Arcot House Residential Home

Arcot House Residential Home provides personal care and support for up to 23 people aged 65 and over. The home does not provide nursing care. The home is a grade two listed Georgian manor house set in lovely gardens. At the time of the inspection there were 17 people living there.

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

Those people who used the service expressed unreserved satisfaction and spoke highly of all staff and services provided. Comments included, "It’s the little things and attention to detail that always make a big difference” and “[Person’s name] is [over 100] and in better health than when they came here five years ago. The attention to details, the care provided and the communication is second to none. Staff are always attentive and welcoming. It’s a huge relief [person’s name] lives in such an outstanding care home.”

People and their relatives agreed the service was safe saying, “We are completely confident in their care. We know they are safe at Arcot.”

Risks were assessed and extremely detailed plans put in place to keep people safe. Staff and people worked together, regularly reviewing risk and balancing risk with independence so people could live their best life. The provider over recruited to ensure there were enough staff to safely provide care and support to people, including monthly one to one sessions for people with their keyworkers.

Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. People were protected by the home's infection control policy and procedures.

The service provided an extremely effective service, taking into account small details to ensure people felt as well as they could and maintained mobility and independence. Training and development was based on research and best practice guidelines to enhance quality and safety of the service provision. Staff felt constantly supported, valued and praised. They told us, "We all strive to give outstanding care. It makes us so proud. Who wouldn’t want to work here” and “I’m so happy to have the opportunity to spend time with the people here. I love it.”

People continued to receive a nutritious, healthy diet that met individual preferences in an extremely personalised, sociable way. Staff all aimed to ensure people ate well and enjoyed their meals, including having fun trying out new foods.

The home was decorated and maintained to a very high standard whilst maintaining a homely feel. People were consulted about the adaptation and design of their home and new extension and choice and preferences were respected. There were various areas to enjoy activities, events and personal private time. The service had been creative in developing areas of the home that would enhance people's wellbeing, such as hair salon, art therapy room and nail bar.

The service was exceptionally caring and put people at the heart of everything they did. People told us, “I think everyone’s wonderfully friendly and caring, staff sat with [person’s name] the other day when she was unwell, it's a very friendly atmosphere here, it's special.” People were relaxed, comfortable and confident in their home. People were valued, had key workers they had become friends with and often had meaningful roles in household chores, received training and held ambassador roles.

Staff had an excellent awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that people's life experiences remained meaningful. The commitment of the staff was excellent. They told us, “We are building up a good trusting relationship and [person’s name] is talking more. Today I've discovered we've both got a love of the lake district, we talked all about the walks and rocks, next time I’ll find a book we can look at together.”

The service was exceptionally responsive to people's health and social needs. People received extremely person centred care and support. Relatives told us, “[Staff name] is our care plan lead. She's superb, it's like a family really.”

Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing.

People were offered a vast array of activities both at the service and in the local community. People, staff and relatives all came together as a community and built friendships.

The whole team were proud and privileged to support people with end of life care.

People benefitted from a service that was very well led. The provider, registered manager, deputy and staff team maintained a clear focus on continually seeking to improve the service people received. Staff told us the registered manager led by example and they had tremendous respect for her and their commitment.

Everyone demonstrated strong values and, a desire to learn about and implement best practice throughout the service. Good quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

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 outstanding in all areas. (published 18 May 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.

Arcot House is a 23 bed residential home for older people who are physically frail and require help with personal care, it does not provide nursing care. The home is a grade two listed Georgian manor house set in lovely gardens. When we visited, 22 people lived there.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. Staff knew each person as an individual and what mattered to them, they treated people with the utmost dignity and respect. A relative said, “Nothing is too much trouble, I can’t speak of them highly enough. Its home from home.” The service used the national ‘Dignity in care’ initiative ten good practice steps to guide their practice. A ‘Dignity Tree’ created by people, relatives and staff provided a tangible reminder to uphold those values at all times.

People living at the home with expertise and knowledge of particular conditions such as diabetes and epilepsy, worked in partnership with staff who valued their experience and contributions on ways in which their care could further be improved. For example, they advised on medicines used for epilepsy, on ‘low sugar’ specialist diabetic foods and obtained health information leaflets to inform staff about their condition. People and staff had lead roles, known as “Ambassadors” worked together and promoted improved healthcare outcomes for people. For example, in pressure area care, diabetes, epilepsy, falls management, dementia, dignity and end of life care.

People living with dementia received best practice care because staff understood the different types of dementia, Staff had signed up to the Alzheimer’s society Dementia Friends initiative and undertook ‘Dementia Friends’ training. A staff member had a lead role for promoting best practice in caring for people living with dementia, and had undertaken training and received a qualification in dementia. The promoted people, staff and relatives to learn about various types of dementia, and how it affected people, and encouraged and supported people living with dementia to live well.

People received exceptionally effective care, based on best practice by staff with an in-depth knowledge of their care and treatment needs, who were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. The service used innovative and creative ways to train and develop staff to put their learning into practice to provide outstanding care that met people’s individual needs. Photographs showed how staff used sensory glasses which simulated visual impairment to experience what it was like to be guided by a member of staff to navigate their way around the home using a walking frame. This helped staff appreciate how those people weren’t aware of trip hazards such as steps and how it affected their sense of balance.

Staff followed national best practice such as ‘One chance to get it right’ and NICE guidelines for end of life care (2015). They worked with hospice and community nursing staff during an ‘End of Life’ project to implement best practice end of life care for people. A staff member championed excellent end of life care and helped staff have the skills and confidence to discuss death and dying with people, families and staff in order to help them have a good death.

People’s experience of eating and drinking was enhanced because staff used innovative ways to promote improved health and wellbeing through good nutrition and hydration. A daily 'nutrition’ and ‘hydration’ boost offered people a variety of food and drinks to try as a fun way to expand people’s food and drink choices and try new flavours and textures. For example, ‘Try it Thursday’ was a scotch egg with different sauce accompaniments, and ‘Fizzy Friday’ each involved trying a range of different juices and sparkling water ‘cocktails.’ What people most enjoyed were incorporated into their individual food and drink preferences. A member of staff had undertaken a qualification in nutrition and health related issues and used that knowledge to enhance people’s care. For example, by introducing simple steps to increase people’s fluid intake and fibre content, which helped aid people’s digestion and reduce constipation and by advising chefs on people’s specific dietary needs.

Where people were on soft or pureed diet because of swallowing difficulties or choking risks, the service used food moulds to present each component of the person’s meal in the shape of food it represented. For example, moulds in the shape of fish, chicken and carrot. This made the person’s food more attractive and appetising and meant it was easier for them to identify what they were eating.

People were safer because a safety culture was embedded at the service. Staff had exceptional skills in managing and reducing risk whilst promoting people to lead fulfilling lives and minimise restrictions on their freedom. For example, by investing in equipment and technology. Personalised risk assessments provided comprehensive guidance for staff, who were vigilant and spotted risks. Staff proactively identified and minimised risks for people, for example, falls risks and effectively reduced injuries from falls.

People mattered and the care was exceptionally personalised. Staff paid attention to detail and demonstrated pride, passion and enthusiasm for the people they supported. Each person had a trusted member of staff, known as a keyworker, who took a lead role in each person’s care and wellbeing. They continuously looked for ways to ensure people had positive experiences and led fulfilling lives. Staff knew about people’s lives, their interests and talents and encouraged them to share them with others. The service used the ‘Living well through activity’ toolkit for ideas and suggestions to support people to pursue their interests and hobbies, try new things and learn new skills.

They service used technology innovatively to engage with people in meaningful ways. For example, a high definition ‘Smart’ TV, enabled staff to use a range of media options via the internet to connect with people on a range of topics. Hand held computer ‘tablets’ helped staff research and reminisce about their old town or street, find old photographs of their local area and to play games. A continuous electronic photographic album showed relatives and reminded people what they had enjoyed doing recently. For example, tossing pancakes and having a party.

The service were creative and enabled people to live life to the full and continue to do things they enjoyed. For example, an artist worked with a group of people on painting landscapes. This was so popular, the home have since bought painting easels, so people can paint on a more regular basis. A member of staff undertook a qualification in aromatherapy hand, foot and head massage, as a way for more people to benefit from its therapeutic effects. For example, massage helped people with physical symptoms such as stiff joints due to arthritis and cramps and made people feel more relaxed, sleep better and reduced agitation.

People received a consistently high standard of care because the service used evidence of what works best to continually review and improve their practice. For example, by using The Social Care Institute for Excellence (SCIE) and National Institute for Health and Care Excellence (NICE) guidelines. In pursuit of excellence, the registered manager regularly read the ‘outstanding’ rated CQC inspection reports for other services. They used them as a way to benchmark the quality of care provided at Arcot House and as a source of innovative and best practice ideas they could adopt.

People were partners in the day to day running of the home, and their experience and contributions were sought and valued. They expressed their views about the quality of the service day to day, through residents meetings, surveys, review cards, and day to day and action was taken in response.

Staff sought people’s consent for their care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Staff were trained to be aware of signs of abuse and were encouraged to report concerns, which were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had a written complaints process. Any concerns or complaints were investigated with actions identified to make improvements.

Staff were supported to continuously improve because the management team set clear expectations of the standards expected, through goal setting and positive role modelling. Staff felt valued and appreciated for their work. The provider used a monthly bonus scheme to recognise, re-enforce and reward positive staff values, attitudes and behaviours. The management team were appro