Arden House

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 requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent

This service scored 58 (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 always make sure people’s care and treatment were effective.

Care plans were reviewed monthly through ‘Resident of the Day’. However, they were not always updated in a timely way when people’s situations changed, and we found some information which was not reflective of their current assessed needs. We found conflicting information in relation to people’s nutritional needs and the pressure relieving equipment they required.

People’s care plans had not been signed by them or their representative and we received mixed feedback about whether they had been involved in planning the care they needed. Some people told us they were aware of what was in their plan and thought it had been revisited. Other people said they had not seen their care plans and did not know what information it contained.

People received face to face assessments, by the registered manager or the deputy manager, before moving into the home or after an extended period in hospital. Care plans were developed and included information about people’s physical, medical, social and emotional needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used risk assessment tools to assess and identify risks to providing people’s care and support. However, we found these had not always been completed to accurately reflect the level of risk. For example, 1 person was doubly incontinent but their risks around continence care had been assessed as low. This person’s nutritional risk had been assessed as low even though they were on a pureed diet and thickened fluids.

The provider followed the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties. The home had implemented supplementary charts to confirm what level of thickener people had received in their drinks; however, the charts did not consistently reflect people’s intake and the consistency of their fluids.

Despite the errors we found in the completion of risk assessment tools, the strategies implemented were appropriate to mitigate people’s individual risks and staff could demonstrate that information was shared with them to deliver safe care.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff described good communication across teams to ensure people’s needs were effectively met. One staff member told us if they had concerns, “We will report it to the senior. There is a meeting every day at ten and if there are any concerns we will bring it up then or we can go and see [registered manager]." When we asked another member of staff about communication, they commented, "It is really good, we use the walkie talkie to call each other, and it is a quick response. All the staff are willing to help each other."

Time was allocated for all senior and care staff to receive a handover from the previous shift. Staff described this as being a useful way to gain the information they needed to provide safe and effective care for people.

The GP visited weekly, supported by a frailty nurse when needed. They reviewed people who staff or relatives had concerns about and triaged to other services when necessary.

A visiting healthcare professional told us staff referred people to their services when needed and in a timely way and worked well alongside them to support people. We were told of 1 person, who needed to receive pain relieving medication before healthcare visits. Staff had worked with the district nursing team to implement strategies to manage this effectively.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to a choice of meals, snacks and drinks and people told us they enjoyed the food available. 1 person told us, “The food is good. We have choices and lots to drink.” Another person said, “The food is very nice, I eat where I want. We have choices and have enough to eat.”

Records demonstrated people were supported to attend appointments with the chiropodist, optician, podiatrist and continence nurse to promote their wellbeing, safety and quality of life.

People were offered regular opportunities to participate in exercise to promote their balance and mobility. One member of staff explained, “If you feel good physically it links to how you feel mentally."

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

Some people required additional monitoring and recording to make sure care delivery met their identified needs. We found some daily records did not always accurately reflect risk management strategies were being met. For example, 1 person was on food monitoring charts because they were at risk of losing weight. Records did not always give enough information about the size of portions, the amount of fluid, how much the person had eaten and whether the meal was fortified with extra calories. Another person was on repositioning charts. Records did not evidence an effective repositioning regime to relieve pressure from vulnerable areas.

Accurate recording helps staff and external healthcare professionals determine if the risk management strategies need to be reviewed to meet people’s needs. Despite these records being checked daily by senior staff, oversight was not effective to ensure these records were completed accurately and consistently.

However, staff, whatever their role in the home, understood the importance of monitoring people and reporting any concerns to ensure positive outcomes for them. For example, a member of the housekeeping team told us, “I have cleaned a toilet, and I have said to the carers that the urine is very dark, and they say they will bring in fluid charts, so they are very good, they do listen."

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 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 mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

At the last inspection, staff understanding of the Mental Capacity Act was raised as a concern and at this inspection the registered manager acknowledged staff still needed to develop a further understanding. To support this, the registered manager had created a form to assess people’s capacity. However, the form tested people’s memory rather than assessing people’s capacity to understand decisions about the care and treatment they required. A care leader told us this check list had been completed for all people living in the home, whether or not their capacity was in doubt.

Improvements were needed in mental capacity assessments to ensure they were decision specific. They also needed to consistently outline how information had been shared with people to ensure they had the maximum opportunity to make their own decision.

Where decisions had been made in people’s best interests, there was a lack of information about who had been consulted in decision making, for instance family, external healthcare professionals or staff in the home. In 1 person’s care plan there was conflicting information about whether they had or did not have capacity to make certain decisions. Despite the conclusion being that the person did have capacity and could consent, an unnecessary DoLS had been applied for to authorise restrictions in the person’s care plan to keep them safe.

Staff were unable to describe which people had restrictions approved in their care plan and why. One staff member told us only 1 person had an approved DoLS and another said everyone living in the home had approved restrictions in their care plans. Neither of these responses were correct. However, people were given choices and staff obtained consent prior to support being delivered. One staff member told us, “I’d have to ask their consent.” Another staff member said, “We don’t force anyone. If they self-neglect on a regular basis, we refer it to the healthcare professionals, what is best for that person.”