Arden Lodge Residential Care Home for Elder Adults

We found the following examples of good practice.

¿ Staff were following Department of Health guidelines to promote safe visits to the home by professionals.

¿ The provider was supporting future visits from relatives by building a visitor pod in the garden, so the risk of the spread of infections was reduced.

¿ People received support from staff so they were able to see and talk to their visitors through the windows at the home.

¿ People were also supported to keep in touch with others who were important to them by using information technology, and more frequent one to one time with staff. This helped to reduce people’s social isolation during the pandemic.

¿ Staff supported people to help them understand the pandemic and explained why staff wore PPE. This helped to reassure people.

¿ Staff understood how to care for people safely through additional training and Covid-19 specific guidance. Senior staff checked to make sure staff had completed the additional training provided.

¿ The management team had recruited additional domestic staff to increase cleaning around the home and to manage any Covid-19 outbreaks. Senior staff undertook additional spot checks to ensure staff were protecting people by wearing appropriate PPE.

Further information is in the detailed findings below.

People’s experience of using this service:

The staff had an exceptional understanding of people's individual needs and they were fully involved in planning how they engaged with their interests. People were supported to have fun and enjoy a broad range of social activities. The staff were enthusiastic to provide people with personalised experiences that exceeded their expectations. The staff had developed positive relationships with local people and organisations to enhance experiences available to people living at the home.

Staff valued people's differences and responded to each person's individual wishes. People’s diversity was fully recognised and promoted by the staff; people were supported to follow their religious beliefs and to maintain important family relationships. There was a warm, welcoming and very friendly atmosphere.

People’s care needs were identified and assessed and there were risk management plans in place to help keep them from harm and support their independence. People were not restricted due to risk and were supported to try new and different experiences.

People were involved in decisions about their safety and people were confident they were protected from unnecessary harm by staff who knew them well. The staff understood how to recognise signs of abuse and knew how to report their concerns. The registered manager reviewed incidents that occurred in the home and within other services, to determine if lessons could be learnt.

People felt the staff were kind and caring. Positive and caring relationships had been developed between people and the staff. People were treated with dignity and respect by staff who understood the importance of this.

Care plans were developed with people and these were reviewed when their needs changed to ensure it reflected their wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was suitable staffing to meet the support needs of people and the trained staff understood their role and how to support people safely. The staff received support from the registered manager to identify personal development opportunities and to raise any concerns they had.

People were encouraged and supported to eat and drink and there was a varied daily choice of meals. People’s special dietary requirements were met and where concerns were identified, people’s weight was monitored. Health care was accessible for people and appointments were made for regular check-ups as needed.

People and their relatives were encouraged to share their views to support the development of the service and share concerns. People knew how to raise complaints.

The registered manager and staff were committed to delivering a service that focused on providing a personalised service. There were processes in place for people to express their views and opinions. Quality monitoring systems were in place to ensure the service was reviewed and areas for improvement identified. The registered manager worked with other professionals to continue to raise standards in the home and to drive improvement.

Rating at last inspection: Good (Published in May 2016).

Why we inspected: This was a planned inspection based on previous rating of Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The home is registered to provide accommodation to a maximum of 33 people. The people that lived there were older people who needed care and support with daily living tasks. On the day of our inspection there were 32 people that lived there.

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.

There were systems in place to monitor the quality of the service provided but they were not always stringent enough to identify shortfalls in the service so that actions could be taken to improve the service.

People who lived at the home felt safe and secure in the home. People were happy that there were sufficient staff available to support them when they needed support.

People received care and support that was safe and that met their individual needs.

People received their medicines as prescribed.

People were asked for their consent before support was provided. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People were supported to eat and drink sufficient amounts to remain healthy.

People were supported by caring and respectful staff that encouraged people to be as independent as much as possible.

People’s health care and support needs were assessed and regularly reviewed. There were no complaints about the service.

People were supported to maintain contact with people important to them and to be involved in activities that they liked to do.

The registered managers (as detailed on the front of the report) and the nominated individual no longer worked for the company. The process to cancel the registration of the managers has been started by the provider. The deputy manager worked a three day week. The deputy manager told us the home had nine care staff and two senior care staff. There were three vacancies. There were no other senior managers who offered support within the home.

The home was laid out over three floors. Some people were unable to communicate with us verbally. We found that most people had some dementia or frailty and chose not to speak with us. During our inspection we spent time in the communal areas of the home observing people to see how they spent their time, and how staff interacted with them.

On the day of our inspection we talked with the deputy manager and looked in detail at the care records for three people. We observed how people were being cared for in the home and sat with 13 people in the lounge area. We talked with five people who lived there. We visited on a weekday and we spoke with one relative. We talked with two staff members and a visiting nurse and a visiting pharmacist undertaking an audit of medication. There were 29 people who lived at the home when we visited.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The deputy manager had an understanding of these safeguards. There was no evidence of any capacity assessments or best interest meetings being conducted with people in the home, to support people with day to day decision making.

Risk assessments and health and safety measures were in place but had not been regularly reviewed. People were not protected from the risks of exposure to chemicals and fire. This meant that people were not kept safe.

People were sometimes cared for by an insufficient number of staff. The staff turnover was high and there was very little management time available. The service had some people who were living with dementia and were at risk of becoming disorientated by having an inconsistent staff team to support them. Risks to people's health, safety and welfare had not always been assessed and remedial action had not been taken.

Is the service effective?

We checked people's care plans and found them to be detailed and relevant to the person. Care plans were linked to people's individual needs, for example, in relation to nutrition and mobility. There were risk assessments in place in relation to each of the areas on the care plan.

The care plans and risk assessments for people had not been reviewed and were not up to date. We found there was a lack of information to support staff in managing some people's behaviour. This meant that some people were at risk of receiving inadequate or inappropriate care.

Is the service caring?

A relative told us staff were caring and respectful. They said, 'I think it's excellent. The food is good and everywhere is kept nice and clean.' One person told us, 'It's alright here the staff are fine.' We saw that staff were kind and concerned for peoples well-being. We spoke with kitchen staff who were very aware of peoples choices and requirements relating to food. Everyone we spoke with said the food was good.

Is the service responsive?

A person told us; 'If a carer is rude or something the manager deals with it quick. I've no complaints about the staff. They are all polite.' The visiting health professional told us that when advice and guidance had been given to staff it was complied with.

We saw that the deputy manager had tried to obtain support from other professionals in relation to some people's behavioural needs. However on the day of our inspection we found that people's behaviours were not being supported appropriately. We saw that a report relating to changes that were needed within the home to protect people from the risks of fire had not been responded to and the suggested changes had not been implemented.

Is the service well-led?

The service did not have an effective quality assurance system in place to ensure that people received safe and appropriate care at all times. One person said, 'We need a decent manager who cares about the place. We've had too many managers.' People we spoke with and staff felt that the home had been through many staff changes and a period of stability was needed. The limited number of management hours available within the home meant that some key areas of people's well-being were being overlooked. A visiting health professional told us that staff felt that the home did not have enough staff on duty and that some staff were frightened by some people's behaviour.

During this inspection we looked at the systems that had been put in place by the provider and spoke with four people living in the home and a visitor.

All the people we spoke with told us that they enjoyed their meal and we saw that people had a choice of meals. The choices were displayed on a board in the dining room. This showed that people were able to choose what to eat.

One person told us, "It's lovely here, never had any problems. We have activities such as bingo and play your cards right." Another person told us, "I'm not going anywhere, I want to stay here." The visitor we spoke with told us, "It's very good and the staff are good." This showed that people were happy with the service provided.

We saw that meetings had been held every two months to enable people to have an opportunity to comment on the service and make suggestions for improvements, for example about the food and activities.

We saw that the provider's representative carried out monthly visits to the home to ensure that improvements were made and took actions where improvements were not happening as required.

We saw that there was a system in place to ensure that maintenance issues were raised and addressed in a timely manner.

We saw that people's needs were planned to ensure that care received was safe and appropriate and met the individual needs of people. We saw that people were able to make choices about the food they ate and how they occupied themselves. This meant they could maintain control over some aspects of their lives.

People's health needs were met by a variety of health professionals who attended the home or by people being taken to the professionals to be seen. People received their medicines as prescribed by medical professionals.

People were protected from harm because staff had the skills and knowledge to protect them.

We saw that people's health and welfare needs were met by competent staff. People spoken with told us that they received care and support in the way they preferred and in a respectful and timely manner.

There were systems in place to monitor the quality of the service and ensure people's views about the service were sought. However these needed to be strengthened to ensure that action was taken in a timely way.