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.

At the last assessment the provider was in breach of regulation relating to consent. At this assessment the provider was no longer in breach of this regulation.

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 because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
Not all care plans were updated to reflect people’s current needs.
People’s care plans were being transferred from a paper-based system to an electronic care planning system. Only a third of people’s care records had been transferred in the 9 months since our last assessment, despite the provider sending us an action plan telling us this would be completed by June 2026. Whilst the electronic care plans were accurate, up to date and detailed, the others were not. Not all paper-based care plans contained sufficient information for staff to provide safe care. Some records were inaccurate or outdated and had not been archived. Paper records were not being reviewed monthly, in line with the provider’s expectations.
Some documentation, for example evidence of best interest meetings was stored on laptops and was therefore not available to all staff.
 

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

People's care and treatment was not always delivered in line with evidence-based guidance because records did not always provide staff with clear and accurate information about how to meet people's needs.

For example, 1 person, assessed as being at high risk of pressure damage required regular repositioning to maintain their skin integrity. However, staff provided conflicting accounts regarding the frequency at which the person should be repositioned. The electronic care planning system stated the person should be repositioned every 4 hours, although the interim manager and deputy manager told us this information was not accurate. We were unable to find any documented guidance within the person’s care plan to support the repositioning regime being followed. The person's skin integrity care plan referred only to 'regular repositioning' and did not specify the frequency required. The interim manager arranged for this to be rectified on the system following our feedback.

Staff had taken action to ensure information relating to people with swallowing was accurate and in line with recognised best practice guidance. Documentation relating to food textures and fluid consistencies was clear and reflected the requirements of the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework. Staff had access to information about people’s assessed dietary needs, helping to reduce the risk of choking and support safe nutritional intake.

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 worked well together. One staff member told us, “We work as a team, we help each other.” Throughout our assessment we saw staff communicating with each other and helping across departments when needed. Staff told us communication was mostly effective and enabled them to remain informed about people's changing needs. Information was shared through daily handovers and heads of department meetings, ensuring continuity of care across staff teams.

Staff worked collaboratively with a range of healthcare professionals, including GPs, frailty nurses and district nurses. Referrals were made when concerns were identified and advice from healthcare professionals was sought. Relatives were updated following medical appointments or changes in people’s needs.

Staff also worked proactively with external agencies when responding to potential risks. For example, during a recent suspected infectious outbreak, staff contacted the local Infection Prevention and Control team and followed the advice to minimise the risk of transmission within the home.

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.

Staff supported people to maintain and improve their health and wellbeing through a range of activities and daily routines. Activities were tailored to people's abilities and included opportunities to maintain mobility, dexterity and physical fitness through games and gentle exercise.
The staff member responsible for activities told us, “I try to encourage movement every day. It would be easy to sit in front of a TV, but people do better overall if we help them remain independent.” Staff recognised people's abilities varied and adapted activities accordingly. They told us some people were only able to participate in short periods of exercise, whilst others were encouraged and supported to take regular walks outside.

People were also supported to manage and maintain their wider health needs. Staff ensured they had access to healthcare professionals such as dentists, opticians and chiropodists. Where possible, people were encouraged to continue using healthcare services they had accessed prior to moving into the home, and staff supported them to attend appointments within the local town.
 

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.

Systems to monitor people's health and care outcomes were not always effective. We could not be assured people's needs were accurately monitored, or that information recorded was being used to improve outcomes.

For example, 2 people required their food intake to be monitored, due to recent weight loss. We observed these people during lunch and found discrepancies between the meals they were served, the amount they consumed, and the information recorded on the electronic care system. This meant records did not always provide an accurate account of people's nutritional intake, limiting staff's ability to identify concerns and respond appropriately.

We also saw examples where information gathered through routine monitoring was not acted upon. One person's records showed they had refused most meals on the day prior to our assessment. However, staff had not offered alternative food choices or escalated concerns in line with the person's care plan.

Another person required bowel monitoring and the electronic system was set to alert senior staff when they had not opened their bowels for 3 days, enabling timely intervention. Records showed the system had generated alerts however, these alerts had not been acted upon and the person's prescribed 'when required' medicine had not been administered.

Whilst systems were in place to monitor people's health and wellbeing, these were not fully implemented or used effectively to make improvements to people’s outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

At our last assessment we found the provider in breach of regulation relating to consent. At this assessment some improvements had been implemented, and the breach no longer remained. However further work was needed to ensure paperwork was fully completed and changes embedded.

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, 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).

Where people did not have capacity to make a decision for themselves, staff had met with them or their representatives and evidenced how they had been involved in making each decision through best interest meetings. However, this information had not yet been transferred to mental capacity assessments, even for those people whose care records had recently been updated to the electronic care planning system. During our assessment, mental capacity assessments were completed for 1 person, and these were decision specific and to the required standard. The provider told us they would complete the outstanding paperwork as a priority, and confirmed, shortly after our assessment that they were all complete.

The provider had recently implemented a new tracker to monitor when people’s DoLs were due to be re-applied for. This identified 2 people’s DoLS had expired In July and had not yet been re-applied for. The applications were completed on the day of our assessment.