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Archived: Arden Court Requires improvement

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Reports


Inspection carried out on 10 February

During a routine inspection

This unannounced inspection was carried out on the 10 February 2015.

Arden Court is a care home in the Eccles area of Salford, Greater Manchester and is owned by Orchard Care Homes. The home is registered with the Care Quality Commission (CQC) to provide care for up to 47 people. The home provides care to those with residential care needs, but mainly for people who required nursing care.

We last visited the home on 7 August 2013 and found the home was meeting the requirements of the regulations in all the areas we looked at, with the exception of meeting peoples nutritional needs safely. We then conducted a follow up visit on 1 October 2013 and found the service to be compliant during that inspection.

There was 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 2008 and associated Regulations about how the service is run.

We found the home was in need of refurbishment with both floors needing updating and modernising. We saw several door frames, skirting boards and hand rails were damaged which as a result, had removed parts of the paintwork. We also observed dirty marks on the walls in the upstairs lounge and a recliner chair to be stained. Additionally, we observed trolleys containing dirty bed linen which was to be stored in the upstairs bathroom/shower area of the home. These issues could potentially place people at the risk of infection. We felt this area could be improved upon. We raised these issues with the manager who, following our inspection, contacted us stating that various new furniture had been ordered and would be delivered within three to four weeks.

Although we saw some evidence of staff supervision in recent months, we found there had been no structured pattern throughout the previous year (2014). The manager told us they did these every eight weeks, although records did not support this. Additionally, we saw no evidence that annual appraisals had been carried out for each member of staff. This meant staff may not be able to discuss any concerns, training opportunities or speak with their manager confidentially. It also meant there were missed opportunities to provide staff with an annual review of their work. The manager told us they would introduce a formal supervision and appraisal system for staff following our inspection.

Staff at the home had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS are laws protecting people who are unable to make decisions for themselves. At the time of our inspection there were three people under a DoLS and we saw documentation in people’s care plans to show appropriate referrals had been made by the home manager to the local authority. Staff had received training in the MCA and DoLS which was recorded on the homes training matrix.

On the day of our inspection the staffing team consisted of the registered manager, two nurses (one covering each floor), six care assistants and various members of domestic, kitchen and maintenance staff. The evening shift was staffed by one nurse and four care assistants. This was to provide care and support to 35 people. Over the course of the inspection we found this proved sufficient to provide care to the people who lived at the home.

Staff spoken with told us they felt supported by the manager and understood the ethos and values of the home. They felt they could raise any issues and they would be dealt with appropriately.

We saw the home followed safe recruitment practices which meant people were kept safe as suitable staff were employed, with appropriate checks undertaken. Several people who lived at the home had been actively involved in the recruitment of staff where they were asked for their views and opinions before staff were formally offered the post. We saw this had been recorded on the back of application forms during the interview process.

There were systems in place to monitor and review accidents, incidents and complaints. The manager told us they monitored staff training using a training matrix, which identified when updates were required for staff and the types of training they had completed. Additionally there was a monthly auditing process in place. This covered things such as weights, bed rails, complaints, pressure sores, care plans and infection control. Where shortfalls were identified, they were added to an action plan to show how they had been addressed.

We looked at the surveys which had been sent to relatives, residents and professionals over the course of the year. We noted the feedback from these had been positive about the care provided at the home.

During the inspection we spent time speaking with the activities coordinator employed by the home. There was a schedule in place which included films afternoons, reading, name the film star, play your cards right, arm chair exercises, quizzes and visits from various singer and entertainers. On the day of our inspection we saw people who lived at the home had baked cakes in the afternoon which they appeared to take great enjoyment from.

People we spoke with and their relatives said they felt able to raise any concerns or complaints with staff and were confident they would be acted upon.

Leadership in the home was good. The registered manager worked alongside staff overseeing the care given and provided support and guidance where needed. Staff spoke favourably about the manager during the inspection. One member of staff said; “The home is very well run. We are well supported and we feel wanted here”.

Inspection carried out on 1 October 2013

During an inspection to make sure that the improvements required had been made

We saw dining tables were set with table cloths, place mats, napkins and condiments. Drinking glasses and jugs of fruit juice were seen on dining tables and we saw people were asked if they would prefer a hot drink.

We looked at a sample of three people's fluid balance charts and saw these were completed on a daily basis and included any drinks provided overnight and where drinks had been refused.

We observed the lunchtime meal being served. We saw a member of staff was seated at dining tables where people needed assistance and support to eat their meals.

We saw a nutritional assessment was carried out for each person. The home used the malnutrition universal screening tool (MUST) to identify people at risk of poor nutrition. MUST is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese.

We spoke with two people who lived at the home who told us: “The food is very nice.” “I enjoy the food.” "They give me lots of drinks."

Inspection carried out on 7 August 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke to the relatives of five people who told us: "I think the staff look after her very well and I know the names of most of the staff here." "I don’t think there is enough staff." "I feel my relative is safe."

We looked at a sample of five peoples' care plans. We saw that they were detailed and easy to read.

We observed the midday meal being served in the dining room. We saw the room was very busy and a number of people needed assistance to eat their meals. We did not see any aids or adaptations such as plate guards or adapted cutlery used to assist people to eat independently. Fluid balance charts were not being completed correctly and some records were missing from the files stored in the person's bedroom. This raised some concerns that people were not supported to have sufficient food and fluid intake.

There were two nurses and six care staff on duty to provide support to thirty eight people. In addition a cook, administrator, housekeeper and handyman were on duty. The staff we spoke with told us they felt there were enough staff to meet people's care needs.

We saw the training matrix that showed mandatory training had been completed.

Inspection carried out on 20 December 2012

During a routine inspection

Arden Court is registered to provide care for up to forty seven people. There were thirty five people using the service on the day of the inspection.

During the inspection we spoke with six people who used the service who all spoke well about the care that they had received. Comments included “I really like living here” and “It’s a happy place” and “The chef is excellent, she come round and talks with us about the kinds of food we might like”.

The people who used the service were well presented and we saw that staff were interacting with them politely and with respect. We saw that care was delivered in a timely and efficient way.

On the day of the inspection there was a social event at the home which relatives had been invited to and during this time we spoke with seven relatives and one friend. One relative told us “It’s fantastic” and “Every time I visit the staff keep me up to date with anything that might have changed”

We found that relevant policies and procedures were in place within the home and that staff were aware of them. We saw evidence of a good staff induction programme and also a comprehensive training programme for staff members as part of their continuous development.