Arbury Court

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed two quality statements from this key question. The rating from the last inspection was good.

Our rating for this key question is requires improvement.

Physical health monitoring was not always recorded appropriately including ongoing physical health observations along with areas such as food and fluid charts. There were often inconsistencies between what staff were recording in records and what staff told us they should or would be doing. This also included inconsistencies across physical health care plans and staff not always following care plans in relation to this.

Records that we reviewed did not always have all of the documentation referenced within them and staff could not direct us to where these were stored, such as an example where a speech and language therapist assessment was referenced in a record, but staff could not identify where this was.

Staff supervision and appraisal compliance rates were low in the months prior to the assessment.

However, the service provided a full range of treatment for patients. All patients had access to a psychologist and to therapy groups. Patients had up to date care plans in place, these were always personalised, and patients were always involved in the development of their care plans.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients gave generally negative feedback about the activities on offer to them on the wards, stating that there was not much variety or that staff were too busy to engage in activities.

Patients generally felt involved in their care and treatment including being informed about their medication and therapies available to them. Patients described that they could give feedback on their medication and staff would explain to them about their medication and the rationale for it.

Patients noted that, if they had any physical health issues, they could access support with this from staff and had access to specialist services as necessary.

Staff told us they held regular multi-disciplinary meetings to discuss patients care and treatment. Patients and their relatives were invited to these meetings. Multi-disciplinary teams included consultants, junior doctors and nurses also included psychology, social work input or occupational therapists.

Ward managers were carrying out audits on a range of quality and treatment issues. These audits showed that patients were receiving one to ones from their named nurse.

Although staff had generally assessed and met patients’ needs for food and drink and for specialist nutrition and hydration, we identified that the recording and monitoring of this was not always clear or consistently being done. There were patients on the ward who required diet and fluid monitoring, and we noted gaps in some of these records or where ongoing monitoring was not taking place despite it being care planned.

Staff did not always receive appropriate supervision and appraisals. The provider initially submitted data which indicated that supervision and appraisal compliance rates were 90% and 89% respectively as of July 2024. Following internal concerns in relation to some of the data that was submitted to CQC, the organisation provided further data for appraisals and supervision within Arbury Court.

CQC were provided with an overall supervision and appraisal matrix 2024 for Arbury Court alongside individual spreadsheets for the months of March, May, June and July 2024.

The matrix spreadsheet contained significant gaps within the supervision dates recorded in comparison to the monthly spreadsheets. The supervision data has therefore been taken from the monthly spreadsheets only.

We reviewed the appraisal data on the matrix spreadsheet. This matrix recorded 311 staff names. 15 had no appraisal due date recorded. 13 of these 15 had last appraisal dates recorded. 5 of these 13 had appraisals that were done prior to June 2023 so would have been beyond the 12-month review date.

We reviewed the data for the remaining 296 staff. To do this, we analysed the appraisal due date against the first date of the on-site assessment, the 22 July 2024. 115 of the 296 appraisal due dates were before the first date of the assessment. This indicated a compliance rate of 61.2%. To note, the matrix indicated that 10 staff were on maternity leave, 2 on long term sick and 2 had left the service.

We also reviewed the appraisal data on the July 2024 monthly spreadsheet. This spreadsheet had 318 staff recorded. 94 of these staff had appraisal due dates that were before the 22 July 2024. This indicated a compliance rate of 70.4%.

On the July 2024 monthly spreadsheet there were 321 total permanent staff members listed, with 11 of these being noted as being on either maternity leave or long-term sick. For the 310 permanent staff members listed, 135 had a date recorded for either line management supervision, clinical supervision or both. This meant 43.5% of staff had some form of supervision for a date within July 2024.

On the same spreadsheet, it listed 33 bank staff; all who were identified as clinical staff. 6 of these staff had dates recorded for both line management and clinical supervision in July 2024. A further 6 bank staff had dates for line management supervision in July. This meant 36.4% of bank staff had some form of supervision for a date within July 2024.

On the June 2024 monthly spreadsheet there were 326 total permanent staff members listed, with 11 of these being noted as being on either maternity leave or long-term sick. For the 315 permanent staff members listed, 144 had a date recorded for either line management supervision, clinical supervision or both. This meant 45.7% of staff had some form of supervision for a date within June 2024.

On the same spreadsheet, it listed 107 bank staff; 105 who were identified as clinical staff and 2 were non-clinical. 5 of these staff had dates recorded for line management supervision in June 2024 whilst 2 bank staff had dates for clinical supervision (part-time) in June. This meant 6.5% of bank staff had some form of supervision for a date within June 2024.

On the May 2024 monthly spreadsheet there were 323 total permanent staff members listed, with 10 of these being noted as being on either maternity leave or long-term sick. For the 313 permanent staff members listed, 207 had a date recorded for either line management supervision, clinical supervision or both. This meant 66.1% of staff had some form of supervision for a date within May 2024.

8 staff had incorrect data entry in both the line management and clinical supervision columns which caused an error to show. It was therefore not clear what dates these were intended to indicate.

On the same spreadsheet, it listed 109 bank staff; 107 who were identified as clinical staff and 2 were non-clinical. No bank staff had dates recorded for line management supervision in May 2024. 9 bank staff had dates for clinical supervision (part-time) in May. This meant 8.3% of bank staff had some form of supervision for a date within May 2024.

This data indicated that staff had not always received appropriate supervision and an appraisal in the three months prior to the assessment.

The service had access to a range of specialists to meet the needs of the patients on the ward. Ward staff included, consultant psychiatrists, nurses, healthcare assistants and social workers. Occupational therapists and psychologists were available on request. Psychological support was provided in group and individual sessions.

Managers gave each new member of staff a full induction to the service before they started work. Staff received a thorough induction package prior to commencing work. Staff also had a local induction on the ward.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Patients gave mixed feedback about their experiences of being supported to live healthier lives. Patients were mostly negative about the activities on offer to them on the wards and the limited options that were available. One patient noted they had previously attended the walking group in the service but stated that this was not on very regularly and had not taken place for “weeks”.

Patients generally felt that the service supported them to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. Most patients noted that, if they had any physical health issues, they could access support with this from staff and had access to specialist services as necessary. Two patients that we spoke to felt that physical health issues they had raised previously in the service had not been managed well or in a timely manner.

Staff told us that they supported patient’s dietary needs and assessed those needing specialist care for nutrition and hydration. During our review of patient records, including ongoing monitoring of diet and fluid, we found inconsistent or gaps in the recording by staff which meant that, it was not always clear that staff were appropriately monitoring and supporting patients with their dietary needs or for those patients who required specialist interventions.

Staff described how patients would be supported to access physical health care, including specialists as required. We saw that patients had accessed dentists and opticians.

Physical health monitoring was not always recorded appropriately including ongoing physical health observations along with areas such as food and fluid charts. We reviewed 17 patient records and identified gaps in ongoing physical health monitoring and checks. There were often inconsistencies between what staff were recording in records and what staff told us they should or would be doing. We reviewed the records for patients who required fluid and bowel movement monitoring. During our review of a patient’s fluid intake chart, staff completing the chart had incorrectly recorded food intake for 3 of the 19 entries on the chart and there were gaps in some of the required columns. The final entries on the fluid intake chart were dated 7/6/24 and then 11/07/24. It was therefore not clear that any fluid intake had been recorded between that period. For a different patient who required daily bowel monitoring as per their care plan, there was no evidence that staff were doing or recording this.

We also identified inconsistencies across physical health care plans and staff not always following care plans in relation to this. We reviewed one patient record which gave conflicting information across three care plans as to how staff should manage a patient that required fluid monitoring and was a choking risk. Staff that we spoke to gave conflicting answers as to how the patient was managed.

Records that we reviewed did not always have all of the documentation referenced within them and staff could not direct us to where these were stored, such as an example where a speech and language therapist (SALT) assessment was referenced in a patient record but staff could not identity where this was.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.