Archived: Arboretum Nursing Home

Arboretum Nursing Home is a residential care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 54 people.

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

The provider’s audits in place to monitor the quality of the service were not effective and had not identified the areas of improvement needed which we found during our inspection and as detailed in the report.

The provider had failed to ensure people had personal emergency evacuation plans in place. Medicines were administered safely however there were no protocols in place to guide staff for medicines administered as and when required. Staff could explain the actions they would take to keep people safe from harm. The provider had a recruitment process to ensure they employed suitable staff to support people safely. Staff followed infection control guidance and had access to personal protective equipment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service was not working within the guidelines of the Mental Capacity Act.

People were supported to eat a healthy diet and staff knew people’s specific dietary requirements. The service worked closely with health professionals to ensure people received the support they needed.

People were supported by kind and caring staff who knew them well. People were treated with dignity and respect and people’s religious and cultural beliefs were respected.

People's support needs were assessed regularly and planned to ensure they received the support they needed. The provider had a complaints process which people were aware of to share any concerns.

Rating at last inspection

The last rating for this service was requires improvement (published 07 March 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 11 (need for consent) and regulation 17 (good governance) at this inspection.

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

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.

Arboretum Nursing Home provides accommodation for persons who require nursing or personal care for up to 54 people. At the time of our inspection there were 49 people living at the home.

At the time of the inspection the home did not have a registered manager in post. However, the provider was in the home on a daily basis managing the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 owner told us that their plan in 2016 was for the current manager to apply to become the registered manager however this did not happen due to personal reasons. The owner stated that they would begin the application to become the registered manager.

People told us they felt safe and were happy with the standard of care they received. Staff were aware of people’s risks and appropriate equipment was available for staff to use. In relation to safeguarding, staff were knowledgeable about different types of abuse and how to raise a concern.

We found there were a sufficient number of staff on duty to meet the care and support needs of people. The provider had a robust recruitment procedure and staff were trained to meet the nursing and care needs of people. We found that there were appropriate arrangements in place for the safe management, administration and storage of medicines.

People were supported to eat and drink sufficiently. People’s care and health needs were assessed and reviewed. The care was planned and delivered to meet people’s needs. People, their relatives and health care professionals had been involved in the planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs.

Staff treated people with dignity and respect and helped to maintain people’s independence. People were given choices by staff to participate in activities.

People told us staff asked for their consent before administering care and support. Staff understood they should gain people’s consent where possible. We found the provider working within the principles of the MCA and adhering to conditions on authorisations to deprive a person of their liberty. The registered manager had a good understanding of their legal responsibilities with regard to the MCA and Dols. Consent to care and treatment was documented in people’s care records.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were involved in assessments and care plans that reflected their needs and preferences. People and relatives told us they were confident any concerns or complaints they had would be listened to and the matter resolved in a timely manner.

People and relatives told us they were happy with end of life care, people were treated with dignity and end of life preferences were captured.

People and relatives told us the staff, provider and manager were knowledgeable about the service and the people using the service. Staff and management were also approachable. People had the opportunity to express their opinions such as speaking to management and completing surveys. The provider also had effective audit processes in place.

We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arboretum Nursing Home on our website at www.cqc.org.uk.

This unannounced focused inspection took place on 12 April 2017 and we found the required improvements had been made.

Arboretum Nursing Home provides accommodation, nursing and personal care for up to 54 older people. The home does not currently have a registered manager in place. However, the provider was in the home on a daily basis managing the home. 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 told us the home was well-run and the provider and staff approachable and friendly.

We found that when able to, people had consented to their care, treatment and support or had been supported to do so by a significant person.

People who used the service and the relatives we spoke with told us they were happy with the care being provided at Arboretum Nursing Home. One person told us: 'I have been here four years and couldn't be happier'.

We saw that the service was clean and had systems in place to prevent the spread of infection.

We found that the service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure which was available for people who used the service or their representatives to raise any concerns they might have had.

Some people who used the service were able to talk with us but others were unable to because of their frailty. People we spoke with told us they liked living at Arboretum Nursing Home and received good quality care. We observed people being cared for throughout the day in a dignified manner.

We looked at the way the service safeguards people who used the service and found appropriate procedures were in place to keep people safe.

Staff we spoke with told us they liked working at Arboretum Nursing Home and felt supported in their role. They told us they received sufficient training to fulfil their role.

On our previous inspection we had concerns over the management of medication and the way in which medication was stored. We found at this inspection improvements had been made.

We spoke with health professionals and relatives of people who used the service and they told us that the care was excellent at Arboretum Nursing Home.

The service had devised audits to monitor the quality of the service being delivered and used the information from these to improve the quality of the service.