Arden House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the management of medicines.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

People told us they could talk to most of the staff but did not always feel listened to. One person said, “They are alright, but I don’t think they really understand me or listen,” and “Some (names) are really good, but not all talk to us about things going on, so I feel on edge sometimes.”
Safety concerns and events were not always reported on, there was no reflection of how the incident/event occurred, steps taken to prevent it happening again or information on how lessons were learned to embed good practices going forward. Staff could tell us examples of how they managed incidents, but outcomes and strategies were not always clearly documented or recorded in risk assessments. This meant it was not always possible to monitor improvements and positive outcomes or escalations of risk.
Safety checks were undertaken by staff, this included environmental checks, and risk assessments for both physical and mental health. However, there were gaps in people’s documentation, that is further reported on under the person-centred care question.

Staff worked alongside other adult social care and health organisations to ensure people received appropriate care. There was regular contact with the local authority, social workers, mental health teams and doctors. Staff told us they knew the health teams well and told us of collaborated teamwork. "We work well with the social care teams and community teams, they are always helpful and answer our queries."

Whilst the provider worked well with people and healthcare partners to establish and maintain safe systems of care, robust pre-admission risk assessments were not always in place. We were told by staff that they would always undertake an assessment of the person before they arrived at the home. Despite pre-admission assessment documents being available these were not always used. The pre-admission visit for some had been documented on loose paper without a format and so key information had been missed and lacked some vital information. This meant staff were not always fully prepared for their arrival and therefore could not always manage or monitor people’s and staff safety.
People were supported to maintain their health, attend appointments both inside and outside of the service. This was confirmed by people. People's care records showed referrals had been made to healthcare professionals where concerns had been identified. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital a version of the care plan and risk assessment went with them. These ensured that hospital staff have vital information about the person and their health.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Discussions with people and staff members, told us that not all incidents and events had been reported to the safeguarding team. Examples of these were discussed with the provider, and a policy immediately introduced, to ensure all incidents regarding people were reported on to ensure a multi-disciplinary approach as well as transparency for the health professionals involved in the person’s care.

Staff had received safeguarding training and were clear on how to report any concerns they had. A staff member told us, “I would report any concerns to the manager and expect them to deal with appropriately, I know we can contact the local authority and safeguarding team.” Another staff member said, “Instructions and telephone numbers are in the office, we get regular training.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific. For example, the use of closed-circuit television CCTV cameras in communal areas and doorways.

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The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Effective systems were not always in place to assess, monitor and mitigate risks to people and keep them safe. We identified some people’s needs were at risk of not being met. This included risks associated with supported people when they were distressed, had specific illnesses or needing continence support. This was because not all relevant information to keep people safe was reflected in care plans and risk assessments. For example, people who lived with health problems such as Korsakoff disease, diabetes and epilepsy, did not all have care plans that linked to their particular illness, alcohol management plan and risk assessments. This had not ensured their overall health was monitored and planned for. For example, if a person was intoxicated, there was no guidance as to whether their prescribed medicines were safe to give.

Care plans did not include up to date guidance for staff about triggers and de-escalation techniques for staff to use to help re-assure the person. Daily records were not always consistent in documenting care delivery regarding behaviours that distress and intoxication and of what actions were taken to manage the risk. This was fully discussed and a new care plan system introduced to mitigate risk and training was provided for staff during the assessment process.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There was evidence that improvements were being made to property. Refurbishment was on -going, however there were areas of safety that needed to be attended to. There were a large number of hot pipes and radiators in communal areas that needed to either be covered or risk assessed to ensure people’s safety. This was done immediately. The steps to the garden were broken and uneven and had the potential to be a risk to staff and people. Not all sharp tools were safely managed in communal areas. There were people at risk of self-harming and there was minimal recorded or guidance supplied regarding how staff assessed their room or the premises for possible risk.

Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Sufficient staff were deployed to attend to peoples support needs. However, there were gaps in staff training that meant staff would not have the knowledge, to provide safe care. For example, supporting people who lived with blood borne viruses. Staff said training was good, but they would like more training in Prevention and Management of Violence and Aggression,(PMVA) which isa specialized course for staff in high-risk environments. The training equips staff with the knowledge and skills to prevent incidents, de-escalate tense situations using non-physical and physical techniques, and manage aggression while minimizing harm to both staff and those in their care.

Staff supervision was in place, but some staff had not received a recent supervision, which was being addressed by the area manager. Some staff felt that supervision sessions could be more meaningful.

Staff had been safely recruited and staff files contained all of the required documents for example, references, employment histories and Disclosure and Barring Service (DBS) records. There were some minor improvements needed, which were fully discussed. DBS help employers make safe recruitment decisions. Staff told us they had an induction period where they carried out initial training and were given opportunities to shadow more experienced staff.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was adequately clean. Staff had all received training in infection prevention and control (IPC) and there was a large supply of personal protective equipment (PPE) which was used appropriately by staff. IPC and PPE policies were in place and were reviewed each time government guidelines were updated.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Not all PRN (as required) medicines had robust protocols in place to advise staff when and how to administer PRN medicines. This was related to pain relieving and anxiety relieving medication. No pain chart or agitation charts were in place to monitor for effectiveness. This meant people were at risk of not receiving medicines when they needed them, as documents did not detail signs for staff to look out for to indicate these were needed. There were also no directions for staff to use distraction techniques before administering anti-anxiety medicines. The recording of the running total for PRN medicines was inconsistent and for some there were large discrepancies for which staff could not account for.

The medicine administration records were not completed following good practice guidance, there were multiple crossing outs, gaps with no reason documented and as there was no running total, it could not be checked as whether it was a missed signature or not given. Staff were not using codes or using the code to explain gaps. Therefore, we were not fully assured that people received their prescribed medicines.

There was a clinical cupboard, which was cluttered and disorganised, there was tablets left in the cupboard which we were told had been found in someone’s room and which were not prescribed for that person. These tablets had not been recorded on any document. An incident report had not been completed or reflected in the person’s care records. Risk assessments were not in place for managing the use of unprescribed drugs and alcohol with anti-viral, anti-depressants and anti-seizure medicines. This placed people at risk of harm. During the assessment process, the provider sought immediate support from the Medicines Optimisation for Care Homes (MOCH) who have provided training for all staff and competency assessments, which has mitigated immediate risk to people, however this will take time to embed.