people could easily understand and access information about them and the home.

¿People’s nutritional and hydration needs were met. Staff knew about people’s specialist dietary needs and supported people when needed.

¿There were caring interactions between staff and people and care plans supported staff to provide personalised care.

¿People were supported to be independent where this was possible and their privacy and dignity was maintained.

¿Some information about people’s end of life wishes was documented to help staff ensure people’s wishes were respected at this time.

¿People were able to participate in some social activities and maintain some links with the local community.

¿ People and relatives were happy with the care they received and spoke positively about the management of the service.

¿Complaints were managed in accordance with the provider’s procedure.

¿ Systems to monitor the quality and safety of the service were mostly effective.

¿Lessons were learnt when things had gone wrong and had resulted in changes in practice where needed.

¿People had been given some opportunities to provide feedback about the service to drive improvement of the home. Responses had been listened and responded to.

At this inspection we found the evidence supported a rating of 'Good' overall. More information is in the 'Detailed Findings' below.

Rating at last inspection: At our last inspection in we rated the service as 'Requires improvement'. The report was published on 21 March 2017.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

The service was last inspected on 30 June 2016. At that inspection we found there were three breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to the safe care and treatment people received. There were not enough staff to meet people's needs, and staff were not deployed effectively. Administration of prescription creams and ordering of medicines required improvement. Suitable systems and processes to monitor and improve the quality and safety of services provided to people were not in place. Quality audits and checks were not effective.

The provider sent us an action plan which stated all the required improvements would be completed by 30 September 2016. During this inspection we checked whether the improvements had been made. We found most of the improvements had been made and sufficient action had been taken in response to the breaches in regulations. However, there were some areas where further improvements were required and the provider had plans in place for on-going improvements to be made.

The home 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.

The provider had increased their staffing levels and had made improvements to the way their staff were deployed. This meant staff were available when people needed them. However, some people we spoke with felt further improvements were still required. The registered manager had received guidance and support from a senior manager to assess people’s needs and to effectively implement the provider’s dependency tool.

The provider had made improvements in how medicines were managed and administered. This meant people received their medicines when they needed them and people's medicines were handled safely. Staff who administered medicines had received training and their competency had been assessed by the registered manager.

People and their relatives told us they felt safe living at Arden Park. Risk assessments and management plans were in place to identify potential risks to people's health and wellbeing. However some assessments had not been updated to reflect known risks. Therefore, we could not be sure people were kept as safe as possible. Despite this, staff knew about these risks and explained how risks were to be managed.

The provider's safeguarding reporting procedures had been reviewed and improved since our last inspection. This assured us allegations of abuse would be investigated correctly to keep people as safe as possible.

Managers and staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Depravation of Liberty Safeguards (DoLS). The registered manager had improved their knowledge in relation to DoLS to ensure the rights of people were protected. Mental capacity assessments had been completed for people who needed them. Staff respected the decisions people made and gained their consent before they provided care.

The provider's recruitment procedures made sure staff were of suitable character to care for people at Arden Park. Staff completed an induction when they first started work at the home. Improvements had been made to the training staff received to support them to be more effective in their role. Records showed a programme of regular training supported staff to keep their skills and knowledge up to date. People thought staff had the skills and knowledge they needed to provide the care and support they required.

People told us they attended healthcare appointments when they needed them. People's records showed how the home worked in partnership and maintained links with health professionals. This meant people who lived at the home received the appropriate health care support to meet their needs.

Prior to living at the home people were assessed to ensure the service could meet their needs. The level of detail in people’s care plans had improved since our last inspection. However, we could not be sure people and their families were involved in reviewing their care.

People were satisfied with the social activities that were provided to occupy their time.

During our previous inspection we observed people were not supported effectively to eat or to enjoy their meal. During this visit some people told us they were not always satisfied with the food and drinks provided. We identified further improvements were required to improve the mealtime experience for people.

Everyone we spoke with had positive comments about the care people received which showed us improvements has been made since our last inspection. People told us staff respected their right to privacy and they maintained their dignity. We observed staff were caring and encouraged people to be as independent as they wished in their day-to-day care. People told us they were offered daily choices.

There were systems in place to gather people's feedback through annual surveys. Regular resident and family meetings had been set up since our last inspection. This gave people an opportunity to give their views on the service they received. People knew how to make a complaint and there were systems in place to manage complaints about the service provided.

During our last inspection we saw records containing people's personal information were accessible to others. During this visit we saw the provider had made improvements and we were assured confidential information could not be seen by people unauthorised to see it.

People and the staff told us they were happy with how the home was run. Staff felt more supported by the senior management team since our last inspection and told us they enjoyed working at the home. The frequency of senior manager visits to the home had increased since our last inspection. This ensured the provider had an overview of how the home was being run.

Since our last inspection improved quality assurance processes had been implemented at Arden Park to drive forward improvements. We saw audits in-line with the provider's procedure had been completed to check the quality and safety of service people received.

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 had mixed views about whether they felt safe at the home. We observed at certain times of the day there was not enough staff on duty to keep people safe and meet their needs. Staff told us they would feel better supported by the provider if they had more staff.

Risk assessments were in place to minimise the risks to people's safety. However, risks were not always managed well and records did not always reflect identified risks. The registered manager and staff understood what constituted abuse and referrals to the local authority had been made when needed.

Medicines were not always managed safely and systems to check whether people received their medicines as prescribed were not effective.

The provider did not have sufficient systems and processes in place to assure themselves that people received a good quality service that met their needs. Audits and checks took place but there was no evidence that actions had been taken to improve the quality and safety of services provided to people.

People were referred to health professionals to ensure their health and well-being was maintained, but we identified that on an occasion there had been a delay before medical advice had been sought.

New staff received an induction and staff received training in health and social care. However, we observed staff did not always put their learning into practice to manage risks. Recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment.

Accidents and incidents had been recorded. However, this information had not been used to identify any patterns or trends, to help prevent them from happening again.

The registered manager and staff demonstrated knowledge of the Mental Capacity Act (2005) and DoLS and supported people if they lacked capacity to make their own decisions to ensure people were looked after in a way that did not inappropriately restrict their freedom.

People told us the staff were kind. However, we saw that not all staff respected people’s right to privacy or spoke to people in a respectful way. People were encouraged to maintain relationships with people important to them and visitors were welcomed at the home.

People were satisfied with the food and drink provided and staff demonstrated good knowledge of people's dietary needs. However, the mealtime experience we observed was not positive for people.

Overall, individual staff members demonstrated a caring approach and knew the people they care for well. We observed people were not always offered choices and staff had limited time to spend with people. We saw ‘task based’ interactions between staff and people throughout our visit.

People's records contained insufficient information to ensure staff had the guidance they needed to meet people's needs. It was not clear how people had been involved in planning their care to ensure they received care and support that met their preferences, likes and dislikes.

People were satisfied with the social activities provided and had opportunities to pursue their hobbies and interests. The provider had made improvements to the environment to be more supportive of people living with dementia since our last visit. Plans were in in place to make further improvements.

People and their families were positive about the care provided and the running of the home. They told us they knew how to make a complaint.

We found three breaches of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with eight people who lived at Arden Park about their experiences of the service. We also spoke with four relatives or friends of people about their family member's experience. We observed the care that was given to people during our inspection. We looked at care records at the home.

We spoke with a range of staff including members of staff who provided personal care to people at Arden Park, the registered manager, the activities coordinator and a regional manager of the service.

We visited the service to check on a number of concerns that had been raised at the previous inspection in December 2013 to see whether improvements had been made. We found there had been improvements made since our last inspection.

During our inspection we looked to see whether we could answer five key questions: is the service safe, effective, caring, responsive and well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked to see whether there were the right levels of staff working at the service. We looked at the staff rotas which showed there were not enough staff to meet people's needs at all times. The provider increased the staffing levels at the service immediately after our inspection to address our concerns.

Safeguarding procedures were robust. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs). We saw no recent applications had been submitted. Relevant staff were trained to understand when an application should be made and how to submit one. The manager was aware of the latest guidance and information on DOLs and was planning a review of their procedures to ascertain whether any changes were required to their policy.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistle-blowing and investigations. This reduced the risks to people and helped the service to improve.

Is the service effective?

People's health and care needs were assessed before they came to the home to determine their needs and make sure the service could meet them effectively. Specialist dietary, communication and equipment needs had been identified in care plans where required.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needs remained appropriate and accurate.

People had access to a range of health care professionals some of which visited the home.

It was clear from our observations and from speaking with staff they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived there.

People and relatives we spoke with were positive about the care provided. One person told us, "I think it is very good'it's relaxed for one thing. Meal times are fun because everyone's together. It's a good place this one.'

Is the service responsive?

We saw people were able to access help and support from other health and social care professionals when necessary. One relative told us, "Since X arrived they've had an eye test and had the chiropodist visit."

People were able to participate in a range of activities both in the home and in the local community.

People who used the service, their relatives and other professionals involved with the service completed satisfaction surveys. Where shortfalls or concerns were raised these were analysed and addressed.

We looked at how complaints had been dealt with at the service and found that complaints were investigated and dealt with in a timely way.

Is the service well-led?

The service had a quality assurance system in place to identify areas of improvement. We saw that there were recent audits in a number of areas including infection control. Records seen by us showed that identified improvements were addressed promptly. As a result the quality of the service was continuously improving.

We found staff were supervised appropriately. The manager and senior staff observed their working practices. We saw that regular supervision meetings were taking place every three months. These had been introduced following our inspection in December 2013 and were being monitored by the manager of the service. As part of the supervision procedure senior staff observed the work of care staff to monitor where performance could be improved, and to inform training and development planning.

People's personal care records were up to date and complete.

We saw staff being supportive and kind to people with dementia living at Arden Park. They were aware of the importance of preserving people's dignity and respect and their actions demonstrated this.

Three people left comments on our comment cards. They were all positive about the care provided by staff.

We saw staff worked hard to ensure the personal care needs of people were met. We saw staff had little time to sit and talk to people with dementia or to support them effectively with their emotional and psychological needs.

We saw people with dementia had good access to health care professionals such as their GP, district nurses and speech and language therapists.

We looked at care records of people with dementia. We saw there were systems for reviewing and updating care plans and risk assessments. However staff were not reviewing and updating information effectively. This meant some people did not have all their needs met.

We saw the environment had not been adapted in line with good practice recommendations for people with dementia.

We looked at how dementia care was delivered. We found the service and staff did not have an overall approach to providing care for people with dementia that considered clinical guidelines and best practice.

We spoke with six people who used the service and a family member of a person who used the service. We observed the care of others. One person we spoke with told us "I have a lovely bedroom and bathroom, and I love it here'. Another person said 'It's comfortable here, I have my own room and furnish it how I like with things that I've brought from home.'

We looked at four care files of people who used the service. We saw care plans were tailored to meet individual needs.

We spoke with four members of staff. The staff spoke in positive and respectful language about the people who used services. One member of staff told us "I love the residents and working at Arden Park."

People were protected from the risk of abuse because the provider had policies and procedures in place for safeguarding vulnerable adults which staff understood and worked to.

During our visit we asked about the process for auditing the quality of the service provided. We saw the provider had good auditing procedures in place. Evidence was available to show that frequent audits were completed by the organisation's quality team to ensure required standards were being met and improvements made.