19 and 20 January 2015
During a routine inspection
This inspection took place on 19 and 20 January 2015 and was unannounced.
Arbor House is a care home that provides residential care for up to 40 people. The home specialises in caring for older people including those with physical and sensory disabilities and people living with dementia. At the time of our inspection there were 37 people in residence.
A registered manager was 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 registered manager and staff were trained in the Mental Capacity Act 2005, which is the legislation that protects people who lack capacity to make decisions about their care. We found there was no procedure in place for staff to follow when they had concerns about a person’s capacity to make a decision about their care. Although significant people such as family members and health care professionals had been consulted there were no records of those meetings and any best interest decisions made. Following our visit the provider sent us the guidance produced for the registered manager and staff and the forms to document the best interest meetings and decisions made.
People told us they felt safe with the staff that looked after them and protected them from harm and abuse. People who used the service gave us positive feedback about how their care and support needs were met. Staff had a good understanding of their role in meeting people’s needs and the action they should take if they suspected somebody was being abused.
Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work at the home. We saw staff supporting people and offering reassurance when they became anxious or distressed. People were supported by staff in a timely and sensitive manner, which meant people’s needs were met because there were sufficient numbers of staff on duty that worked in a co-ordinated manner.
People received their medicines as prescribed and their medicines were stored safely.
People lived in a comfortable, clean and a homely environment that promoted their safety, privacy and wellbeing. All areas of the home could be accessed safely including the outdoor space.
People were supported by staff who had a good understanding of their needs and had received training to carry out their role effectively. Risks associated with people’s care needs had been assessed and plans of care detailed how those risks should be managed. Where appropriate expert advice was sought from health care professionals.
Staff were knowledgeable about people’s needs and things that were important to them. Staff had access to people’s care records and were trained to ensure people safety and wellbeing was maintained. Communication between all the staff was good. Staff told us they had access to people’s care records and were supported by the registered manager, which meant all staff were kept up to date as to the needs of people.
People told us there was always a choice of meals provided, which they enjoyed. The meals presented were nutritious and looked appetising. Drinks and snacks were readily available. We saw staff supported people who needed help to eat and drink in a sensitive manner. The catering staff were provided with up to date information about people’s dietary needs and requirements.
People’s health and wellbeing was monitored and staff sought appropriate medical advice and support form health care professionals when people’s health needs changed. Records showed people were referred to the appropriate health care professionals when necessary and that their advice was acted upon. This meant people were supported to maintain good health.
People told us that staff treated them with care and compassion. People who used the service and relatives visiting their family members were complimentary about the staff and the care. They told us that the attitude and approach of staff was caring, respectful and positively promoted their sense of wellbeing. Throughout our inspection we saw people’s dignity and privacy was respected, which promoted their wellbeing.
People were supported by staff and their visitors to take part in hobbies and activities that were of interest to them, including observing their religious beliefs. Visitors were welcome without undue restrictions. This protected people from social isolation.
People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. People had access to advocacy services if they needed support to make comments or a complaint. There was a clear management structure and procedures in place to ensure concerns were addressed.
Staff were supported and trained for their job roles to ensure their knowledge, skills and practice in the delivery of care was kept up to date. Staff, including agency staff, were encouraged to make comments or raise concerns about any aspect of the service provision and make suggestions on how the service could be improved for the people who lived there and knew it would be acted on.
The registered manager understood their responsibilities and demonstrated a commitment to provide quality care. They had an ‘open door’ policy to encourage feedback from people who used the service, relatives of people who used the service, health and social care professionals and staff.
There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment which was well maintained and safe. Internal audits and checks were used to ensure people’s safety and their needs were being met. The quality of the service provided was monitored and action was taken to address any deficiencies found. The registered manager reported the service’s performance to the provider who also monitored the quality of care provided.