Arbour Court

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 66 (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.

There were systems for investigating incidents and ensuring lessons were learnt. However, care plans did not always demonstrate that all action to mitigate risk was taken. For example, in relation to incidents between service users, guidance had not always been clearly added to the care plans to help staff know how best to manage this. On the first day of inspection, we found a person trying to get out of bed, but their equipment had not sounded to alert staff; we raised this with the unit manager who arranged for checks of the equipment. The following day the person was found on the floor and the alert had not been sounded and we discussed alternative alert equipment with the registered manager following this incident. We found other examples of detailed lessons learnt and were assured that this information was shared with families through effective duty of candour processes. Families told us they did not have any concerns about the action taken in response to incidents and we were confident people were well looked after.

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.

People and families told us that staff knew people well and we observed this during our visit. Staff were able to identify if people were showing signs of infection and appropriate action was taken. Appropriate referrals were being made to services such as the speech and language therapy team (SALT), where there were concerns about people’s swallowing difficulties. However, the guidance given by the SALT team was not always fully transcribed into people’s care plans, although staff knew and understood what action they needed to take. We fed this back to the registered manager who was very responsive in addressing this matter.

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.

The provider had suitable policies in place and staff completed regular training in this area. People and families were very happy with how people were supported, with one relative telling us, “Whilst I worry about [family member] I never have to worry about the care”, and another relative told us, “[Family member] has settled in very well. They are checked on day and night.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had a range of risk assessments and care plans to assess and manage risk. We found care plans did not always provide sufficient guidance for staff about the action they needed to take to manage risk, for example around distress and anxiety or falls. Families confirmed they had been involved in care planning; however, this input was not clearly recorded within care records. Risk assessments were in place for people with swallowing difficulties, so that drinks and snacks could not be accessed independently in communal areas. However, people in their bedrooms also did not have independent access to drinks within their bedroom; there was limited evidence that this risk had been considered for each person on an individual basis.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There were appropriate checks and maintenance of the environment and the home was clean and tidy. The registered manager completed regular walk round checks of the environment and maintenance completed regular health and safety checks of the environment. On the first day of our visit we found thickening powders were not always appropriately secured; this had been addressed when we returned for a second day. We found keys for a cupboard which held substances which may present a risk for people living with dementia, such as creams or thickening powders, were not always removed from the cupboard lock, meaning these were accessible to people. The registered manager had ordered new locks to be fitted during the inspection.

Some people chose to stay in their bedrooms, and in some cases have their bedrooms doors locked. It was not evident the environmental risk of this had been fully assessed in the event of an emergency. People in their bedrooms did not always have access to adapted call bells or suitable sensor equipment, which they could use to summon help.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The provider had not always followed the recruitment policy to ensure staff were safely recruited. We found some shortfalls in how references were sought and obtained; limited evidence of follow up questions when staff had moved around services and why; and where risks were identified, a lack of records to demonstrate that this had been discussed and action taken to mitigate risk. Whilst interview records were completed this was not always in line with the company policy of two members of a panel and not all interview records had been fully completed. Checks of criminal records were completed in line with policy.

There were checks of the competency of staff in relation to some areas, including medicines and moving and handling, and checks of care delivery were completed within the managers walk round checks and dining audits. However, this process did not ensure all staff had checks of their skills to support people with eating and drinking or ensure care was delivered with dignity and respect. We discussed this with the registered manager who assured us that action would be taken in this area.

People and families told us there were plenty of staff available and that staff were very good. We observed that there were suitable staffing levels during the day but identified staffing arrangements at night were significantly lower and impacted upon the timeliness of care given for people, especially those who required the assistance of two staff. One member of staff told us, “It can be difficult at night. There is a lot to do and we only have 2 care staff on each floor. We have to work very fast.”

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.

The home was generally clean and tidy and domestic staff worked hard throughout the day to keep on top of the cleaning. Any malodours were generally quickly addressed. Staff were seen to use personal protective equipment appropriately.

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.

Systems were in place to ensure regular medicines were given safely and at the right time. On people’s medication administration records, allergies were recorded accurately. We saw staff encourage people to take their medicines in a patient and person-centred manner. Medicines were stored safely and stock levels recorded correctly. For people with diabetes, blood tests were carried out regularly and recorded accurately. We saw good practice systems in place for the safe management of medicines patches. Information to support staff to safely give ‘when required’ medicines was in place. Records for adding thickening powder to drinks, for people who have difficulty swallowing, were not always completed accurately. However, following the assessment, the service provided evidence to show they had addressed this issue and implemented a new recording process. Medicines audits were completed at regular intervals to identify issues and drive improvement. Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely.