Arden Grange Nursing & Residential Care Home

Arden Grange Nursing and Residential Care Home provides nursing and personal care for up to 45 people including people with dementia. At the time of the inspection there were 23 people using the service.

The home is an adapted building with all care provided on the ground floor. People have access to lounges, dining areas and outdoor spaces. Bathrooms and toilets are situated near to all communal areas.

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

Improvement had been made to the environmental risks we identified at our last inspection, but some areas still required some on-going work. People’s medicines were not always safely managed.

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.

People were supported to eat and drink but records did not always confirm how much people should be drinking to keep them well. People’s care plans had been reviewed and updated since our last inspection. More work was needed to ensure these records always reflected people’s preferences and wishes, including their communication needs.

Although the provider had improved their quality monitoring and oversight since our last inspection, further improvement was needed to ensure shortfalls in the service were identified.

Staff understood how to protect people from harm and followed safe hygiene practices to prevent and control infection. People were supported by enough staff who had been safely recruited. The provider had systems in place to make sure lessons could be learnt from accidents, incidents and when things went wrong.

People’s needs were assessed and they had care plans in place. Staff had received the training they needed to meet people’s needs. People’s routine health needs were met, and referrals were made when people needed other health care support or staff were worried about a person’s health.

People were supported by kind and caring staff. Staff had developed good relationships with people and their relatives, and they were treated with dignity and respect.

People and relatives felt confident to raise concerns if they needed to.

Staff and the registered manager understood their roles and responsibilities; they felt supported by management and involved in the development of the service. People and relatives praised the service and felt staff and managers were supportive.

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 this service was inadequate (published 28 December 2022). The provider had breaches in relation to people's safety, consent to care and treatment, dignity and

respect, person centred care and governance of the service.

At this inspection we found the provider had made improvements and was no longer in breach of the regulations for dignity and respect and person-centred care but remained in breach of the other regulations.

This service has been in Special Measures since 28 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arden Grange Nursing & Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to the management of people’s medicine, consent and the governance of the service.

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

The home is an adapted building with all care provided on the ground floor. People have access to lounges, dining areas and accessible outdoor spaces. Bathrooms and toilets are situated near to all communal areas.

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

People were not always cared for safely. Lessons were not always learnt if things went wrong. People were not fully protected from the risks of infection. People were protected from the risk of abuse

People did not have detailed care plans or risk assessments which meant staff may not have the information to support people safely. People were not always supported in a timely manner at mealtimes meaning their hot food could go cold. Staff did not always meet people’s support needs at mealtimes.

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.

People were not always treated with dignity and respect at the home. People could not be assured that their equality and diversity would be respected as the provider had not identified their preferences or characteristics for staff to be aware of

People could not be assured they would receive person centred support as care plans lacked detail about the people they were written for. People’s communication needs were not being met.

People could not be assured that the provider’s governance and oversight was effective at identifying concerns and making timely improvements.

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 August 2022).

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 some improvements had been made but further improvements were required, and the provider remained in breach of regulation and new breaches of regulation were found.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 and 20 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements, which they had not.

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

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arden Grange Nursing and Residential Care on our website at www.cqc.org.uk

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 and will take further action if needed.

We have identified breaches in relation to people’s safety, consent to care and treatment, dignity and respect, person centred care and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home is an adapted building with all care provided on the ground floor. People have access to lounges, dining areas and accessible outdoor spaces. Bathrooms and toilets are situated near to all communal areas.

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

Governance systems were ineffective at identifying and correcting failures at the home.

People could not be assured they would be cared for safely. People were not fully protected from the spread of infections. People were not protected from the risk of abuse from inappropriate and unauthorised restraint. People could not be assured that lessons would be learnt if things went wrong.

People did not have detailed care plans and risk assessments which meant staff may not have the information to support people safely. People were not supported in a timely manner at mealtimes meaning their meals could go cold. People could not be assured that action would be taken in response to concerns around food and fluid intake.

People could not be assured they would receive person centred support as care plans lacked detail about the people they were written for. People may not receive information in a format they understand.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

This service was registered with us on 29 October 2021 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 1 July 2021.

Why we inspected

We received concerns in relation to the use of restraint at the home. We decided to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report

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 and will take further action if needed.

We have identified breaches in relation to regulation 9, person centred care, regulation 12, safe care and treatment and regulation 17, good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Clear infection control systems were in place, however a few staff were observed not following these in regards to ensuring good hand hygiene at all times.

Visiting arrangements followed current government guidance for routine visits and the use of essential care givers.

Hand sanitiser and personal protective equipment (PPE) was readily available at the home. The home had sufficient supplies of PPE.

People, staff and essential care givers took part in the home’s COVID-19 testing regime, which followed current government guidance. Appropriate processes were in place should anyone display any symptoms of Covid-19.

The registered manager reported good support from the local health professionals during a current COVID-19 outbreak at the home.