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Archived: Arbury Lodge Good

Reports


Inspection carried out on 31 July 2018

During a routine inspection

We inspected this service on 31 July 2018 and the inspection was unannounced. The inspection was carried out by one inspector, an assistant inspector and a specialist advisor. A specialist advisor is someone who has current up to date practice in a specific area. The specialist advisor who supported this inspection visit had experience and knowledge in nursing care.

The local Clinical Commissioning Group (CCG) commissioned Arbury Lodge, on behalf of George Eliot Hospital, from Sanctuary Care Limited as a short- stay nursing service located within George Eliot Hospital. Arbury Lodge opened in 2016, the service continues to be operated by Sanctuary Care Limited, who are a large provider of care services.

Arbury Lodge provides accommodation with personal and nursing care for up to 16 adults. All 16 beds, funded by George Eliot Hospital, are for in-patients who have been assessed as ‘medically optimised.’ This means people admitted to Arbury Lodge are ‘medically stable’ but need an additional short-stay to assess their future care and support needs. The average length of short-stay at Arbury Lodge is six weeks, and assessments include whether people require ongoing support care packages and for some people end of life care is required.

At the time of this inspection, 13 people were receiving a short-stay placement at Arbury Lodge, with a further two admissions during the day of our inspection.

A requirement of the services’ registration with us is that they have 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. There was a manager registered with us for this location, at the time of our inspection visit. However, they had applied to us to de-register because they had changed their role within Sanctuary Care. A new manager was in post at Arbury Lodge and, at the time of our inspection visit, was in the process of applying to become registered with us.

We last inspected this service on 4 May 2017 and gave an overall rating of Requires Improvement. At this inspection we found the provider continued to provide a caring, effective, and responsive service and improvements had been made to how well led the service was. Some further improvements were required to ensure the service was consistently safe. We gave an overall rating of Good.

There were sufficient trained staff on shift who had, overall, been recruited in a safe way so as to ensure people were not placed at risk of abuse, harm or injury. The provider had not, however, always undertaken a risk assessment as a part of their recruitment process when needed.

Risks management plans were in place and actions described for staff to take so that risks of harm or injury were mitigated. However, actions to mitigate risks were not consistently followed by staff. This posed risks to some people of potential harm or injury.

Medicines were stored and handled safely. People had their prescribed medicines available to them. Some medicine recording errors had occurred and timely action had not always taken to address these with nursing staff. Further improvements were planned for by the manager to address such delays.

Staff on shift met people’s individual needs. Staff worked closely with George Eliot Hospital healthcare professionals in meeting people’s nursing, health and rehabilitation care needs.

Staff received training and, overall, used their skills, knowledge and experience to provide safe, effective and responsive care to people.

The manager and provider had systems in place to monitor the quality of the service people received. The manager had plans in place to make continued improvements.

Further information is in the detailed findings below.

Inspection carried out on 4 May 2017

During a routine inspection

The inspection took place on 4 May 2017 and was unannounced.

Arbury Lodge is a short stay nursing service located within George Eliot Hospital. The service has 16 individual bedrooms with shared toilet and bathroom facilities. There is a communal lounge and dining room. The local Clinical Commissioning Group (CCG) commissioned Arbury Lodge, on behalf of George Eliot Hospital, from Sanctuary Care, who are a large care provider.

Arbury Lodge provides accommodation, nursing and personal care for up to 16 people. All 16 beds, funded by George Eliot Hospital, are for in-patients who have been assessed as ‘medically optimised.’ This means people admitted to Arbury Lodge are ‘medically stable’ but need an additional short stay to assess their future care and support needs. The average length of short stay at Arbury Lodge is six weeks, and assessments include whether people require ongoing support care packages and for some people end of life care is required. At the time of the inspection 13 people lived at the Arbury Lodge.

Arbury Lodge is required to have a registered manager in post. 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 and associated Regulations about how the service is run. At the time of this inspection there was a registered manager in post.

Arbury Lodge opened in 2016 and this was their first inspection since their registration with us.

Care staff knew how to protect people from risks of harm and injury because they knew people’s individual needs. However, information in people’s risk assessments was not always accurate which meant staff did not have the information to refer to if needed. Some risks to people’s wellbeing had not been identified or acted on.

Some staff felt under pressure on shift and thought staffing levels needed to be increased. We found staffing levels were not determined by people’s levels of dependency on staff support. Higher dependency levels increased staff workload, and other important tasks, such as completing care records, were not always completed by staff.

People had their prescribed medicines available to them and were supported to take these by nurses. However, medicine records were not always accurate. People were protected against the risk of abuse because staff were trained and knew how to raise concerns and the provider completed checks to ensure staff were of good character.

Staff were trained and people felt they had the skills the needed to deliver care and support to them. Staff worked within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People had choices offered to them about what they wanted to eat and drink and were supported to maintain their health by visiting healthcare professionals.

Staff had a kind and caring approach toward people and felt care staff promoted their privacy and dignity. People were able to choose where and how they spent their time.

People felt their care and support was personalised to them during their short stay at the service. People and their relatives felt involved in making decisions and planning care. There were planned group activities that some people were able to take part in and said they enjoyed.

The provider had systems in place to monitor the quality of the service provided. Some of the provider’s checks had effectively identified areas requiring improvement. However, we found planned improvements had not always taken place or been sustained by staff. Care records were not always updated in a timely way and insufficient checks were made on them. Some care records were not written clearly and improvements had not been made as planned for by the provider.

Staff told us they felt supported by the registered manager whose positive vision for the s