Arden House Residential Care Home

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

Following the previous inspection, the provider sent us their action plans to improve the care delivery at Arden House Residential Home. This included information about the steps they had taken to make improvements at the home including working with external professionals and consultants to develop and improve the home.

Quality assurance systems had been introduced and continued to be developed and improved. This included audits of medicines, falls, infection control and the environment. Changes had been made to people’s care plans, risk assessments and daily record keeping, and this was ongoing. The provider and staff team had worked hard to address the areas for improvement following the last inspection. Further time was needed to fully embed these changes into day to day practice.

The provider and staff worked hard to improve and ensure that appropriate infection control procedures for the pandemic were in place to keep people safe. This included increased cleaning schedules and cleaning, and adequate PPE was available with hand gel. Staff had completed training in relation to COVID-19 and testing for both people and staff was in line with current government guidance.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service. Staff understood the risks associated with the people they supported. Risk assessments provided some guidance for staff about individual and environmental risks. People received their medicines safely.

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 03 November 2020). There were three breaches of regulation. We served a warning notice in relation to the Safe care and treatment of people, and requirement notices for Safeguarding service users from abuse and improper treatment and Good Governance and told the provider to make these improvements. At this inspection we found improvements had been made and the warning notice was met.

This service has been in Special Measures since 03 November 2020. 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

We carried out an unannounced inspection of this service on 22 October 2020. Breaches of legal requirements were found. We issued a warning notice to the provider about Safe care and treatment and requirement notices for Safeguarding service users from abuse and improper treatment and Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this targeted inspection to follow up on specific concerns, which we had received about the service.

We inspected using our targeted methodology developed during the Covid19 pandemic to examine those specific risks and to ensure people were safe.

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

Care and treatment was not consistently provided in a safe way. People ‘s specific health needs were not identified and planned for. People’s health therefore was at risk and this had not been addressed by the manager or provider. There was a lack of management plans for supporting people with their mental health needs which had the potential to impact negatively on peoples’ overall health and social care needs.

People were not protected from potential harm and abuse. Some people had been subject to abuse and this had not always been escalated and investigated to prevent further occurrences. Abuse or improper treatment was not always reported, investigated or acted on.

An infection prevention control audit was carried out by CQC during the inspection. It was found the

provider was not meeting government guidelines in regard to Covid-19. People had not been self -isolating safely in the home. There was a lack of zoning and cleaning of high traffic areas.

Staff had not all received essential training and specific training to meet people’s individual needs and there was minimal evidence of regular supervision and competency assessments.

The provider's systems failed to identify that care and treatment was not provided in a safe way. Audits did

not always identify risks to people, safeguarding concerns and a failure to report incidents. Staff practice was not effectively monitored.

Staff were open and transparent during the inspection. Staff were kind to people and wanted to deliver good care.

Rating at last inspection:

The last rating for this service was Good (published 12 September 2018).

Why we inspected:

We undertook this targeted inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service. We inspected and found there was a concern with staff training, accident/incident management so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement:

We are mindful of the impact of the Covid19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

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.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 14 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, physical disabilities, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

At a comprehensive inspection in July 2017 the overall rating for this service was requires Improvement. We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service had sustained the improvements. The overall rating for Arden House has been changed to good.

The service had a registered manager in place. 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.

Whilst there were systems and processes to assess and monitor the quality of the service provided and ensure that the premises were safe and well maintained, there were some areas of essential maintenance that had been overlooked and needed to be addressed. For example, ensuring that fire risk assessments were updated by a competent person. The yearly legionella test had not yet been undertaken and the five year electrical safety certificate was slightly out of date. Following the inspection, we received written confirmation that these had been taken forward with urgency with timescales for completion by the end of August 2018.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with specific health problems such as diabetes. Formal personal development plans, including regular supervisions and annual appraisals were in place. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation. People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were individual to people at this time apart from when entertainers visited. People told us that they enjoyed doing their own thing, “I like to choose to do what I want, I don’t like games but I enjoy the quizzes.” People told us that they enjoyed going out to local venues. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 16 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

There was no registered manager in post. The previous registered manager de-registered in January 2017. The current manager has submitted their application and an interview arranged. 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.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016. We undertook an inspection in May 2016, to see if improvements had been made. We found that considerable improvements had been made and the provider had met four of the five previous breaches of Regulation.

We undertook an inspection in July 2017 to see if the improvements made had been sustained and embedded into everyday practice. We found that not all improvements had been sustained: the management of medicines were not always safe, the premises were not always clean and hygienic and risks to people were not always mitigated. We also found that further improvements were needed to ensure management oversight of care delivery and documentation. At this time we served warning notices to ensure peoples safety and well-being.

This focussed inspection was specific to the safe and well-led questions to see if the necessary improvements to people’s safety had been made and systems to sustain improvement had been put in place.

At this inspection there was strong managerial oversight to ensure documentation was kept up to date and ensured people received safe, effective, caring and responsive care. A range of audits had been introduced and completed monthly. When audits had identified issues there was evidence of recorded actions taken to address the issues. For example, poor recording of medicines administered had led to the further training and competencies. We still found some inconsistencies in medicine records and these will be addressed further within staff's individual performance supervisions.

At this inspection the management and storage of medicines were safe. There were areas to further develop in respect of the management of 'as required' (PRN) medicines and these were immediately actioned. Risks related to infection control and lack of cleanliness had progressed with new house keepers and more in-depth audits.

Accidents and incident reporting had been completed and there was management overview of audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure learning and preventative measures had been taken.

Staff had training on keeping people safe and understood the process of reporting concerns. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. There were sufficient staff at this time to meet peoples’ needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

The provider had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 20 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

There was no registered manager in post. The previous registered manager de-registered in January 2017 and whilst another manager had been in post until March 2017 they had not registered with CQC. The current manager has submitted their application. 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 has arranged for the manager of a sister home in the organisation to provide regular support for the acting manager. The provider confirmed that she is visiting or in contact daily to provide support and guidance.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016. We undertook an inspection in May 2016, to see if improvements had been made. We found that considerable improvements had been made and the provider had met four of the five previous breaches of Regulation. Further improvements were needed to ensure management oversight of documentation.

This inspection in July 2017 was to see if the improvements made had been sustained and embedded into everyday practice. We found that not all improvements had been sustained.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits had not been undertaken for four months. This had impacted on the safety and well-being of people. The premises were not clean and placed people at risk of cross infection. Laundry facilities were not kept clean and procedures for soiled linen were not followed. The washing machine had not worked for up to six days. The premises had areas of poor maintenance that had not been identified and reported for repair. Whilst there were procedures for the safe management of medicines, these had not been consistently followed. The staff deployment had not enabled staff to care for people, clean the premises, undertake laundry chores and provide activities. The maintenance cover for the organisation and for three premises was provided by one maintenance person over three days which was not sufficient to keep the premises well maintained for people.

Whilst the provider had arrangements in place for the management of medicines, we found the administration and recording of medicines were potentially unsafe. There were some people at risk of not receiving their prescribed medicines, as there were a large number of staff signature omissions (identified as gaps) in medication administration records (MAR). Staff had not completed the MAR record to state why the medicine had not been given. Identification photographs of some people were missing from the medicine administration charts (MAR), as were details of allergies.

Whilst people received support in a person centred way and were treated with dignity and respect there was a lack of social activities for people to partake in following the resignation of the dedicated activity co-ordinator. Documentation to guide staff in supporting people who were at Arden House for a short stay were not available for some people. This included people who lived with diabetes and who have had a recent limb operation.

Accidents and incident reporting had been completed but there was no management overview or audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure learning and preventative measures had not been taken.

Staff had training on keeping people safe and understood the process of reporting concerns. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Deprivation of Liberty Safeguards had been requested for those that required them.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given choice on what they wanted to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow. People had access to appropriate healthcare professionals, such as dieticians. Staff told us how they would contact the GP if they had concerns about people’s health.

The provider had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

We found 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 this report.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 14 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, diabetes, Parkinson’s disease and heart disease.

There was no 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. The management team had been unstable due to senior staff leaving employment over the past few months. The area manager had also left the organisation since our last inspection. An acting manager had been in post for three weeks. We have been informed that once her role is established she will be submitting her application to be registered with CQC. The provider has arranged for the managers of the sister homes in the organisation to provide regular support and meetings with the new acting manager. The provider confirmed that she is visiting or in contact daily to provide support and guidance.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The inspection in July 2015 found significant risks to people due to the poor management of medicines and people not receiving appropriate person centred care. This was because where people’s health needs had changed considerably, care plans had not been updated. Staff therefore did not have the most up to date information about people’s health. This meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wounds and pressure damage. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. Risks associated with the cleanliness of the environment and equipment had been not been identified and managed effectively. People had not been protected against unsafe treatment by the quality assurance systems. We also found that training had not been delivered where identified as needed and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016.

During our inspection on 25 and 26 May 2016, we looked to see if improvements had been made.

At this inspection we found that considerable improvements had been made and the provider was now meeting four of the five previous breaches of Regulation. We could see that action had been taken to improve people’s safety. Whilst improvements in the management of medicines had not been sustained fully, this service in no longer in special measures as the risk was reduced immediately with support from the GP, pharmacist and district nurse. .

People were supported to access health professionals or appointments. However, there was an on-going need to ensure the relationship between the service and health professionals was improved in order for people to get the support required to manage changes to their heath in a safe way.

The training plan we first saw during the inspection was not clear or up to date. The provider then showed us an up to training plan with the confirmation that the training had been undertaken. Staff said they felt supported and confirmed that they were having supervision. We received an up to date supervision record following the inspection. We asked why records were difficult to locate and were told this was due to a gap following the departure of the previous acting manager in March 2016 and the starting of the new acting manager. The provider acknowledged that there had been some issues with the management of the home which had resulted in senior staff moving on and a new staff being employed. The provider said that it could have been a smoother transition, but felt it was now coming together. Their main priority had been ensuring that people’s care was appropriate and met their needs.

There were systems and processes to assess and monitor that the service was of a good quality. However, we found the medicine audits had not identified issues around medicine administration in April and May 2016. Following the inspection we received information and supporting documentation which confirmed an in-depth medicine audit had been conducted by the manager of the sister home. It also confirmed support from the dispensing pharmacy and district nurse. All medicine givers had been given further training and the staff had a staff meeting specifically to address management of medicines. The service was working with Commissioners to ensure that clear outcomes for people were identified and worked towards.

People received support in a person centred way and were treated with dignity and respect. People were receiving support which was individualised to their needs.

Accidents and incident reporting had taken place and were recorded. Records contained documented investigation and measures to ensure learning and preventative measures. Staff had training on keeping people safe and understood the process of reporting concerns. Staff had been checked to ensure they were suitable before starting work in the service.

Staffing levels were stable and sufficient in numbers to meet people’s identified needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

Staff had an understanding of the Mental Capacity Act 2005 and had received refresher training.

Staff had attended staff meetings to enable them to raise concerns and discuss issues collectively.

We found a breach 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 this report.

There were 23 people living at the home on the day of our inspection.

We spoke with seven people and six staff. We spoke with two relatives. One person told us, 'The staff are always very welcoming to my family.'

We found that people were shown respect and dignity. There was a range of activities for people to engage with.

We looked at four care plans and saw that they reflected the care that was provided to people. The home had systems in place to ensure people's individual needs were met.

We found the home to be clean and tidy. One person told us, 'My room is kept nice and clean.'

The home had effective staff recruitment systems in place.

The home had an effective complaints system. People we spoke with were aware of how to make a complaint.

People were supported and encouraged to be independent and have choice over their daily living routines. We saw that food was well presented and people were seen to enjoy their meals.

We saw records that showed that people were involved in decisions about their life and that people were treated with dignity and respect. We looked at training records that showed that staff received development to help them perform their roles safely and well.