Archived: Arden Court

Updated 20 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 30 November and 12 December 2017 and was unannounced. The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC), a pharmacist inspector from CQC who looked at how medication was handled and an expert by experience. An expert by experience is someone who has personal experience of caring for people with similar care needs to those living in Arden Court.

Arden Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Prior to the inspection we reviewed all of the information we held about the home in the form of notifications, previous inspection reports, enforcement notices and safeguarding incidents.

We contacted relevant stakeholders from Salford City Council which included safeguarding, infection control, environmental health and the Clinical Commissioning Group (CCG) . We also contacted Salford Healthwatch. This was to see if they wanted to share any information in advance of the inspection.

During the inspection we spoke with a wide range of people and viewed certain records in order to help inform our inspection judgements. This included the home manager, three nurses, eight care assistants, four people who lived at the home and two visiting relatives. We also spoke with the activities coordinator, the cook and a cleaner/domestic person and two visiting health care professionals.

Records looked at included eight care plans, six staff personnel files, 16 Medication Administration Records (MARs) , training records, building/maintenance checks and any relevant quality assurance documentation.

Updated 20 January 2018

This unannounced inspection took place on 30 November and 12 December 2017.

Arden Court is owned by Ramos Healthcare Limited and is located on a busy main road in Eccles, Greater Manchester. The home provides care for people with nursing, residential and continuing care needs. The home is close to local shops, bus routes and has adequate car parking facilities located at the front of the building.

At our last inspection of Arden Court in February 2017, the home was rated as Requires Improvement overall and for each of the five key questions we inspect against. We identified breaches of the regulations with regards to person centred care, safe care and treatment, good governance and staffing. This inspection looked at the progress made since our last visit, to ensure the requirements of the regulations were being met.

During this inspection we identified two (continuing) breaches of the regulations with regards to safe care and treatment and good governance. You can see what action we have asked the provider to take at the back of this report.

At the time of our inspection, there was no registered manager in post, however the current home manager had submitted an application to register with CQC, which was in progress with our registration team at the time of the inspection. 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.

Improvements were still required to the handling, recording and storage of people’s medication.

We found that accurate and contemporaneous records were not always being maintained in certain areas such as oral and personal hygiene, when people had received a shave and when they had their finger nails cut/cleaned . Staff were not always consistently signing people’s fluid intake sheets to ensure the amounts consumed were sufficient and records regarding when people’s drinks had been thickened were not being maintained consistently. This meant we could not be certain if people’s care needs were always being met.

Since our last inspection, in June 2017, a person passed away at the home and their death was referred to the coroner for further investigation. The concerns related to the management of falls. Subsequently, a Regulation 28 report was issued to the home by the coroner which identified future deaths could occur unless the necessary action was taken to keep people safe. The home manager had provided a written response to the coroner, detailing any action that would be taken. We reviewed this response as part of the inspection.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

At our last inspection, we received feedback (mainly from staff and visitors) that staffing levels were not adequate to safely meet the needs of people living at the home. Since then, we found staffing levels had increased with an additional member of staff added to both the day and night shift. Everyone we spoke with during the inspection including people living at the home, visitors and staff said there were currently enough staff working at the home to care for people safely.

We found staff received sufficient training, supervision, appraisal and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work. At the last inspection we found not all staff were trained in moving and handling, however this training had now been provided.

We found appropriate DoLS applications were made to the local authority where people had been assessed as lacking capacity to make their own choices and decisions. The staff we spoke with had a good understanding in this area and told us they worked in people’s best interests where possible. The relevant paperwork regarding these applications was held within people’s care plans.

The people we spoke with said the food served at the home was of good quality and we saw people being supported to eat by staff. People were weighed on a regular basis and more frequently if they were identified as being at risk of losing weight.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professions was recorded within people’s care plans.

At our last inspection, people reported there was a lack of continuity of care due to a high turnover of staff and regular use of agency staff. Since the last inspection, the home had recruited lots of additional members of staff and all of the staff working at the home during the inspection were permanent.

We received positive feedback from people we spoke with about the care provided at the home. People said they felt treated with dignity and respect. Staff were also able to describe how they aimed to do treat people well when delivering care.

Each person living at the home had their own care plan in place which provided an overview of their care requirements and any associated risks. These were updated each month or when people’s care needs changed.

During our last inspection, there was a lack of consistency with regards to the recording of people’s likes, dislikes and preferences as this information wasn’t captured for each person. Additionally, the care plans we looked at did not demonstrate that families had been involved in them and whilst reviews were done, they were signed off by staff and did not involve people living at the home and their families. People’s preferred choices of activities also weren’t clearly documented in their care plans. We found this information was now clearly recorded in people’s care plans for staff to refer to.

During the inspection we observed several activities taking place which people participated in. This included a quiz in the afternoon which people seemed to enjoy.

There were systems in place to monitor the quality of service being provided to ensure good governance, with a range of audits being undertaken by the home manager.

Staff meetings took place on a regular basis, giving staff the opportunity to discuss their work and raise any concerns about practices within the home. We also observed a handover taking place where the lead nurse provided an update on people’s care needs.

Staff spoke positively about management at the home and said the manager was supportive and approachable. Staff said said the manager had made changes for the better since starting working at the home.

Policies and procedures were in place and were being reviewed regularly.