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Inspection carried out on 7 August 2018

During a routine inspection

We inspected this service on 7 August 2018. The inspection was unannounced.

The service provides accommodation and personal care for up to 33 older people who may live with dementia. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in a residential area and the accommodation is split over five floors. Twenty eight people were living at the home on the day of our inspection visit.

There was a registered manager 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 was unavailable at the time of our visit, so our inspection was supported by the deputy manager.

At our previous inspection in February 2016, we rated the service as ‘Good’ overall but we identified processes to support good governance needed to be improved. At this inspection we found those improvements had been made. However, managers needed to be more consistent in the application of the Mental Capacity Act 2005 when there were restrictions in people’s care they may not have the capacity to consent to. The effectiveness of the service now ‘Requires Improvement’ but the service remains rated ‘Good’ overall.

People felt safe and secure living at Arden House. There were enough staff to provide safe care, although there were occasions when staff were very busy. There were risk management plans for each person that related to their abilities and the support they needed to minimise risks. Staff had received training in safeguarding people from abuse and understood their responsibilities to protect people from avoidable harm, neglect and discrimination.

Staff completed training to ensure they had the knowledge and skills to meet people’s assessed needs and deliver safe and effective care to people. Staff understood their roles and responsibilities and had regular individual meetings and observations of their practice to make sure they carried these out safely.

Care plans provided staff with the information they needed to meet people’s needs. People’s care and support needs were kept under review and staff were informed about changes in people’s care.

Staff worked well with other healthcare professionals and arrangements were in place to support co-ordinated care. Medicines were managed in accordance with good practice and people received their medicines as prescribed. There was a choice of food and people were supported to eat a nutritionally balanced diet to maintain their health.

The home was welcoming, clean and well-maintained. People were able to take part in a range of leisure activities to promote their physical and mental wellbeing as well as activities to encourage people to socialise and reminisce together.

Staff were caring and engaged positively with people. Staff supported people to maintain their independence and knew how to provide care in a dignified way that protected people’s right to privacy. Staff offered people choice and asked people if they would like support with anything.

People thought the home was well-managed and were happy with the care they received. Staff spoke positively about the leadership and availability of managers and senior staff.

The provider and registered manager conducted regular audits of the quality of the service to make sure people received safe. responsive care. They also responded to feedback they received from people to identify areas of development. The provider welcomed external scrutiny to improve the standards of care within the home.

Inspection carried out on 3 February 2016

During a routine inspection

We carried out an unannounced inspection at Arden House Care Home on 03 February 2016.

Arden House Care Home provides accommodation for up to 33 people who require personal care. The home has three floors and a well maintained garden area. At the time of our inspection there were 25 people living at the home, two people had been admitted to an acute hospital and five rooms were vacant.

Arden House Care Home had a registered manager in place. 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.

All the people we spoke with told us they felt safe living at Arden House. Staff we spoke with were able to confidently describe a good understanding of the types of abuse that may occur and knew how to report this should they need to. All staff were trained in safeguarding. We looked at the care records of six people who lived at the home. There were personalised assessments for identified risks for each person. These were written in enough detail to protect people from harm whilst promoting their independence.

We saw that there were processes in place to manage risk in connection with the operation of the home, however these were not consistently completed. For example the cleaning schedules for the home did not have any expected instructions detailed and they were not completed consistently. In addition the night staff task checklist, which included cleaning tasks, was not completed consistently.

There were enough qualified, skilled and experienced staff to meet people's needs however the necessary recruitment and selection processes to ensure that staff were suitable to work with people who lived at the home were not always in place.

Appropriate arrangements were in place in relation for the recording of medicine and records which showed that people received their medication as prescribed.

People we spoke with were able to tell us that they had been involved with and participated in the care planning process and had agreed to the content of their plans. Members of staff we spoke with were very positive about the standard of care they provided. Staff knew what was expected of them and that they had the necessary skills to carry out their role to a good standard. Staff told us that they had received regular supervision meetings with their line manager which we verified in the supervision records.

Most of the staff had received training on the Mental Capacity Act 2005 (MCA) and were aware of the Deprivation of Liberty Safeguards (DoLS). They demonstrated an understanding of the requirements of the MCA.

There was plenty of choice of food and people could have drinks and snacks whenever they wanted them. We saw people were offered drinks and snacks throughout the day.

The staff were very caring and ensured people’s privacy and dignity were protected. They knew the people they were caring for well. This included knowledge of people’s likes and dislikes, how they could communicate, their backgrounds and the relationships that were important to them. This meant that people were cared for appropriately.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. People told us that they were supported to access healthcare services.

All of the staff we spoke with said that staff morale was very good and that their manager was approachable and responsive to suggestions made to improve the quality of service. Some systems and processes were not established or operated effectively to ensure good governance.

Inspection carried out on 28 October 2013

During a routine inspection

On the day of our inspection we saw there were 31 people living at Arden House. We spoke with four members of staff, five people who used the service and two visitors. We looked at policies and processes, three care records and four staff records, to gain an insight of the care provided.

We saw that people were involved in decisions about their care. Care plans and risk assessments were in place and were updated regularly to ensure people received the care they needed.

There were a variety of activities designed to meet people's needs and maintain their independence. People told us they liked living at Arden House. One person told us, "It isn�t my home but the staff do all they can.� Another person told us, �The staff are so kind.� A relative we spoke with told us, �I have no worries whatsoever. I know they are well cared for.�

We reviewed the way that medicines were managed and found that adequate safeguards were in place to administer people's medication.

There were appropriate selection and recruitment systems in place and staff were supported by the provider. Staff we spoke with said they liked working there. One member of staff told us, "There is a great team spirit here� and another staff member told us, �It is a wonderful feeling to put a smile on somebody's face.�

People experienced good quality care because systems for monitoring were in place. There was evidence that people and their families knew how to complain if things were not right.

Inspection carried out on 15 October 2012

During a routine inspection

We talked with four people who lived at the home about how they were cared for and supported. They all told us that the staff were kind and the food was good. One person we spoke said, �I am friends with most of the staff.� Another person told us, �I wouldn�t change anything, I like it the way it is.�

We saw that staff were friendly with people and knew them well. We saw care staff helping one person to move around the home safely and giving another person a manicure. We saw that people were relaxed and comfortable with the care staff. Several people joined in a game of bingo with prizes that staff organised during the afternoon. In the hallway we saw photos of people who had been on day trips with staff to places of interest to them.

We spoke with the registered manager, the deputy manager and two members of care staff. We found they all knew people well and understood their individual support needs, likes and preferences.

The provider made regular quality assurance visits to the home to check that people received the care and support that they needed.

Inspection carried out on 15 February and 8 March 2011

During a routine inspection

Everyone we spoke to who live at Arden House gave positive comments about the staff and the care they received. One person was not totally satisfied with the quality of the main meal but felt that some efforts had been taken to address issues raised. This person also agreed that it is difficult to please everyone and felt that it may be a case of personal taste.

People spoke positively about the laundry saying that it was a quick and efficient service and said that staff were all friendly and helpful. It was noted that although it was not everyone�s choice to join in activities, they all knew what was taking place and when.

We were told that people have a choice in where to spend their time and what they can eat. One person was pleased that they were still able to go out of the home and visit local shops.

Those people spoken to in their bedrooms were generally happy with their rooms and the view from their window. People said that they had bought some of their own furniture with them.

The cleanliness of bedrooms was discussed and everyone agreed that they were always kept clean and tidy but it was acknowledged that domestic staff did not have the time on each occasion to move furniture to clean behind it.

People said that visitors are made welcome and are now able to make themselves drinks from the tea bar located in the lounge. We were told that visitors could come at any reasonable time.

We saw that the atmosphere at the home was relaxed and friendly and during the day people were engaged in activities of their choice.

Some of the comments made by people on the day of our visit include:-

�Staff cannot do enough for you and everything is OK�,

�Staff are great, they are all friendly, they are very nice�

�It is very homely here, I wouldn�t change anything�

�The laundry is good, they bring your clothes back quickly�.

�I have no problems, if you have to be in a home, this is a good one�.

Reports under our old system of regulation (including those from before CQC was created)