Arbour Lodge

Arbour Lodge is a residential care home providing personal care to up to 29 people. The service provides support to older people, some of whom are living with dementia as well as people with physical disabilities or sensory impairment. At the time of our inspection there were 27 people using the service. Arbour Lodge accommodates people in one adapted building.

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

People told us they felt safe living at Arbour Lodge. Staff had been trained in safeguarding and knew how to escalate concerns for people’s safety. Risks were assessed, managed and known by the staff team. People received their medicines as prescribed and systems used for the management of medicines were safe. Staff followed guidance in infection control and the home environment was clean and tidy. Incidents and events were reviewed to ensure learning and improvement could take place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and staff felt the home was well managed. The registered manager encouraged feedback and had established strong working relationships with people, relatives and the staff team. There were governance processes in place to monitor and review the quality of care people received. Feedback was welcomed and encouraged and staff worked in partnership with external organisations to ensure people’s holistic needs were met.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 June 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the management of people’s health needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arbour Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arbour Lodge is a residential care home providing accommodation and personal care to 28 people aged 65 and over, some of whom were living with dementia. The service can support up to 29 people in an adapted building over three floors.

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

The provider’s systems were not effective in providing oversight of the service. Systems had failed to ensure people's fluid intake was monitored, equipment for pressure care was checked and people's risk assessments and care plans were not always completed.

People who had risks to their safety assessed and plans put in place to meet them were not consistently followed and, in some cases updated.

People felt safe and were protected from the risk of abuse by trained staff who understood how to report concerns. There were enough, safely recruited staff to keep people safe and promote their wellbeing. People had their medicines as prescribed. Staff protected people from the risk of cross infection and there were systems in place to learn when things went wrong.

People were supported by staff who had received an induction, training and ongoing support in their role. People could choose their meals and drinks and were supported to maintain a healthy diet. People received consistent care and staff understood people’s individual health needs. People were supported in an environment which was adapted to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests.

People were supported well by care staff who were compassionate and attentive to their needs and treated people with dignity and respect. People were able to make decisions about their care and what they wanted to do.

People were supported to take part in activities of their choice and received person centred care. People had their communication needs assessed and received information in a way they could understand. People were able to share concerns and understood how to make a complaint.

People’s needs and independence were promoted by staff and the management team. The registered manager understood their legal responsibilities in the safety and care of people. There were systems in place to seek people’s views about their care. The registered manager had developed partnerships with the local community and other agencies.

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 04 November 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified breaches in relation to the governance arrangements in place to identify areas for improvement.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Arbour Lodge is a care home which provides accommodation and personal care for up to 29 older people. At the time of our inspection, there were 27 people living at the home.

During this inspection, we met with the acting manager who had applied to CQC to become registered manager of the service. 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.

At our last inspection on 23 June 2016, we gave the service an overall rating of requires improvement. At this inspection, we found significant improvements had been made to the service, although some areas for improvement remained.

It was not always clear whether, in meeting people’s nutritional needs, the provider had sought appropriate specialist nutritional advice. The provider’s induction did not fully incorporate the requirements of the Care Certificate. The Care Certificate is a set of minimum standards that should be covered in the induction of new care staff.

People were supported by staff who had received training in, and understood, how to recognise, respond to and report abuse. The risks to individuals had been assessed and plans put in place to keep people as safe as possible. Staffing levels were maintained to ensure people’s needs could be met safely. People received their medication safely and as prescribed from trained staff.

Staff received training and ongoing support to help them succeed in their job roles. People’s rights under to the Mental Capacity Act 2005 were understood and promoted. People had enough to eat and drink and their food-related preferences were taken into account. Staff monitored people’s general health and helped them seek professional medical advice or treatment when required.

Staff promoted positive, caring relationships with the people living at Arbour Lodge. People’s contribution towards care planning was encouraged by the management team. Staff understood how to treat people in a respectful and dignified manner.

People received care and support shaped around their individual needs and requirements. People had support to participate in social and one-to-one activities. People’s care plans covered a range of needs and these were followed by staff. People and their relatives knew how to raise concerns and complaints, and the provider responded appropriately to these.

The management team promoted open communication with people, their relatives and community professionals. Staff felt well supported by a fair and approachable management team. The provider completed audits and checks to assess, monitor and improve the safety and quality of the service.

We last inspected the service on 6 August 2014; we rated the service as requires improvement overall and there was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, management of medicine. Although requirements of the regulation had now been met, further improvements were still required.

At our inspection carried out on the 6 August 2014 we found the registered manager had moved to work at another location and was no longer employed at the home. We had not been informed of this as is required under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During this inspection we found that the provider had appointed a registered manager. 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.

People’s medicines were not always stored safely. Medicines were not being stored at the correct temperatures and therefore were at risk of being ineffective. We also saw staff being disturbed during the administration of medicines which increased the risk of people’s medicines not being administered safely. People told us they received their medicines as prescribed.

People were not always supported by sufficient numbers of staff to respond to their needs in a timely and caring way. Staff, relatives and visiting professionals told us that there was not always enough staff deployed appropriately across the location to ensure that people were responded to promptly. People and their relatives told us that they sometimes had to wait for their requests for support to be responded to. We observed some people having to wait long periods of time for staff to respond to them.

People were not always cared for in a kind and compassionate way and were not supported to regularly engage in activities they enjoyed. Interactions between people and staff were often task orientated, although we did observe some examples of positive interactions during our inspection.

Mealtimes may not always have been a pleasant experience for everyone. People were offered a choice of food and drink, however there were inconsistencies in how people were afforded choice about what they ate and drank. We saw some people being offered choices whilst others were not. People were not always provided with drinks when they requested them.

People’s personal and sensitive information was not always kept safe. We saw that people’s daily notes were left unattended in communal areas. We also found notes relating to other people in people’s care records.

People were supported by a staff team who had been subject to appropriate pre-employment checks to ensure that they were of a suitable character to provide care and support to people. Staff understood how to recognise and report harm or abuse and how to keep people safe.

People were asked for their consent by staff before they provided care and support. The principles of the Mental capacity Act were being followed and people were offered choices.

People had good access to healthcare when required and staff were able to recognise any changes in a person’s health or wellbeing and act on this promptly.

People’s privacy and dignity was promoted and they were encouraged to maintain their independence and supported to maintain relationships that were important to them

People and their relatives were involved in the assessment, planning and review of their care. People were supported by a staff team who knew their care and support needs well and carried out care and support in a way that reflected people’s needs and preferences.

People and their relatives knew how to raise a complaint. The provider had a complaints procedure and people and relatives felt confident to use the procedure if they had a concern or complaint.

People and their relatives knew who the registered manager was. Staff told us the registered manager was a visible presence on the floor and offered practical help when needed.

Staff felt well supported by the registered manager and told us that the registered manager was approachable and supportive. Staff felt that they were well communicated with and involved in the development of the service.

The registered manager had systems in place to monitor the quality of the care and support provided to people, however these were still being developed. The registered manager had a good understanding of their roles and responsibilities and kept up to date with current legislation, guidance and best practice. They had a good understanding of the areas that required development and had started making steps to address this.

We found that people were supported in making day to day decisions about the care they received. One person told us, 'There's a choice of food'. People's values and diversity were respected and promoted.

Staff were not always clear about the care needs of people. We saw that some people were not supported with eating in an appropriate way.

People told us that they felt safe living at the service. Some people's financial transactions were not appropriately recorded.

We found that staff were recruited in a safe way and correct checks were carried out to ensure their suitability to care for people. One person told us, 'The girls are lovely'.

The service maintained a number of audits to ensure the quality and safety of care. People's views about their care were obtained by the provider.

We found that people were offered involvement and choice. One person told us, 'I'm always asked what I want to eat'. We saw that people received care which supported their needs.

People's safety was protected by the home and one person told us 'I feel safe here'.

Medications were given to people as prescribed and one person told us that medication was given 'on time'.

Staff were recruited in a safe way to ensure people were cared for by staff who were suitable to work with vulnerable people.

We saw that the provider had systems in place to monitor the quality of the service provided to ensure that people's needs were met in a safe way. We saw that the home had checks in place which ensured people's safety. The management sought feedback on people's views and one person told us they 'couldn't complain about the home'.