This inspection took place on 06 and 07 of December 2018 and was unannounced. At our last inspection visit on 21 January 2016 the service was given an overall rating of Good. At this inspection the service rating remained Good.

Arboretum Nursing Home provides accommodation for persons who require nursing or personal care for up to 54 people. At the time of our inspection there were 49 people living at the home.

At the time of the inspection the home did not have a registered manager in post. However, the provider was in the home on a daily basis managing the service. 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. The owner told us that their plan in 2016 was for the current manager to apply to become the registered manager however this did not happen due to personal reasons. The owner stated that they would begin the application to become the registered manager.

People told us they felt safe and were happy with the standard of care they received. Staff were aware of people’s risks and appropriate equipment was available for staff to use. In relation to safeguarding, staff were knowledgeable about different types of abuse and how to raise a concern.

We found there were a sufficient number of staff on duty to meet the care and support needs of people. The provider had a robust recruitment procedure and staff were trained to meet the nursing and care needs of people. We found that there were appropriate arrangements in place for the safe management, administration and storage of medicines.

People were supported to eat and drink sufficiently. People’s care and health needs were assessed and reviewed. The care was planned and delivered to meet people’s needs. People, their relatives and health care professionals had been involved in the planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs.

Staff treated people with dignity and respect and helped to maintain people’s independence. People were given choices by staff to participate in activities.

People told us staff asked for their consent before administering care and support. Staff understood they should gain people’s consent where possible. We found the provider working within the principles of the MCA and adhering to conditions on authorisations to deprive a person of their liberty. The registered manager had a good understanding of their legal responsibilities with regard to the MCA and Dols. Consent to care and treatment was documented in people’s care records.

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 were involved in assessments and care plans that reflected their needs and preferences. People and relatives told us they were confident any concerns or complaints they had would be listened to and the matter resolved in a timely manner.

People and relatives told us they were happy with end of life care, people were treated with dignity and end of life preferences were captured.

People and relatives told us the staff, provider and manager were knowledgeable about the service and the people using the service. Staff and management were also approachable. People had the opportunity to express their opinions such as speaking to management and completing surveys. The provider also had effective audit processes in place.

We carried out an unannounced comprehensive inspection of this service on 21 January 2016. Breaches of legal requirements were found. After the comprehensive inspection the provider told us what they would do to meet legal requirements in relation to the breaches of Regulation 18 CQC (Registration) Regulations 2009, Notification of other incidents and Regulation 16 CQC (Registration) Regulations 2009, Notification of death of a person who uses the service.

We undertook this focused inspection to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arboretum Nursing Home on our website at www.cqc.org.uk.

This unannounced focused inspection took place on 12 April 2017 and we found the required improvements had been made.

Arboretum Nursing Home provides accommodation, nursing and personal care for up to 54 older people. The home does not currently have a registered manager in place. However, the provider was in the home on a daily basis managing the home. 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 told us the home was well-run and the provider and staff approachable and friendly.

This unannounced inspection took place on 21 January 2016. At our last inspection visit on 26 November 2013, the provider was meeting the regulations we looked at. Arboretum Nursing Home provides accommodation for persons who require nursing or personal care for up to 54 people. At the time of our inspection there were 47 people living at the home.

The home did not have a registered manager in post. However the provider was in the home on a daily basis managing the home. 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 said they felt safe within the home and were happy with the care they received. Staff were aware of the need to report concerns. Staff were aware of people’s risks and equipment was available for staff to use.

There was sufficient staff on duty to meet the care and support needs of people. The provider ensured that staff were recruited and trained to meet the nursing and care needs of people. People received their medicines as prescribed and appropriate records were kept when medicines were administered.

People were supported to eat and drink sufficiently. People’s health and care needs were assessed and care was planned and delivered to meet those needs. People were supported to access other healthcare professionals to ensure that their healthcare needs were met.

People told us staff asked for their consent before providing care. Staff understood people’s choices and decisions when supporting them. People and relatives felt staff were kind, caring and respected their dignity and privacy when providing care. People were supported to maintain their interests as far as possible.

People and relatives were confident if they had any concerns or complaints, they would be listened to and the matter resolved. However the provider did not have an adequate process in place to monitor and investigate complaints. Relatives we spoke with said they were made to feel welcome when they visited the home.

People told us the staff; provider and manager were knowledgeable and approachable. The provider had audit systems to record incidents and accidents. However, we found that there were no processes in place to identify and monitor trends that would improve the quality of care people received. The provider has not submitted any notifications to CQC as they are required to by law.

During the inspection we found breaches of the CQC (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Arboretum Nursing Home on a planned unannounced inspection which meant the service did not know we were coming. In this report the name of a registered manager appears. They were not in post and not managing the regulatory activities at this service at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. We were supported with the inspection by the registered provider. We spoke with people who used the service and observed their care. We spoke with relatives and staff throughout the inspection.

We found that when able to, people had consented to their care, treatment and support or had been supported to do so by a significant person.

People who used the service and the relatives we spoke with told us they were happy with the care being provided at Arboretum Nursing Home. One person told us: “I have been here four years and couldn’t be happier”.

We saw that the service was clean and had systems in place to prevent the spread of infection.

We found that the service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure which was available for people who used the service or their representatives to raise any concerns they might have had.

We inspected Arboretum Nursing Home on a planned unannounced inspection which meant the service did not know we were coming. The service currently does not have a registered manager. We were supported throughout the inspection by the registered provider.

Some people who used the service were able to talk with us but others were unable to because of their frailty. People we spoke with told us they liked living at Arboretum Nursing Home and received good quality care. We observed people being cared for throughout the day in a dignified manner.

We looked at the way the service safeguards people who used the service and found appropriate procedures were in place to keep people safe.

Staff we spoke with told us they liked working at Arboretum Nursing Home and felt supported in their role. They told us they received sufficient training to fulfil their role.

On our previous inspection we had concerns over the management of medication and the way in which medication was stored. We found at this inspection improvements had been made.

We spoke with health professionals and relatives of people who used the service and they told us that the care was excellent at Arboretum Nursing Home.

The service had devised audits to monitor the quality of the service being delivered and used the information from these to improve the quality of the service.

We spoke to five people who live at the home and seven relatives. People we spoke to, told us that they were happy living there. One person told us, " all the staff pop in to say hello".

We saw that people received the care they needed. People told us how they spend their day. They said that they can get up and go to bed when they choose and were able to have their meals in the main lounge/dining room or their bedrooms if they preferred or were unwell. They told us that they enjoyed the activities that take place.

People told us that they mainly liked the meals that were served. Some people told us that an alternative meal was available if they did not like their meal, although not everyone was aware of this.

People told us that staff were respectful and helpful to them. They told us that staff assisted them when they needed it. One person told us, "Staff are nice they never tell you off, and they always maintain my dignity". Another person said, "They are all very good there is nothing to complain about".

People had their medicines administered safely by trained nurses. Medicines were not stored within required temperatures to ensure their effectiveness.