The Arkley Care Home

The Arkley Care Home is a nursing home providing accommodation with personal care and nursing care for up to 52 older people. Some of whom are living with dementia. On the day we inspected there were 43 people living in the home.

People’s experience of using this service and what we found

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

People's care was planned and risks to their safety and wellbeing were assessed. The service reviewed these plans regularly, involving people in these reviews and asking for their opinions.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People and staff praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the newly recruited manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity.

Staff consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

Care plans contained information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people.

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

Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

The managers of the service actively sought the views of people and their relatives about the running of the service and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

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

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Rating at last inspection

At the last inspection we rated this service Good. The report was published on 12 March 2020.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider was following the current Government National Guidance regarding care home visiting. Residents had three named visitors and an essential care giver. Information was available for visitors to follow. Visitors were supported to test for COVID 19 prior to entering the home and instructed how to use PPE.

The home had alternative methods to support social contact for visitors who were not named. For example, video calling and a visiting pod which was a converted room with a giant transparent screen separating the room and an intercom for people to speak with visitors, with an external entrance.

The provider had a system in place to ensure staff had the necessary vaccinations and had completed the necessary COVID 19 testing prior to working in the home.

The layout of the service and communal areas supported social distancing. The premises looked clean and hygienic throughout. There were enhanced cleaning schedules in place and adequate ventilation.

The staff were aware of who to contact should they have a outbreak of COVID 19 and the protocols to follow.

The home had sufficient supplies of personal protective equipment (PPE). There were PPE stations available throughout the premises. Staff had received training in infection prevention and control and how to don and doff PPE.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

The Arkley Care Home is a nursing home providing accommodation with personal care and nursing care for up to 52 people. On the day we inspected there were 44 people living in the home.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were enough staff to meet people's needs and recruitment processes and procedures were safe.

The management of medicines was safe, and people received their medicines in a timely manner as prescribed. People received a healthy, well balanced and nutritious diet.

The service was extremely clean and well maintained, and there were appropriate procedures to ensure any infection control risks were minimised.

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

The registered manager and staff team knew people well and detailed care plans provided staff with guidance on how to meet people's needs. People were extremely well-cared for. Staff consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way.

The management team had forged successful partnerships with a number of other stakeholders and worked closely with peoples’ families to provide an excellent care experience for people.

Staff respected people’s privacy and dignity and encouraged people to remain independent. People and relatives could express their views about the running of the home and their views were always taken on board.

People received personalised care and support which met their needs, reflected their preferences. People benefited from a variety of activities, events and trips out that were available to reduce social isolation, give meaning and purpose and enhance their wellbeing.

The service was well led. People, staff and relatives spoke extremely positively about the registered manager. There was a positive culture throughout the service which focused on providing care that was personalised. The management team used a variety of methods to assess and monitor the quality of the service. They were aware of their regulatory responsibilities associated with their role.

More information is in the full report.

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

The last rating for this service was good (report published 22 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirement in relation to the breach.

We undertook a focused inspection on 24 July 2018 to check that they had followed their plan and met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Arkley on our website at www.cqc.org.uk.

The Arkley Care Home is a nursing home providing accommodation with personal care and nursing care for up to 52 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection there were 38 people using the service.

At our focused inspection on 24 July 2018, we judged that the provider had made improvements and had now met legal requirements.

The home has 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 and associated Regulations about how the service is run.

We found people were protected against abuse or neglect. People had personalised risk assessments tailored to their support requirements

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We saw sufficient staff were deployed to keep people safe.

People were protected from avoidable harm and risks to individuals had been managed so they were supported and their freedom respected.

The service was clean and there were systems in place to prevent and control infection.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Sufficient numbers of suitably qualified staff were employed to keep people safe.

Medicines were now managed safely. Staff had received relevant training and regular medicine audits were taking place.

The home was well led by an experienced registered manager. People, relatives, staff and health and social care professionals spoke highly of the registered manager; they found them to be dedicated, approachable and supportive.

The registered manager understood their responsibilities and ensured people, relatives and staff felt able to contribute to the development of the service. Staff were supported to be valued members of the organisation. The continued development of the skills and performance of the staff was integral to the success of the service. and the provider had systems in place to monitor the quality of the service, seek people's views and make on-going improvements.

The premises were safe and equipment was appropriately maintained.

The Arkley Care Home is a nursing home providing accommodation with personal care and nursing care for up to 61 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection there were 30 people using the service.

We carried out an unannounced inspection of this service on 13 June 2017.Breaches of legal requirements were found. We saw multiple issues with stocks of medicines not matching what the recorded stock was, medicines being given at the wrong time and medicines being disposed of unsafely. We took enforcement action and served a warning notice on the provider requiring them to become compliant with this regulation by 26 July 2017.

At this inspection we found that a number of improvements had been made and the provider had been working closely with the pharmacist from the CCG. Medicines were stored and disposed of appropriately and administered by people who had received training to do so. However we found that for one person the allergy status had been incorrectly recorded and another person receiving long acting medicines did not always receive them as prescribed. This meant that the service had still not met legal requirements in this area.

At our last inspection, we also found breaches of regulations in respect of consent and governance. The service did not have a registered manager in post.

The service now had 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.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. Relatives we spoke with said they felt welcome at any time in the home; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The care records contained information about how to provide support, what the person liked, disliked and their preferences and interests.

The staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Staff told us that a number of improvements had taken place and we found this to be the case. They enjoyed working in the home and spoke very positively about the management of the service. Staff had the training and support they needed to carry out their role. There was evidence that staff and the manager at the home had been involved in reviewing and monitoring the quality of the service to drive improvement

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of many health conditions.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people home.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration.

There was an open and transparent culture and encouragement for people to provide feedback. The provider took account of complaints and comments to improve the service. People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Improvements had been made in medicines management and there was evidence of some good practice, however we found that for one person the allergy status had been incorrectly recorded and for another person receiving long acting medicines did not always receive them as prescribed.

We found improvements had been made with consent documentation. 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

People, relatives, staff and health and social care professionals spoke highly of the registered manager; they found him to be dedicated, approachable and supportive. The registered manager understood their responsibilities and ensured people, relatives and staff felt able to contribute to the development of the service. Staff were supported to be valued members of the organisation. The continued development of the skills and performance of the staff was integral to the success of the service.

The provider’s governance framework ensured quality performance, risks and regulatory requirements were understood and managed. There was good use of a number of monitoring tools in support of this. The service learnt and made improvements when things went wrong.

Overall, we found that the provider had addressed the three breaches of regulations.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to the safe management of medicines. You can see what action we asked the provider to take at the back of the full version of this report.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the all reports link for this service on our website at www.cqc.org.uk.

The Arkley Care Home is a nursing home providing accommodation with personal care and nursing care for up to 61 people. At the time of our inspection there were 44 people living there.

The service did not have a registered manager in post; a condition of the registration of the service was to have a registered manager in post at the service. There was a manager registered with the service but they had left their post in February 2017 and were no longer working in the service. 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.

Medicines were not managed safely. We saw multiple issues with stocks of medicines not matching what the recorded stock was, medicines being given at the wrong time, medicines being disposed of unsafely and pain medicine for one person running out. We saw some evidence of good practice on one of the floors of the home where medicines were stored tidily and Medicine Administration Records were complete.

Documents around a person’s known risk of bruising were not in place to assess or mitigate the risk to this person of further bruising.

We found a continuing breach in the governance of the home. Gaps and inconsistencies in consent documents had not been picked up in care plan audits, and the extent of the medicines issues had not been identified by weekly or monthly medicines audits.

The home was not always in keeping with the principles of the Mental Capacity Act 2005. There were gaps in consent documents. Inconsistencies that were found at the last inspection were still found and sufficient improvement had not been made in this area.

Staff supervisions were now taking place and staff felt supported by the new home manager.

People were receiving person centred care and information about people’s needs had improved in files. However not all files had the same level of individualised care recorded.

Complaints recording and handling had improved. People felt confident to complain to the manager and that they would be listened to. Complaints records were in keeping with the provider’s policy.

There were overall three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Arkley Care Home is a nursing home registered to provide accommodation, nursing and personal care and treatment of disease, disorder or injury for up to sixty people.

There was a registered manager in post on the day 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.

People and staff told us they thought there were too many agency staff. The home was trying to recruit new nurses. We saw on the day of inspection people were having their basic needs met but the care was affected by the level of agency staff being used.

Effective support in the form of supervisions and appraisals for staff were not always taking place which meant staff were not getting the full support they needed to effectively carry out their role.

The Arkley Care Home was not complying with the Mental Capacity Act 2005. Applications for DoLS were not made in a timely manner and documentation around mental capacity were not accurately completed.

Complaints were not recorded effectively or people making complaints supported through the process.

The provider had sent in extra managers to help make improvements in the home and regular audits were taking place that picked up some issues. We saw that further improvements were required.

Medicines were being stored, administered and disposed of safely by staff who had been trained and had their competency in administering medicines tested.

People and their relatives enjoyed the food and found there was a range of food on offer and it was tasty. We saw that some people could not always reach their drinks and fluid intake for those people at risk of dehydration was not consistent.

We saw kind and caring interactions between staff and people and relatives and people said the staff were friendly and helped them.

People fed back to us they enjoyed the activities on offer and when suggestions were made they were listened to at meetings held for feeding back opinions.

We found breaches of six of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the registered provider and will report further on this when it is completed.

You can see what action we told the provider to take at the back of the full version of the report.

The Arkley Nursing Home is a nursing home that is registered to provide accommodation, nursing and personal care for up to sixty people. The home did not have a registered manager, but the manager had applied to register. 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.

A significant increase had been made to the number of permanent staff working in the home, so that no agency staff had been used within the last two months. People living at the home and their relatives indicated that this had resulted in a marked improvement in the quality of care they received. They described staff as caring and skilled, and said that the atmosphere of the home had improved. We also found improvements made to the management of medicines as recommended at our previous inspection.

A new management team was in place for the service, and people spoke positively about their impact and approachability. The provider had systems for monitoring the quality of the service and had engaged with people and their relatives for feedback, with action plans put in place to address issues of concern. When people made complaints they were addressed appropriately.

We found some gaps in staff supervision frequency particularly for care staff, and some areas for further training. Staff were not always aware of which people living at the home were subject to a deprivation of liberty safeguard, which might place people at risk of inappropriate care.

Staff had knowledge of people’s preferences regarding their care and support needs. Personalised care plans were in place to record people’s care needs, with risk assessments where needed to minimise the risk of harm. Staff were clear about the procedures for reporting abuse. Safe systems were in place for recruiting staff, and the home was kept clean and hygienic.

People were provided with a choice of food, and were supported to eat when this was needed. People had a range of activities available to them, and access to health and social care professionals when needed.

At this inspection we found that the service had made improvements. The provider had addressed most of the areas identified in their action plan.

The inspection team who carried out this inspection consisted of an adult social care inspector and two specialist advisors a nurse and an occupational therapist, along with a second inspector. During the inspection, the team worked together to answer five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with 10 people who use the service, two relatives, the registered manager, the administrator, three care staff and healthcare professionals. We also reviewed records relating to the management of the home which included, six care plans and daily care records.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had ensured that the correct equipment was available and suitably maintained. However, staffing levels were not adequate to meet people's needs.

Is the service effective?

We saw that most staff were up to date with training requirements and had received recent supervision. Risk assessments for people were in place and update regularly.

Is the service caring?

Staff understood people's needs and preferences. Some people told us that staff were, 'excellent.' However, others said staff were sometimes rough and did not respond quickly to call bells.

Is the service responsive?

We saw evidence of referrals to healthcare professionals, such as Tissue viability nurse (TVN), and Speech and Language Therapy (SALT). Staff had recently completed respect and dignity training. People felt confident to make a complaint if there were not happy.

Is the service well-led?

The registered manager had completed an action plan following our inspection in December 2013. We saw that some actions had been addressed. These included, staff training and supervision and an audit of the call bell system. However, there remain concerns at the response levels for call bells, which the provider is aware of.

Although care plans and risk assessments had been reviewed, we found gaps in the way care was planned and delivered. This meant that people were at risk of receiving inappropriate or unsafe care and treatment. People were not protected from the risk of unsafe or unsuitable equipment, because the provider failed to ensure that these were fit for purpose.

Systems were in place to protect people from the risk of abuse; however, staff were not supported to deliver care effectively. Appropriate arrangements were in place to manage the administering and recording of medicines. Systems were not effective in ensuring that records for people who used the service were up to date.