Arden House Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvements. At this assessment the rating has remained Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of the legal regulation in relation to governance at the service.

This service scored 54 (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 had a shared vision and culture, but improvement was required to ensure it was embedded throughout the service and understood by staff. The provider was passionate about ensuring that people received support based on equality and human rights, and diversity and inclusion. However, staff needed support in understanding some peoples’ behaviours in order to have a better understanding of their role in promoting person centred care. Some staff shared they would like further training in managing people and situations that may cause distress to other people and staff. One staff member said, “We do understand people have different ways of coping and to be able to respond correctly and respect that, we need further training. We were told that this would be sourced.
The acting manager and staff understood and supported people’s cultural and spiritual needs. People were treated equally, and their individual needs were met in line with their preferences. The management team knew people well and worked alongside staff to support and promote good practice.

Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The management team was committed to improvement and was open and transparent regarding the improvements made and those that were on going. We were told that the focus of the service was to ensure people were safe and supported with understanding.
There were systems and processes in place to support staff development and progression within their roles. They talked of how they were supported to attend training, gain qualifications and extend their role, for example becoming a medicine giver. Staff supervisions, and competencies took place.

People did not always feel they could speak up and that their voice would be heard.

Formal and recorded opportunities for staff to speak up included staff surveys, we were given a sample, however these were not dated and did not include actions taken on the feedback.

Staff told us they had not received regular supervision meetings recently and that there had been few staff meetings other than the meetings at shift handovers. The area manager was completing supervisions in a new format which will be used for all staff going forward. Staff told us their initial impression of the area manager was positive and there appeared now to be greater consistency and oversight. As with other management areas, this required time to embed before benefits could be realised.

The area manager had begun regular supervision meetings and acknowledged the need to capture and share both poor and good staff practice. A staff member told us, “I think it will be good, we can ask for training and put ideas forward.”
Staff told us that whilst confident to speak up about concerns, they said things didn’t change. Comments included, “We do put suggestions forward, but nothing seems to happen for a long while.” One staff member had completed a survey which stated, ‘felt listened to but no action taken.’ Staff were aware of the whistle blowing policy and felt that they could raise concerns. The provider had up-to-date whistleblowing policies and procedures which were in line with current guidance.
The provider understood their responsibilities under the duty of candour. The Duty of Candour is to be open and honest when untoward events occur. CQC have however not always received notifications as required. This was due to staff not understanding the importance of the necessity of sharing information. This was fully discussed and extra training given to staff. During our assessment we found that the management team were open and transparent. They admitted when things had gone wrong and demonstrated how they were using these to make improvements.
People confirmed they knew how to complain, and a copy of the complaints policy was available in the home. A record of complaints was held in the service, but they did not always contain the outcome and action taken to resolve the issue. There was one recent complaint recorded, which did not evidence any management of the concern or follow up to ensure people involved were supported.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Several members of staff had worked at the service for over ten years. Staff retention reflected their satisfaction at working at the service over time, despite the recent changes. Different cultures and religions were represented within the workforce and staff told us that any requests for changes in shift or days off due to wanting to celebrate feast days had been supported by managers. Equal opportunities and equality and diversity policies were in place and although not reviewed recently, remained fit for purpose.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.
The quality assurance systems demonstrated there were still improvements to be made in respect of the collection of data to ensure that shortfalls were acted on in an effective way with an action plan. For example, the need to expediate necessary improvements to the environment.
Care plans and risk assessments lacked important health details, for example one person was at risk of choking but there was no risk assessment to guide staff in actions to take should they choke. We also found a lack of emergency equipment for the people supported, such as suction machines. Daily notes lacked the information that ensured people were receiving the support and social needs they wanted or required. Events and incidents had not been fully analysed for patterns and trends to ensure lessons were learned and shared with staff. It was acknowledged that some audits and overviews lacked depth, for example first aid kits, stated they were checked but we found some empty and covered in grease. This was immediately rectified. The area manager is a month into their role and would be completing audits.
The service followed robust arrangements for the confidentiality of data, records and data management systems. The provider monitored and managed staff performance and acted quickly to improve skills or conduct. The staff were positive about the management team and felt improvements were happening.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

People were consistently supported across a range of different services and agencies. There were established systems in place to liaise with other professionals. In addition, within the organisation there were regular conferences which staff and leaders attended. These were opportunities to share knowledge and learning and consider future developments.

The provider and registered manager worked cooperatively with partners and commissioners. However, this needs to be reflected back into the care documentation, so all staff are fully aware and kept up to date with any changes and to support people safely.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Because of the recent lack of auditing and quality monitoring there was no record of learning lessons when things went wrong. Lack of management oversight meant that longer term trends were not captured. Accidents and incidents were recorded and then discussed at handover or daily ‘flash’ meetings’ but there was no written record of these conversations. The current system was due to be replaced with a better presented care plan recording process. The absence of recent supervision meetings meant that staff did not routinely have the opportunity to raise concerns or best practice with managers. Again, this had resulted in good practice being missed. The area manager was aware of these concerns and had begun the process of capturing lessons from incidents and trends from auditing processes. Again, this required time to embed and become usual service practice.