Arboretum Nursing Home

Arboretum Nursing Home is a care home providing personal and nursing care to up to 54 people. The service provides support to younger adults and older people who have dementia, sensory impairment and physical disabilities. At the time of our inspection there were 46 people using the service.

People’s experience of using this service and what we found

Improvements were required in relation to the recording and responding to people’s concerns and how the provider used information from people and their relatives to drive improvements. Furthermore, improvements were required in relation to communicating in timely manner with health and social care professionals linked to the service.

Risks to people's health and well-being had been assessed and monitored to ensure they were kept safe. The provider had safeguarding systems and processes in place to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm. Staff were recruited safely and there were enough staff to meet people's needs. People lived in an environment that was clean and well maintained.

Staff observed and followed infection control procedures in line with national guidance for reducing the spread of Covid-19. Staff followed the infection control procedures the provider had in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests: the policies and systems in the service supported this practice. People's individual communication needs were considered to support them to be involved in their care.

Audits took place to ensure the quality of the service was maintained.

People were assessed before they used the service to ensure their needs and preferences could be met.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement, (published on 16 November 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arboretum Nursing Home is a care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

People’s experience of using this service and what we found

Medicines information to aid staff to administer medicines prescribed on a when required basis (PRN) was not in place.

Staff did not have the information they needed on how to prepare and administer medicines given via a feeding tube safely.

We found staff applied some topical medicines (creams) to peoples skin without the necessary training or competency checks.

Some medicines including insulin and eye drops were stored incorrectly.

Risks to people's health and well-being had been assessed and monitored to ensure they were kept safe. The provider had safeguarding systems and processes in place to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm.

People lived in an environment that was clean and well maintained.

Staff observed and followed infection control procedures in line with national guidance for reducing the spread of Covid-19. Staff followed the infection control procedures the provider had in place.

Staff were recruited safely and there were enough staff to meet people's needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found three Deprivation of Liberty Safeguards (DoLS) authorisation had expired and the provider had not sent a request for a renewal in a timely manner. We found two people had DoLS requests and urgent authorisations even though both were assessed as having full capacity. Staff had received training in the Mental Capacity Act however, further improvement was required to enable staff to fully understand how to work within the principles of the Act.

People or their relatives were not involved in reviews of their care.

People were assessed before they used the service to ensure their needs and preferences could be met.

People and their relatives told us they felt well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible.

People’s communication needs were assessed and understood by staff. People were provided with information in a format which met their needs.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

The provider's audits to monitor the quality of the service were not consistently effective in driving forward improvements

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service under the previous provider was requires improvement, published on 21/02/2020.

Why we inspected

The inspection was prompted in part due to concerns received about the management of safeguarding incidents. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to Regulation 12 (safe care and treatment), Regulation 11 (need for consent) and Regulation 17 (good governance) at this inspection. The provider responded to the concerns on the day of the inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.