Arden House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff felt supported by the management team and were confident to seek advice and inform managers of any errors or mistakes. One staff member told us, “If I am unsure or think something is wrong, I will always go straight to the manager’s office. I will then get clarity if I am doing the right thing.” Another staff member said, “The manager’s office is always open for us. If something happens, we always go and talk with them and if I did make a mistake, it is better to talk and solve."

When something had gone wrong, lessons learnt were completed and shared with the staff team to prevent the risk of re-occurrence. We saw evidence these had been discussed in handovers and staff meetings.

Incidents and accidents were analysed monthly to identify any patterns or trends at service level. Any changes in service delivery were shared with staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Managers and senior staff visited people in person to assess their needs before they moved to Arden House. Staff told us they were supported to provide the care new people coming to live at the home required, through prompt communication of their needs and preferences. One member of the catering team told us, “We communicate with each other when a new person comes. When they (managers) do the assessment, they come to me and tell me the dietary requirements, so I know before the new person comes in.”

Staff knew what information needed to be shared in urgent situations. Care plans contained paperwork which was prepared with essential information to assist other health care professionals taking over people’s care. When someone needed to be admitted to hospital in an emergency, staff ensured someone was with them to ensure a safe transition. One relative told us they lived a distance from Arden House, and when their family member was admitted to hospital, the registered manager visited the person every day to ensure they were comfortable and supported. This relative commented, “[Registered manager] knew we couldn’t go, and she was worried about [Name] being alone, so she visited her every day. It was amazing really.”

After a period in hospital, people were assessed by managers before being discharged back to Arden House. This ensured information was updated and reflective of people’s current needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the home. Comments included, “I don’t know why, but I feel safe here,” and “I feel safe, it’s a nice place and everyone is friendly, so I feel safe.”

Relatives felt their loved ones were safe. Feedback included, “I have no concerns because I know if there was a problem they would let us know immediately.” Another relative told us, “He is safe here. I am told what is happening on a regular basis.”

Staff received safeguarding training and understood their responsibility to protect people from the risk of harm or abuse. They told us they would report any concerns and escalate these if they felt action had not been taken to protect people. One staff member told us, “I need to write a report and inform my manager. If they did not do anything, I would go higher and speak to the local authority." Another said, “I would report and record. It's our job to protect people from harm.”

The managers understood their responsibility to report any safeguarding concerns to the local authority and to us, the Care Quality Commission. Records demonstrated this had been done appropriately and in a timely manner. Information on safeguarding and the provider’s policy on whistleblowing was accessible and available to staff around the home.

The provider did not always work well with people to understand and manage risks.

When people’s needs had changed, care plans were not consistently updated to reflect changes in risk management strategies. For example, a healthcare professional had advised 1 person be placed on thickened fluids due to an increased risk of choking. The care plan did not reflect this guidance. This person was also at risk of skin damage. There was a lack of clarity about how often they needed to be repositioned and the equipment to be used to protect vulnerable areas.

However, despite the inconsistency in some care plans, our observations and conversations with staff demonstrated they had been made aware of the nutritional changes and were working in accordance with healthcare professional advice. In other instances, risks to people’s health and safety were reviewed and actions implemented to reduce identified risks. This included in relation to risks around moving and transferring people, skin damage and nutritional risks.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Maintenance staff completed environmental checks that included water quality and fire safety. They also carried out regular checks of equipment to ensure it was safe and in good working condition. Improvements to the security of external doors had recently been upgraded following an incident, to alert staff if they were opened without a code.

Chemicals and products that could pose risks to people were kept locked away, and staff understood their responsibility to report any concerns immediately. However, on the first day of our inspection, we observed people had access to the main kitchen, which at times was left unattended, putting people at risk of burns or scalds. The provider had not identified this risk but took immediate action to fit a lock to the door, preventing access to the kitchen without a code. We also found a cupboard in the alcove of the attic, was used to store linen and continence products, which act as fuel in the event of a fire, thereby increasing risk to people. This was immediately emptied.

External contractors carried out regular checks of services and equipment to help to ensure people’s safety.

Each person had a personal emergency evacuation plan which described the help they would need to evacuate the building in an emergency. There was a fire marshal on each shift and fire drills ensured staff were aware of their individual responsibilities during an emergency

The provider made sure there were enough qualified, skilled and experienced staff. Staff received effective support, supervision and development. However, processes to ensure the safe recruitment of staff needed to be improved.

We found some records missing from staff files such as 1 reference which had not been printed, induction records which could not be located, and others that were incomplete. Audits to identify short falls in staff files were not robust and there was no oversight in place to track which files were compliant and which needed further action. Systems were in place to check the suitability of staff before they commenced employment. These included obtaining references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

People told us they felt that there were enough staff to meet their needs, and they seemed trained to carry out their role. One person told us, “There is enough staff to meet my needs,” and another said, “They are trained to look after us, it’s a care home not a hospital and they do this well.”

Overall, staff told us staffing levels enabled them to provide the care set out in people’s care plans. However, they acknowledged days could be very busy, especially if there was unexpected absence within the staff team. Staff told us they worked together to ensure people’s safety. Comments included: "It is okay, it is just if there is any sickness, but they cover that with agency generally", and "You will always get your busier times of day, but I think we are pretty much where we need to be. If a call bell goes off, the team who aren't the carers can always check people are okay, we won’t just leave them sat there."

The provider used a dependency tool to monitor people’s needs and ensure there was adequate staff on each shift. They acknowledge that due to the style and layout of the building they needed more staff at night than the tool implied, and this had been implemented.

Staff had completed appropriate training through a mixture of online and face to face sessions and some staff were completing additional qualifications in care. Staff received supervision from their line managers which gave them opportunity to raise any concerns and think about future development.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and their relatives told us the home was clean and they had no concerns. The home was clean, tidy and there were no unpleasant odours. We identified some chipped and worn woodwork that would make it difficult to clean effectively, but overall, the home was well maintained. We recommended some broken bins were replaced, to further reduce the risk of infections spreading. The deputy manager took immediate action to address this.

Staff received infection control training and implemented their learning in their day-to-day practice. Housekeeping staff were available 7 days a week and understood their role in following guidelines to promote good infection control practices. They told us they were informed of any infections in the home so they could implement the right strategies to mitigate the risk of infections spreading. For example, enhanced cleaning and increased use of personal protective equipment (PPE). However, minutes noted in a recent meeting, implied that staff were not always aware of what would be a notifiable outbreak and had not always followed processes regarding reporting potential outbreaks to leaders in the home. The registered manager gave us assurance that they would address this with staff.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines on time and as prescribed. People’s care plans contained information about how people preferred to take their medicines and what support they required.

Medication was stored safely and securely and staff ensured there was an adequate supply of people’s medicines. The home used an electronic system to aid safe administration, and the system alerted managers if a dose was late or not given. Medication was audited daily and more thorough checks were completed once a week.

Where people needed time specific medication, for example to manage the symptoms of Parkinson’s disease, these were consistently given correctly, even when those times were outside the regular medication cycles. 1 person received a medicine which posed an increased risk to staff through exposure to it. Risk assessments were in place which gave staff information about what additional precautions they should take to keep them safe.

Staff who administered medication were trained to do so and their competency to understand safe processes was checked regularly. Medication errors were monitored, and actions taken to prevent reoccurrence.

People or their representatives had signed to say they were happy for the home to administer their medication.