Archived: Arboretum House

We found the following examples of good practice.

National COVID-19 government guidance was overall observed. Where we found shortfalls in expected standards the registered manager took immediate action.

At the time of the inspection, significant refurbishment work had commenced to make improvements to the environment, including the risks associated with infection prevention and control. This included new flooring, decoration and furnishings.

Staff had sufficient access to personal protective equipment (PPE) and hand sanitiser was available throughout the service. PPE was disposed of following best practice guidance.

Competency assessments and observations of staff practice was regularly completed in hand washing and the use of PPE.

Action had been taken to upskill staff's awareness and compliance in COVID-19 national guidance. Staff demonstrated an awareness of their role and responsibilities in following infection prevention and control measures. Staff had access to ongoing best practice guidance and information.

Both staff and people who used the service, were supported to participate in regular COVID-19 testing. Immediate action was taken should people or staff, received a positive test or showed signs of infection to reduce the risk of transmission.

People were supported to maintain contact with their family and friends by telephone and the registered manager had been successful, in seeking funding for people to have access to a computer as an additional method to keep in contact with others. Staff supported people with their welfare by providing information and reassurance.

Prior to people transferring to the service their COVID-19 status was checked. On admission, people received a COVID-19 test and were required to self -isolate for a period of 14 days to reduce the risk of transmission.

COVID-19 signage was displayed throughout the service. The provider had a COVID-19 and business contingency plan that provided staff with guidance of how to manage the service should an outbreak occur.

We observed staff interacting with people, social distancing of people and staff were respected and staff wore PPE. A person told us they were happy with the care and support provided, that staff were attentive and responsive and wore PPE to keep them safe.

Consideration had been given to how staff entered the building, when and how they had their breaks and how staff meetings and the exchange of information was managed. At the time of this inspection agency staff were not being used.

About the service

Arboretum House is a residential care home and is registered to provide personal care for up to 38 people. At the time of the inspection, two people were receiving long-term care, and six people were receiving support in a 'discharge to assess' bed. This is a stay in a residential care setting, which allows an assessment of the person's health and social care needs.

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

Four out of the ten people we spoke to, reported a poor experience of a 'discharge to assess' bed at Arboretum House. People had not completed the existing feedback questionnaire. The registered manager advised a different type of questionnaire had been created and would be used in the future instead. People had not always been discharged with sufficient medicine, however the registered manager had investigated this and new processes had been implemented.

We found there were enough staff to support people safely while they stayed at Arboretum House. However, there were not always enough senior staff to support people when they left assessment placements. The provider had recognised this and was recruiting another senior staff member.

Staff records were not always comprehensive enough. This could impact external professionals’ ability to assess people’s needs and arrange suitable discharge. Care staff did not have access to visiting professionals records, this could impact their understanding of a person’s needs

The provider had recognised that some improvements were needed to assessment bed placements at Arboretum House. An action plan showed that plans were already in place to improve the service.

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 Requires Improvement (published 19 March 2020).

Why we inspected

The inspection was prompted due to concerns received about the safety of discharges from Arboretum House assessment placements. A decision was made for us to inspect sooner and complete a targeted inspection into discharge planning at Arboretum House.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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.

Arboretum House is a residential care home and is registered to provide personal care for up to 38 people. At the time of the inspection, five people were receiving long-term care, and four people were receiving short-term care.

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

Not all people felt safe living at Arboretum House. Systems to reduce risks and protect people were not always effective. Opportunities to learn lessons when things went wrong were not always taken as incident forms were not always completed. Care plans did not always reflect the care people needed.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems and processes to monitor and improve the quality and safety of services were not always effective as they had not identified the shortfalls we identified at this inspection.

Medicines were managed and administered safely. Staff took steps to help protect people from the risks associated with infections. There were enough staff employed to meet people’s needs. Staff recruitment processes were in place to ensure any staff recruited would be checked to help ensure their suitability to work with people.

Assessments of people’s health, care and well-being needs were in place. Staff had been trained, and were checked for their competence, in some but not all areas relevant to people's needs. People had choices of food and drink to help them achieve a balanced diet. Staff worked with other health and social care professionals to help people receive effective care. The premises included a variety of adaptions to help meet people’s needs.

Staff were caring, and people and their visitors felt welcome. Staff encouraged people to maintain their independence and respected their privacy and dignity. Staff had been trained to help them understand and meet people’s equality and diversity needs. People were involved in decisions about their care and treatment.

People received responsive and personalised care. People enjoyed different activities and staff had access to a range of resources to help people organise games and activities. People’s communication needs were assessed, and guidance was provided to staff on how to meet any additional needs when identified. A complaints policy was in place and followed when complaints were received. End of life care planning was available should people wish to discuss this with staff.

The registered manager provided support and guidance to staff, who considered the registered manager to be approachable. The service took account of the views of people, relatives and staff. The service worked well with other professionals and took opportunities for continuous learning and improvement.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this full report.

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 6 September 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.

Arboretum House is registered to provide residential care and support for up to 38 people providing care and support to older people, including those with a physical disability. At the time of our inspection there were eleven people using the service. People using the service were accommodated on the first floor. The ground floor of the service was used by Derby City Council to provide day care and operated independently of Arboretum House.

The overall rating of good, which was awarded following the CQC's focused inspection of 25 August 2016, was displayed throughout the service. Arboretum has retained its rating of good.

Arboretum House had 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.

The registered manager had been in post for five weeks when the inspection visit took place. A number of changes had been introduced, which had had a positive impact on people using the service and staff. The registered manager spoke with enthusiasm and commitment to bring about further improvements to the quality of the service provided and had an action plan which outlined the changes planned to make.

People were protected from avoidable harm and abuse. Potential risks had been assessed to minimise incidents and accidents, whilst recognising people’s rights to make informed decisions and maintain their independence. People were supported by sufficient staff that had the necessary knowledge and skills to provide the care and support they needed, which included the management of all aspects of their medicine.

People health, welfare and independence were promoted, with referrals to relevant health care professionals being made when required. People had sufficient to eat and drink and their dietary needs were met.

People’s privacy and dignity was promoted by staff that had developed positive and caring relationships with those living at Arboretum House. People were confident to express their views about their care and support and had the opportunity to influence the care they received.

The registered manager promoted a positive and open culture for people using the service and staff. Positive comments were received about the registered manager and their impact on the day to day running of the service. The quality of the service provided was monitored by the registered manager, through a range of audits and consultation.

After the last comprehensive inspection visit, the provider did not write to us to say what they would do to meet legal requirements in relation to the breach.

This report covers our findings in relation to the breach and other areas that required improvements at our last inspection visit. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the 'all reports' link for Arboretum, House on our website at www.cqc.org.uk

Arboretum House is a care home which provides residential care for up to 38 people. The home specialises in caring for older people, including those with physical disabilities. At the time of this inspection there were 17 people in residence. Since the last inspection the provider was providing care to a younger adult. The provider told us they would change their registration details with us to reflect these changes. Since the last inspection visit the ground floor was being used by the provider in providing day care provision for younger adults. This provision was for people with profound and multiple learning difficulties and not part of the care provided by Arboretum House.

There was a registered manager in post, who registered with CQC on 5 September 2016.This 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.

When people lack mental capacity to take particular decisions, any decisions made on their behalf must be in their best interests and as least restrictive as possible. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). At our last inspection visit we had not received the relevant notifications. At this inspection visit we found another person had an authorised application in place to deprive them of their liberty but we had not been notified of this. The manager completed the relevant notification at the inspection visit and sent it to us.

At this inspection visit, we saw that improvements had been made to how people’s medicines were managed. This included the introduction of new medicines administration procedures.

There were enough staff on duty to meet people's needs. A staffing tool had been implemented to determine staffing levels at the service. People and most staff we spoke with told us staffing levels had improved.

People told us they were happy with the staff team. The staff provided effective care and understood the importance of offering people choice. The acting manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005.

There were 22 people using the service at the time of our inspection visit. We spoke with six people about the care and treatment they received. We observed interactions between care staff and people who were using the service.

We used the information we gathered to answer our five key questions.

Is the service safe?

People told us they felt safe and had no concerns regarding the staff that supported them. Comments from people included, 'I feel safe at Arboretum House,' 'I have no concerns with the staff they are pleasant' and 'They (staff) are very caring and helpful.'

The service were not clear about their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (Dols). Although no Dols applications had been made, some staff were not clear of the circumstances when an application should be made. Where people lacked capacity and decisions needed to be made in their best interests, the provider had not acted in accordance with legal requirements.

Suitable equipment was in place to support people in a safe way with their mobility needs. We saw that staff used the equipment confidently which indicated that moving and handling equipment was used frequently. Equipment was well maintained and serviced regularly to ensure it was safe to use.

Medication was not always being stored at the correct temperature and there was the potential for their efficacy to be reduced.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to capacity and best interest decision making and medication management.

Is the service effective?

People's health and care needs had been assessed and care plans were in place.

People told us that the staff supported them in a dignified way and ensured their rights were respected.

People had access to a range of health care professional which included doctors, opticians and dentists.

Is the service caring?

People using the service told us that they liked the staff and found them friendly and supportive. We observed a positive working relationship between the care staff and the people they supported.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Staff were attentive to people's needs throughout our visit and we saw that people were provided with support as needed.

People told us that staff were responsive to their needs. One person said; 'There are always staff around to help you.' Another person stated 'The staff understand you're nice, I wouldn't want to be anywhere else.'

The service had a limited understanding on how to support people who could not make decisions for themselves when required.

Is the service well-led?

Staff understood their role and responsibilities for meeting people's care needs and reporting any concerns or changes in people's health and safety needs. Staff spoke positively about the management support they received.

Quality assurance systems were in place to demonstrate how the service provided to people was monitored and improved upon as needed. Satisfaction surveys were completed by people who used the service; we saw that any identified areas for improvement were acted upon.

People told us they were happy with the care and treatment they received at Arboretum House and felt staff treated them with dignity and respect. One person said "The care is very good; I came for respite and I am staying here permanently.' People that we spoke with confirmed that they felt safe and that staff supported them in a safe way.

A family member and health care professionals we spoke with were complimentary about the service provided and the staff.

We found that one person's needs had significantly changed, however care plans and the associated risk assessments had not been updated to reflect the changes.

People who use the service, staff and visitors were generally protected against the risks of unsafe or suitable premises. The provider may find it useful to note that we did not see that a risk assessment had been completed, ensuring the safety of people using the service, staff and visitors whilst the refurbishment was taking place.

Staff we spoke with told us that recently there had been a reduction in the number of staff available in the afternoon. This meant that there were times when there were not enough on duty to ensure the safety of people using the service was maintained.

People told us they enjoyed the meals provided. People told us there were two choices for each meal time, and they could always request an alternative if they wanted something different to the planned menu. One person told us "The food is marvellous."

People we spoke with told us they would raise any concerns they had with a member of staff from the office. However, they also told us they had no cause to complain whilst they had lived at Arboretum House.