Arrowsmith Lodge Rest Home

Arrowsmith Lodge Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Arrowsmith Lodge Rest Home provides accommodation and care and support for up to 35 people, including people living with dementia. The service does not provide nursing care. There were 24 people accommodated in the home at the time of the inspection.

Arrowsmith Lodge Rest Home is an extended detached property which is situated in a residential area of Houghton on the outskirts of Bamber Bridge, Preston. There are a range of amenities close by including a bus link to Preston and Bamber Bridge village centre. Accommodation is provided on two floors with a passenger lift and chair lift access. Car parking is available for visitors and staff.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection carried out on 19 and 20 July 2017, the service was rated as ‘Requires Improvement’. We found four breaches of the regulations in respect of risk management, safe recruitment and a lack of effective monitoring systems and a continued breach in relation to people's needs not being recorded clearly. This was the second occasion the provider had failed to meet the regulations as they were also rated as requires improvement in July 2016.

At this inspection, we found the rating had improved to ‘Good’.

Monitoring of the service had improved. Effective quality assurance and auditing processes helped the provider and the registered manager to identify and respond to matters needing attention. The management team were aware further improvements were needed and there was a plan in place to support this. There were systems to obtain the views of people, their visitors and staff. People felt their views and choices were listened to.

Recruitment procedures had improved. A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. We observed people’s calls for assistance were promptly responded to but we received mixed views in relation to the availability of staff. Following the inspection, we were told action had been taken to improve the staffing numbers.

Records relating to people's care and support had improved. The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care. People's care and support was kept under review and, where possible, people were involved in decisions about their care. Risks to people's health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

People's medicines were managed in a safe manner. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely.

The home was clean, safe and comfortable although further improvements were needed to provide a pleasant environment that was suitable for people living with dementia. There was a plan in place to ensure improvements were ongoing. Appropriate aids and adaptations had been provided to help maintain people's safety, independence and comfort.

People were happy with the personal care and support they received. They told us they felt safe in the home and that staff were caring. Staff understood how to protect people from abuse. People told us they did not have any complaints and knew how to raise their concerns.

Where possible, people were supported to have 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. Staff respected people's diversity and promoted people's right to be free from discrimination.

People had access to a range of activities both inside the house and in the local community. People living in the home, their visitors and staff told us this felt this could be improved. People were given a choice of meals and staff knew their likes and dislikes. We discussed how the dining experience could be improved for people. People's nutritional needs were monitored and reviewed and appropriate professional advice was sought when needed.

Arrowsmith Lodge Rest Home provides accommodation and care and support for up to 35 people, including people living with dementia. The service does not provide nursing care. There were 29 people accommodated in the home at the time of the inspection.

Arrowsmith Lodge Rest Home is an extended detached property which is situated in a residential area of Houghton on the outskirts of Bamber Bridge, Preston. There are a range of amenities close by including a bus link to Preston and Bamber Bridge village centre. Accommodation is provided on two floors with a passenger lift and chair lift access. Car parking is available for visitors and staff.

The service was managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 had been a change to the registered manager since our last inspection. The registered manager had been registered with CQC in November 2016.

At our last inspection on 10 May 2016 we found the service was not meeting all the standards assessed. We found advice from community professionals had not always been followed in day to day practice and changes in individual needs were not recorded clearly. Following the inspection we asked the provider to take action to make improvements and to send us an action plan

During this inspection we found breaches of regulation in respect of risk management and record keeping and a continued breach in relation to people's needs not being recorded clearly. You can see what action we told the provider to take at the back of the full version of the report.

We also made a recommendation in relation to using a tool to determine appropriate staffing levels.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse.

People's medicines were managed safely. Records showed there were sufficient numbers of staff available who were provided with training, professional development and supervision. Safe recruitment practices had not been followed.

Care plans and risk assessments had been completed to help ensure people received appropriate care. However, information in the care plans did not provide clear guidance for staff and records relating to care were not always accurate. The provider acknowledged the care plan documentation and record keeping required development and said improvements were underway. Systems had been introduced to make sure people were involved in the care planning review process.

Accidents and incidents were monitored. However, further information was needed to make sure that staff responses were effective, to identify any trends and to see if any changes could be made to help minimise the risk of the same occurrence in the future.

People told us they enjoyed the meals and they were offered a choice at mealtimes. However, improvements could be made to the overall mealtime experience.

People told us they were happy with the facilities available in the home. There was a development plan to ensure improvements and regular maintenance were undertaken. We found the cleanliness of the home had improved.

People were encouraged to remain as independent as possible and were supported to participate in daily activities. People’s rights to privacy and dignity were recognised and upheld by the staff although most bedroom doors did not have suitable locking devices fitted.

People had access to a complaints procedure and most people were confident their complaints and concerns would be responded to.

New quality assurance and auditing processes were in place but needed further review to ensure they were effective in identifying shortfalls. New systems had been introduced to ensure feedback about the service was sought from people, their relatives and staff on a regular basis.

We last inspected Arrowsmith Lodge on 13 May 2014, when we found the service to be compliant with the regulations assessed at that time.

This unannounced inspection was conducted on 10 May 2016. The registered manager was on duty when we visited Arrowsmith Lodge. She had managed the day-to-day operation of the service for several years.

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 of the Health and Social Care Act and associated regulations about how the service is run.

The planning of people’s care was based on an assessment of their needs, conducted before a placement at the home was arranged. We found the plans of care to be, in the main, person centred, providing staff with clear guidance about people’s needs and how these were to be best met. However, advice from community professional had not always been followed in day to day practice. On two occasions changes in individual needs were not very clear, as information had been entered in various places within the care files. This was later addressed by the registered manager. Staff we spoke with were easily able to discuss the needs of people in their care.

Mental capacity assessments had not been conducted prior to applications being made to deprive someone of their liberty. We made a recommendation about this.

Staff we spoke with did not fully understand the Mental Capacity Act [MCA] and related procedures. However, the registered manager had subsequently arranged training to be provided for the staff team by an external organisation, as we had advised at the time of our inspection.

Consent had sometimes been obtained from relatives of those who lived at the home, but egal documentation had been obtained to demonstrate that they had the authority to act on someone’s behalf.

Medicines were, in general being well managed. However, we made a recommendation about some minor issues we noted during our assessment of the management of medicines.

There were sufficient numbers of staff on duty to keep people safe. Staff members were well trained and had good support from the management team. They were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at Arrowsmith Lodge. The recruitment practices adopted by the home were robust. This helped to ensure only suitable people were appointed to work with this vulnerable client group.

We found the premises to be well-maintained, clean and hygienic throughout. There were no unpleasant smells and infection control practices were good. We noted that progress was being made in relation to a more dementia friendly environment.

Equipment and systems had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. A range of assessments had been conducted within a risk management framework. This helped to promote people’s safety and well-being and protect people from harm.

People were helped to maintain their independence. Staff were kind and caring towards those they supported. However, interaction provided by staff varied. We discussed this with the manager of the home at the time of our visit and we were confident that she would address our observations. Assistance was provided for those who needed it in a dignified manner and people were enabled to complete activities of daily living in their own time, without being rushed.

Records showed that staff received a broad range of training programmes and those we spoke with provided us with some good examples of modules they had completed. Evidence was available to demonstrate that supervision sessions were conducted for staff, as well as annual appraisals, which enabled them to discuss their work performance and training needs with their line managers.

Staff spoken with told us they felt well supported by the registered manager of the home. They described her as being, ‘approachable’ and ’easy to talk to’.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for person centred care.

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

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

People's needs were assessed by suitably experienced staff, prior to admission to the home, to determine whether they could be looked after properly.

We found staffing levels were consistently maintained and there were sufficient care and ancillary staff to meet people's needs. Any shortfalls, due to sickness or leave, were covered by existing staff. This made sure people were looked after by staff who knew them.

We found some people presented, at times, with difficult and challenging behaviours. We saw guidance was available to help staff to respond appropriately. However, staff had not received any training in this area. Training was needed to help keep themselves and others safe.

We found all areas of the home to be bright, safe and comfortable. We found improvements were ongoing and there were systems in place to maintain standards of the environment and standards of cleanliness.

Is the service caring?

People told us they were happy with the care and support they received. Comments included, 'I am totally satisfied' and "Staff are very good to me; I am very well looked after". Comments from visitors included, 'I have no concerns; I come at different times and it is always the same' and 'I know that when I leave my relative will be looked after'.

We observed staff interacting with people in a kind, patient and friendly manner and being respectful of people's choices and opinions.

We found the care plans contained some useful information about people's preferred routines and likes and dislikes. This would help staff to look after them properly and ensure people received the care and support they needed and wanted.

Is the service responsive?

From looking at records, from observation and from discussions with people who used the service, it was clear there were opportunities for involvement in suitable activities and people were able to attend religious services in the home. This meant staff tried to tailor activities to people's individual needs and preferences.

People had been encouraged to express their views and opinions of the service through regular meetings, annual reviews, regular newsletters and during day to day discussions with staff and management. Their views had been listened to and used to improve the service.

We found the provider had responded appropriately to people's complaints, comments and suggestions and the information had been used to improve the service.

Is the service effective?

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. Records showed some people living in the home had been involved in the planning and review of their or their relatives, care but this was not always clearly recorded.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. People told us their health needs were met.

Is the service well led?

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. There was evidence these systems identified any shortfalls and that improvements had been made. This would help protect people from poor standards and identify any areas of non -compliance.

The service had a registered manager who was responsible for the day to day management of the home. Staff told us the management team was very supportive and they were confident the management team were approachable and would listen to them and act on any concerns.

The service worked in partnership with the local authority and safeguarding teams to ensure people's safety and well-being. Incidents and/or safeguarding concerns had been reported to the local authority. However, from looking at the records, we noted there had been a delay in reporting one recent incident. The manager agreed to follow this up.

We did not need to speak with people using the service or staff members on this occasion.

We found that the manager and her team had worked very hard to address the sections in need of improvement. We did not have any concerns with the areas we assessed.

We also spoke with two visitors who were complimentary about the staff team and the managers of the home. They spoke positively about the care and support their relatives were receiving, although one commented, "My Mum sometimes has other people's clothes on and one day I saw someone else wearing her cardigan."

Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those living at Arrowsmith Lodge included:

"I'm quite enjoying living here. It isn't bad at all."

"There's nothing going on. It is pretty boring really. I have always been fairly active, but now I just sit and do nothing."

"The staff are OK I suppose. Some are better than others."

"The place is always spotless. My bedroom is cleaned very often."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at the recruitment practices adopted by the home. Standards relating to nutrition and monitoring the quality of service provision were also inspected. We identified some concerns in two of the outcome areas we assessed.