Arliemoor Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment, we rated this key question good. At this assessment, the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to safe care and treatment, safeguarding, person-centred care, dignity, and good governance.

This service scored 38 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Managers told us that people’s needs were assessed by the provider prior to them moving into the service. However, they were unable to locate recent assessments, and these did not form part of people’s support plans. This meant the provider could not demonstrate that people’s assessed needs were current, accurate, or used to inform their care.

We reviewed people’s support plans and found that risk assessments for key areas of need, including personal care, epilepsy, diabetes, and behaviours that may present risks, were either missing or incomplete. Where risk assessments were in place, they did not always sufficiently identify, assess, or mitigate known risks. For example, one person had known risks associated with poor personal hygiene. Although a risk assessment had been completed, it did not fully identify the impact of poor personal hygiene on the person’s health and well-being, nor did it provide clear guidance for staff on how these risks should be managed or mitigated. In addition, daily records did not evidence the support provided to the person in relation to this assessed need.

While managers told us they were reviewing people’s support plans, they had not identified that care records lacked sufficient detail about people’s goals and aspirations. We found that some support plans were outdated, and others were missing essential information needed to guide staff in providing consistent, person‑centred care.

The failure to effectively assess and document people’s needs placed people at an increased risk of receiving inconsistent or unsafe care. This contributed to breaches of regulations relating to safe care and treatment, person‑centred care, and good governance.

Managers acknowledged that more work was needed to ensure people’s care and support plans accurately reflected their current needs and preferences.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The service was not consistently delivering care and treatment in line with best practice or current evidence‑based guidance. Support plans and risk assessments were incomplete or lacked sufficient detail to reflect people’s assessed needs and recognised clinical standards. Staff did not consistently follow national guidance in key areas such as medicines management, infection prevention and control, and risk management, and there was limited evidence that audits, learning, or professional advice were used to inform or improve practice. In addition, we identified a care culture that did not reflect recognised good practice for supporting people with mental ill health, which limited people’s choices, experiences, and expectations. Although managers and staff demonstrated a caring approach, they did not always have the necessary knowledge or skills to meet people’s assessed needs or understand the significant impact that the environment and quality of care had on people’s dignity and quality of life. As a result, care was not always planned or delivered in a way that was safe, effective, responsive, or person‑centred, placing people at risk of receiving inappropriate or unsafe care.

The provider had not recognised how their actions and practices had shaped the culture within the service. They had also failed to ensure staff understood the importance of promoting choice, control, independence, and inclusion as fundamental principles of good quality care. The absence of consistent values‑based practice and effective leadership oversight increased the risk of people receiving care that was not person‑centred or aligned with evidence‑based guidance. This contributed to a breach of regulation relating to safe care and treatment, person-centred care, and good governance.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Managers described how they supported the effective sharing of information with external professionals, including GP practices, primary care services, and, where appropriate, people’s relatives. Daily handover meetings were used to help ensure staff were kept up to date with any changes to people’s support needs.

However, despite staff and managers working hard to support people, teamwork and communication with external partners were inconsistent, and systems did not always ensure the safe coordination of care. We found examples where staff did not seek advice, request additional support, or appropriately escalate concerns when required. Although staff had access to people’s care and support plans, records were not consistently kept up to date. This created a risk that people could receive care that was unsafe or not aligned with their assessed needs. This contributed to a breach of regulation relating to safe care and treatment, person-centred care, and good governance.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or, where possible, reduce their future needs for care and support.

People were supported to access a range of healthcare services, including GPs, dentists, opticians, and community‑based activities, and to maintain relationships that were important to them. We saw some positive examples of engagement, such as people taking trips into town and visiting local attractions.

However, some people's health needs were not proactively managed. Support plans contained limited information to demonstrate how people were supported to understand and manage their health needs. In addition, care records provided minimal detail about how people were supported to make choices, exercise their rights, or develop greater independence.

The failure to deliver care and support in a person‑centred way contributed to a breach of regulation relating to person‑centred care.

Following the inspection, the provider told us, "Many conversations are had with people to encourage them to live healthier lifestyles and for them to understand the importance of managing their health needs."

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor and improve outcomes were ineffective and did not identify significant risks. Managers told us that people’s care and support was continuously monitored and reviewed to promote good outcomes for people. Some support plans were informative and provided staff with detailed information on people’s likes, dislikes, personal preferences, care needs, and medical history. However, some lacked detail of the support people needed to meet their assessed needs, develop life skills, and increase their independence, which meant staff did not always have the information they needed to meet people’s needs safely.

Reviews of people’s care and support were taking place. However, we found reviews did not consistently consider all available information or identify where information or guidance for staff was missing. For example, information recorded following incidents was not used to update support plans or inform staff practice. This represented a missed opportunity to identify and mitigate risks.

There was little evidence to show how people participated in the development of their care and support. More work was needed to ensure people were truly involved and seen as partners in their care.

Care plan audits were either not being completed or records were missing. Effective governance systems had not been developed or implemented to assess, monitor, or improve the health, safety, and welfare of people using the service. As a result, the provider failed to identify and address key areas of concern. This contributed to breaches of regulations relating to person‑centred care, safe care and treatment, and good governance.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

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 the mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The provider had policies and procedures in place to support people in understanding their rights. Records showed, and staff confirmed, that training had been provided in safeguarding adults, the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff spoke about the importance of obtaining consent and applying the principles of the MCA.

However, this knowledge was not consistently applied in practice. For example, records for one person stated they required supervision when leaving the home. Managers confirmed that the person’s capacity to consent to these arrangements had not been assessed and that a best‑interests decision‑making process had not been followed. As a result, there was no lawful framework in place to support these restrictions. This meant restrictive practices were being applied without an appropriate legal framework or clear justification, placing people at risk of having their rights restricted unlawfully.

The failure to assess and record people's capacity and best interest decisions risked compromising people's rights. This contributed to a breach of regulation relating to safeguarding, person-centred care and good governance.