Archived: Arden Grange Nursing & Residential Care Home

Arden Grange Nursing & Residential Care Home is a residential care home that was providing personal and nursing care to 34 people at the time of the inspection. The service can support up to 45 older people across three units. All accommodation is at ground floor level.

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

People received their medicines when they needed them. We have recommended the provider replaces the thermometer in the medicine fridge with a type which measures minimum and maximum temperatures. A record of accidents and incidents were maintained however there were no systems to monitor any trends. People felt safe and staff had been trained to recognise and report any concerns. People were supported by adequate numbers of staff who were safe to work with them. People were protected from the risks associated with the control and spread of infection.

The provider’s systems were not always effective in ensuring people received adequate food and drink. People did not always receive a consistent approach to maintain their skin integrity. People were supported by a staff team who were trained and competent in their role. 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. People were able to personalise their bedrooms. People saw healthcare professionals when they needed. Before moving to the home people were assessed to ensure their needs and preferences could be met.

The provider’s systems to monitor and improve the quality of the service people received were not always effective in identifying shortfalls. People’s views were valued and responded to. The service worked in partnership with other professionals to ensure people received a service which met their needs and preferences. People were cared for by a staff team who were well supported in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (report published December 2020).

Why we inspected

We received concerns in relation to staffing levels, people’s nursing care needs, diet and hydration, infection prevention and control, and the general management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

We have identified a breach in relation to meeting nutritional and hydration needs. We have recommended the provider replaces the thermometer in the medicine fridge with a type which measures the current and minimum and maximum temperatures. Please see the safe, effective 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 & Residential Care Home on our website at www.cqc.org.uk.

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

Arden Grange is a nursing home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 45 people.

The home is situated in a rural location. The building accommodates people on one level. The home is divided in to three separate areas with one area specialising in care for people living with dementia.

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

The provider reported incidents to the local authority as required and incident forms were reviewed by the registered manager. An improved template for the recording of incidents was being implemented. Risks to people’s safety were assessed and reflected professional’s guidance.

People were supported by sufficient numbers of staff and a concerted effort was being made to increase the number of permanent nurses. People received their medicine on time and as prescribed.

Infection and prevention controls were in place. However, we raised some concerns regarding the environment. The environment had been improved since the last inspection, but further work was required to bring the home up to standard.

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. Following the inspection, the provider improving their recording around the swabbing for Covid -19 to ensure there was a clearer audit trail of decisions made.

People’s needs were assessed, and people were supported to maintain a balanced diet. People were supported with their health needs and supported to attend health appointments.

Staff received training relevant to their role and worked alongside other agencies to support people in receiving consistent care. Staff were complimentary of the improvements to the culture in the service and governance checks had improved. The registered manager was aware of the work required to raise the quality of the service offered to people.

People told us they knew what was happening in the service and staff were able to join in regular discussions about what was happening and ask questions of the management team. Examples of continuous learning could be demonstrated.

Relationships with partner organisations were being developed and the provider understood their duty of candour.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 24 October 2020) and there were multiple breaches of regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 and 19 September 2019. 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 the safe care and treatment.

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, Effective and Well-led which contain those requirements.

Further to this we had received concerns in relation to the management of infection, prevention and control and needed to explore these concerns further.

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.

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 remained the same. 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 Grange 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.

Arden Grange Nursing and Residential Care Home is a residential care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can support up to 45 people across two wings of one purpose- built building. One of the wings specialises in providing care to people living with dementia.

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

Since our previous inspection the quality and safety of the service provided for people had deteriorated. People’s safety was not always effectively assessed and managed at the home; and there was a pattern of not always reporting events that would reasonably be thought to be a safeguarding concern to the local authority. The provider had not always had effective oversight of the safety of people living at the home.

The provider had not always ensured that new staff had robust checks of their previous conduct in health and social care; as they are required to do so. The administration of medication at the home was mostly safe. However, the guidance available for staff on how people receive their medication was not always up to date.

The services and equipment used in the building had been regularly checked for safety; and there were plans and systems in place to help keep people safe in the event of a fire. However, there were areas of the environment that needed attention to improve the safety and experience of people living at the home.

The home had very few points, or areas of interest for people and very few adaptations to help people find their way around. There was evidence that the lounges, in which some people spent a lot of time were not meeting people’s needs and preferences.

We recommend the provider look at the environment of the home and how this met people’s needs; including the storage of waste and the use of CCTV.

Each person had their needs assessed using a recognised model. This helped staff establish the level of support that each person needed. People were supported with their healthcare needs. When people had a particular health need, they had a care plan covering that health need which gave guidance for nurses and care staff.

Each person had an individualised care plan which was regularly reviewed, if appropriate with people’s family members. We saw times when this method of care planning had helped staff to support people to achieve positive outcomes. We also saw times when care planning had not helped staff to provide responsive care and support.

We recommend the provider looked at how care planning and information was used to ensure that care provided was responsive to people’s needs and wishes.

We saw that people were consulted with and asked their opinions in day to day matters; if appropriate people’s families were involved by the home to help support people to make decisions. People’s family members told us that they felt involved and consulted with about the care of their relative. People were consulted about their likes, dislikes and preferences of food choices. The feedback was that people at the home liked the food provided.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

For most of the time we saw kind, caring and respectful interactions between staff and people at the home; however, at other times staff seemed indifferent towards or unable to meet people’s needs or wishes. We saw that people were usually treated with dignity and respect.

There were enough staff at the home to meet people’s needs in a timely manner. Staff told us that they received training and support to help them be effective in their roles. The provider had a program of training and training refreshers. However, records still showed that there were gaps in the training provided to staff.

The provider had recently recruited two activity co-ordinators to help increase the responsiveness of the service in supporting people to engage in meaningful activities. They had recognised that this was an area that needed improving.

The providers assessing of the quality of the service provided had not been robust. The systems in place had not been effective in ensuring that the provider could assess, monitor and then use this information to improve the service. This had allowed the quality of the service to deteriorate.

During the inspection the provider, the area manager and newly appointed home manager were candid, open and keen to make improvements at the home. They were candid with staff members during a team meeting and they were immediately responsive to the concerns raised and recommendations made during our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 17 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At the inspection, we have identified breaches in relation to; safeguarding people from the risk of abuse, assessing and mitigating risks, fit and proper persons employed, governance of the service provided and failing to notify the CQC of events they had a legal responsibility to do so.

The provider immediately started to address many of these concerns.

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

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.

Arden Grange Nursing Home provides accommodation and nursing care for up to 45 people. On the days of our inspection 42 people were living there.

At the last inspection on the 8 and 9 February 2016 we identified that improvements were needed regarding all five of the key questions. These were, is the service safe? Is the service effective? Is the service caring? Is the service responsive? And is the service well-led? We identified one breach of regulation 12, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan in August 2016 telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

A registered manager was in post and present throughout this inspection. 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.

People received help with their medicines from staff who were trained to safely support them. Medicines were stored safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

The registered manager and provider had contingency plans in place for times of emergency to ensure people did not receive disruption to the care they received.

People were supported by enough staff to safely meet their needs. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had positive relationships with the staff members who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently. People were supported to eat and drink sufficient amounts to maintain good health.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that the service was safe because people were protected against the risks associated with the use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

Staff employed to work at the home were suitable and had the necessary skills and experience.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

We found care plans for managing medicines were detailed and gave clear guidance to care workers about how to administer and handle medicines appropriately.

People told us they were generally happy with the care they received and their needs had been met.

From speaking with staff it was evident they had a good knowledge of the people they supported.

Is the service effective?

We found care plans for people were detailed and gave clear guidance to care workers about how to support people.

People told us they were generally happy with the care they received and their needs had been met.

Staff were knowledgeable about people's needs. One person who used the service told us, 'They're all wonderful here.'

Is the service caring?

People were supported by kind and attentive staff who knew them well and spoke positively about people as individuals. Care records showed people were cared for using individual approaches.

Is the service responsive?

People's needs were assessed before they were provided with support by the service. People's needs were regularly reviewed and their health monitored. Where appropriate referrals were made to other health professionals this was done in a timely manner.

Is the service well-led?

We saw systems for quality assurance and monitoring at the home. These included medicines, infection control and accidents and incidents. It was clear that the registered manager carried out regular audits which ensured people received good care and support.

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who could talk to us told us they felt involved in the running of the service and felt their opinions mattered. Staff were clear about their roles and responsibilities.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'The staff are very helpful' and another said, 'The staff are wonderful'.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

We saw maintenance, repair and improvement work being carried out in communal and private areas within the home. This involved such things as new flooring, decorating and installing new doors in the corridors.

You can see our judgements on the front page of this report.

Some people were able to say that they were well looked after. They said the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect. They told us staff talked to them about how they would like their support to be provided.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'Staff are very good'.