Arbour Court

We found the following examples of good practice.

National guidance was followed on the use of personal PPE and regular Covid 19 testing was taking place.

There were supplies of PPE readily available to staff and visitors.

Staff had received training in handwashing, Infection Prevention and Control (IPC) and use of PPE.

There were procedures and risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors.

The systems in place allowed people to be admitted to the home safely. National restrictions on visiting were in place at the time of the inspection and alternative measures such as video calls were being used.

The home had also built a pod to support people with safe visits. The home was clean and uncluttered. Communal areas had been reorganised to promote social distancing.

Arbour Court is a care home providing personal and nursing care to people living with dementia and associated care needs. The service can support up to 60 people, 58 people were receiving care during the inspection. All the rooms are single occupancy. Accommodation is provided over two floors serviced by a lift. There are communal lounges and dining areas, and an accessible garden.

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

People felt safe and staff had good knowledge of safeguarding processes. There were enough staff to support people safely. Care plan and risk assessments were up to date and reviewed regularly. People received their medicines as prescribed.

People were looked after by kind and caring staff who knew them well. Positive behaviour support was used to good effect, so that when people became upset or agitated, staff used distraction techniques. People were encouraged to be involved in decisions relating to their care and they were treated with dignity and respect.

Staff provided excellent end of life care with great care and compassion. People and their families were always supported with consideration and understanding to ensure their decisions and preferences were taken into account.

People were able to engage in a wide range of meaningful activities and maintain regular links with the community. People reported they really enjoyed getting involved in activities and outings because it made them feel busy and useful. People's choices were always respected by attentive and understanding staff, who found creative and innovative ways to ensure people lived their lives to the full. The whole staff team were very responsive to the needs of people and enabled them to improve and enjoy their life.

The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them. There was regular involvement by families and relatives and external services. Staff felt valued by the management team. A system of audits monitored and measured all aspects of the home and were used to drive improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 27 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service in January 2015 At that inspection we found the service was not meeting all the regulations that we reviewed.

At the last inspection on 5, 6 and 7 January 2015 we rated the service as ‘Requires Improvement’ At that inspection we identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to good governance. This inspection was to check improvements had been made and to review the ratings. We saw evidence to confirm that action required had been taken.

Arbour Court is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 60 older people living with dementia. The home is owned and managed by Barchester Healthcare Homes Limited. Accommodation is on two floors all bedrooms are single and have en-suite facilities available. Car parking is at the front of the building. At the time of this inspection 58 people were living at the home.

A registered manager was not 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.

The location has a condition of registration that it must have a registered manager, but it does not have one. However steps were being taken by the provider to recruit one within a reasonable timescale.

Following this inspection the registered provider notified us that a registered manager was in post from 17 January 2017.

People who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. They told us they were happy with the service provided and overall their needs were being met. They also told us the registered nurses and care staff treated people caringly, sensitively and with respect.

People were supported by sufficient numbers of suitably trained staff. We saw that recruitment procedures helped to make sure staff had the appropriate qualities to protect the safety of people who used the service and we saw they received the training and support required to meet people’s needs.

Care staff and nurses we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was always available to them. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Individual staff training records indicated that all care staff had received appropriate training to carry out their roles effectively. Some staff were working towards a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care and the Care Certificate. The Care Certificate is a professional qualification which aims to equip health and social care staff with the knowledge and skills they need to provide safe care and support to people using the service. This qualification helped them to carry out their roles effectively. Staff members confirmed they had received safeguarding and whistle blowing training and knew who to report to if they suspected or witnessed abuse or poor practice.

Care records were in place to reflect peoples identified care and support needs. Information about how people wanted to be supported, their likes and dislikes, when support was required and how this was to be delivered was also included in the care records we examined. Information regarding people’s dietary needs was included in their care records and clear guidance for staff members helped make sure these requirements were met.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review.

Medicines were stored safely and administered by registered nurses (RN) who were trained appropriately to ensure medicines were given safely. Any specific requirements in relation to medicines to be taken when required (PRN) such as paracetamol, were clearly documented so that staff members could administer the medicine appropriately and were aware of any risk following administration of such medicines.

Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act 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 particular 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 so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

Staff members received regular supervision to help make sure they were carrying out their duties safely.

Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives was addressed by the registered provider. People spoken with knew how to make a complaint and felt confident to approach any member of the staff team if they needed to.

The registered provider had systems in place to monitor the quality of the service such as service user and relative surveys, to ascertain their views and opinions about their satisfaction of the service provided. Any feedback received was noted and used to make improvements to the service and the care and support being provided.

During the course of our visit we spent time in various parts of the home, both on the ground and first floor, in the lounges and corridors and accompanied a staff member doing their hourly checks. This helped us to observe how staff looked after the people who lived at the home. We saw staff talking with people respectfully, responding to their needs for comfort and support with empathy, care and skill. We observed that they spent time with people, treated them as individuals and were patient when required.

We spoke with six of the people who lived at the home and all made positive comments about the staff. We could see that staff enjoyed good relationships with the people who lived at the home and had sufficient time to meet their needs without hurrying.

We spoke with six staff members who were knowledgeable about people's individual

needs and how they were being met. We looked at the care records for three of the people who lived at the home and observed that staff were meticulous in their record keeping . Records showed that each person's health and well being was monitored and where appropriate staff sought medical attention or advice and guidance from the person's health and social care professionals.

We observed staff carrying out their duties and responsibilities in good humour and in a relaxed and positive manner. We could see that staff enjoyed good relationships with the people who lived at the home and had sufficient time to meet their needs without hurrying.

All the people spoken with during our visit made positive comments about the staff, standard of care and facilities and services provided. One person said 'I am happy and well looked after'. Another person said, 'I can not say I am happy but I can say that I am well looked after'.

We looked at the care records for four of the people who lived at the home and could see that improvements had been made in the way care plans were being written. Records showed that each person's health and well being was monitored and where appropriate staff sought medical attention or advice and guidance from the person's health and social care professionals.

We found that there were areas where improvements were needed. These included care planning and food and fluid balance monitoring records. These issues had been raised following our previous inspection. Although the manager had devised a satisfactory action plan to address them it was clear that more work needed to be done to ensure people were safeguarded from inappropriate or ineffective care.