Care service description

Arbrook House Care Home is a care home that provides care, support and accommodation for a maximum of 42 older people some of whom are living with dementia. 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. At the time of the inspection 41 people were living at the service.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence supported the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We found the service had improved in the Caring, Responsive and Well Led domain.

Why the service is rated outstanding

Staff and the management team took great steps to ensure that people and their families were at the heart of the care they provided. People were treated as individuals whose life and experiences mattered to the staff. The manager and staff went out of their way to ensure that people and their relatives were comforted and looked after in a kind and compassionate manner. People were treated with dignity and respect. People and relatives were at the centre of decision making about their care.

Staff at the service went the extra mile to find out what people had done in the past and evaluate whether they could accommodate activities that there important to people. There were a range of activities available within the service and within the community. Staff ensured that people’s lives that were near to the end were provided with care and compassion and that people’s last wishes were provided where possible. Complaints were used as a way of improving care to people.

The service had a strong, visible person-centred culture and was exceptional at helping people to live their lives to the fullest. People, their relatives and staff told us the registered manager and all of the senior staff were supportive, valued their input and ensured that they were included in any changes to the service provision. The registered manager and senior management took a personal interest in people and knew them well. The registered manager worked in partnership with people's families and outside organisations to improve the care and support people received. The registered manager had systems in place which monitored health and safety and the quality of people's support. The systems were responsive and had led to changes being made. The registered manager was proactive with regard to how people's support could be improved.

People told us that they felt safe and secure with staff at the service. Staff understood risks to people’s care and what they needed to do to reduce the risks of injuries to people. Staff had received training in how to safeguard people and what they needed to do if they suspected abuse. Before staff started work checks were undertaken to ensure that they were suitable.

The provider had procedures in place ensure people remained safe in an emergency. Staff understood what they needed to do to prevent the risk of infections to people.

People were supported with their health needs including nutritional and hydration needs. When people were at risk of dehydration and malnutrition this was managed well by staff. Staff worked well together to ensure appropriate care was delivered. Staff understood the principles of the MCA and what they needed to do if they suspected a person lacked capacity. People’s consent was gained by staff before they delivered care.

Staff received appropriate training and supervision in relation to people’s needs. Clinical support was provided to staff and where health care professional advice was sought staff followed their guidance.

People's needs had been assessed both before and after admission to the service. Care plans reflected pe

This inspection was carried out on the 3 August 2016. Arbrook House Care Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 44 people. The service also provides end of life care to people with the support of the local palliative care service. On the day of our visit 40 people lived at the service.

On the day of our visit there was 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.

Staff and management were committed to a supportive approach to caring and found ways to make sure that each person using the service were happy and comfortable. There were outstanding elements to the way the registered manager and staff cared for people and their relatives as well as care which was very good. People and relatives felt that staff were kind and caring. One person said “The carers are just brilliant.” The manager and staff went out of their way to ensure that people and their relatives were comforted and looked after in a kind and compassionate manner and treated with dignity and respect. It was clear that staff understood people’s needs and how to communicate with people. People and relatives were involved in the decisions about care. People were cared for in kind and dignified way at their end of life.

People said that they felt safe. Relatives of people felt their family members were safe. One person said, “I’m not worried at all about staff, they treat me well, I’m never scared or frightened.” Staff understood safeguarding adults procedures and what to do if they suspected any type of abuse.

There were enough staff deployed at the service. We saw that staff responded to people’s needs straight away. People told us that there were enough staff. One person said, “There are a lot of carers here.”

Risks to people’s safety were identified and appropriately managed. Staff knew what action to take to protect people from harm and recue the risks. Incidents and accidents were recorded and action taken to reduce the risks of these reoccurring. There were robust recruitment processes in place before staff started work.

People's medicines were managed safely and medicines were stored securely and in an appropriate environment. People were supported to be independent with their medicines where appropriate.

People and relatives told us that they felt staff knew how to undertaken their role. Staff had the training and experience to meet people’s needs. Staff’s competencies were assessed regularly in one to one meetings with their manager.

People’s human rights were protected because the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS) was being followed. Where gaps had been identified around MCA assessments these were being addressed by the manager.

People enjoyed the food at the service. Comments included, “It’s always lovely, and I think I could have second helpings but they know I like my food so I get a big plateful”, “I quite enjoy the food.” People at risk of dehydration or malnutrition had effective systems in place to support them including being regularly weighed and food and fluid charts being put in place if needed.

People told us they could see health care professionals at any time they needed to. Advice given by health care professionals was followed by staff.

Detailed assessments of people’s needs were undertaken and people felt they were getting good responsive care. Staff understood the needs of people and responded to these without delay.

People enjoyed the activities at the service and these were specific to the needs of people that lived there. People in their rooms were visited by the

We carried out an unannounced comprehensive inspection of this service on 28 July 2014. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the cleanliness and infection control and the staffing levels.

This inspection was carried out on the 22 July 2015 to check whether they were now meeting the legal requirements. This report covers our findings in relation to those requirements and additional any other areas that we looked at on the day of the inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Arbrook House Nursing Home on our website at www.cqc.org.uk.

Arbrook House Nursing Home provides residential, nursing, respite and end of life care for older people. It is registered to accommodate up to 40 people. The accommodation is arranged into two floors. On the day of our visit 40 people lived at the service.

On the day of our visit there was 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 said that they felt safe. Comments from people included “I feel safe, I don’t get disturbed a lot and I feel safe with staff.”

The service was clean throughout and there were adequate systems in place to help prevent the spread of infections.

We recommend that the DoH guidance on the use of personal protective equipment (PPE) is used and staff regularly wash their hands to protect both people and staff from the risks of cross-infection.

Staff responsible for the management and administration of medicines were not always competent in their role. Where a risk had been identified around people’s medicines staff did not always have the understanding they needed to assess this risk.

There were sufficient numbers of staff deployed around the service to meet people’s needs in a timely way. Staff said that there were enough of them and that they didn’t feel as ‘Rushed’ as they used to.

Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. One said “If I saw something I would approach the manager and if necessary take it higher.” Staff knew where to access policies and had all been provided with the appropriate training.

Assessments were undertaken to identify risks to people. Management plans were developed to reduce the likelihood of risks occurring. Staff had knowledge of people’s risks and we saw plans being put into action on the day of the inspection.

Appropriate recruitment checks were undertaken before staff started work. This meant that only suitable staff were employed.

In the event of an emergency such as a fire each person had a personal evacuation plan which were reviewed regularly by staff. These were left in the reception area and could be accessed quickly and easily if needed.

People said that staff understood their needs. One person said “Nurses are excellent, I wasn’t well and they looked after me so well” whilst another said “I get looked after the way I want.”

Not all clinical staff had received appropriate training or supervisions to assess their competencies around the care they were providing. Other staff were up to date with the one to ones with their managers and had received the required service mandatory training.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although staff were provided training around their responsibilities of the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS) they did not demonstrate a good understanding. Assessments were not always completed appropriately. Staff gained consent from people before they provided personal care and before they entered their rooms to clean them.

People said they enjoyed the food. One person said “I enjoy my breakfast in bed. I get a choice of two meals and can have an alternative if I don’t like either, there is always plenty to eat and drink”

Nutritional assessments were carried out to assess any specialist dietary needs. People’s weights were recorded and where needed advice was sought from the relevant health care professional.

People had access to a range of health care professionals, such as GP, physiotherapist, and nutritionist. One person said “They (staff) look after your health well, I needed my eyes to be tested and this has been seen to (by staff).”

People were cared for by staff that were kind and considerate. One person said “I think that the staff are caring here, they are respectful.” People in their rooms looked comfortable and were visited by staff throughout the day. People were treated with dignity and respect, one person said “Staff always shut the curtains when giving me personal care, they are respectful.”

People and relatives were involved in the planning of care. One person said “I like to be able to get up on my own; I have a sensor mat to alert staff when I have got up.” They said that this helped them remain as independent as they could be.

People’s personal history, individual preferences, interests and aspirations were all considered in their care planning. Plans provided staff with information so they could respond positively, and provide the person with the support they needed in the way they preferred.

Care plans were reviewed every month to help ensure they were kept up to date and reflected each individual’s current needs. We found instances where a change had occurred and care was changed to reflect this. Staff responded to people’s needs as and when they needed it.

There was a programme of activities in place and activities coordinators who worked there full time. People were also supported to access the outside community.

There was a complaints policy in place and this effective. People and relatives knew how to make a complaint if they needed to.

Audits of systems and practices carried out and were effective. Where concerns had been identified these had been addressed.

People, visitors and staff said they felt supported and listen to by the registered manager. Regular meetings took place and all contributed to how the service ran. Meetings were minuted and made available to everyone.

Annual surveys were sent to the people and relatives who were very complimentary of the service. Staff were also asked to complete a survey each year.

During the inspection we found 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.

Two inspectors visited the home and an expert by experience. We spoke with some of the people who used the service, their relatives, the management and care staff. We toured the building, spent time with people and observed the interactions between people and staff during the day.

We set out to answer our five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

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

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

Is the service safe?

We found that risk assessments included people's skin integrity, oral health, moving and handling and environment were in place. Risk assessments were reviewed regularly, with particular attention paid to any physical or mental deterioration or any area of concern. Records confirmed that people were referred to healthcare professionals appropriately such as GPs and dieticians.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Care documentation viewed showed that mental capacity had been considered. Where people lacked capacity and decisions were made on people’s behalf the documentation reflected that the service had consulted with relatives / friends or advocates. This was needed to show that the service had acted in people’s best interest and that people’s human rights and rights of choice were not compromised.

People were not protected from the risk of infection because appropriate guidance had not always been followed. The standard of cleanliness was not consistent in all areas of the service. We found that two of the bedrooms and the activities room had strong odours.

We found in one of the downstairs toilets the walls were stained. We saw that skirting boards throughout the home were unclean and had a layer of dust on them. We saw in the shower room on the ground floor that the window did not close properly and had a plant growing through it. This had been identified in the homes Infection control audit undertaken on the 12th July 2014 however no actions had been undertaken to address the issues identified.

There were not always enough qualified, skilled and experienced staff to meet people's needs. We were told by staff that the ground floor should have five care staff however on the day of our visit one staff member had been on sick leave and had not been replaced to support the needs of the people living at the home.

We saw that on the ground floor one of the staff members was being utilised to provide one to one support for a which meant that two carers were left to support the needs of 16 other people living on the ground floor of the home.

Is the service effective?

We found that the service was effective. People told us that they were happy with the care that they received and that their care needs were met. One person we spoke with told us, “I am very happy here I have no concerns”. A relative said, "Staff treat my mother well". We saw that staff were attentive to people who used the service and responded promptly when needed. People’s health and care needs were assessed with them and /or their representatives where possible.

Is the service caring?

We found that the service was caring. People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

The expert by experience observed one person having their hair done. We saw that the attitude of the hairdresser towards the person was caring and they were interested in what they had to say. We saw that eight people took part in a crossword quiz which was being run by a member of staff who took care to involve everyone.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of six people who used the service. These had sufficient detail and guidelines about the support needed to meet the people's needs.

Is the service responsive?

We found the service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs.

We found that the management and staff were approachable and encouraged people to voice any concerns or ideas for change. People were consulted and were given the opportunity to contribute towards the running of the service. We noted evidence of regular meetings which enabled people to air their views.

People who used the service were weighed regularly and weight fluctuations were noted and acted upon. We found that food and fluid intake were appropriately logged and that special dietary requirements were respected where needed. This meant that the provider was responsive and made reasonable adjustments to meet people's individual needs.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

Staff told us that they felt well supported and were given the information they needed to support the people who used the service.

The manager took an active role in the running of the home and met with staff and people who used the service to listen to what they had to say. We saw minutes of regular staff meetings where changes or issues with peoples’ care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about running the service.

During our inspection in December 2013 we found the provider to be non compliant in record keeping and asked them to become compliant by 22 January 2014. We carried out an inspection on 14 February 2014 to check that the provider had made improvements in this area.

We found that their had been significant improvements in record keeping. We saw that people's care records had been reviewed and most information about people's care had been recorded accurately. However, we noted that there was still work to do.

We spoke to a visitor on the day of our inspection who told us that they thought record keeping in relation to their relative had improved.

This was a follow up inspection to check that Arbrook House had made improvements following our inspection of 19 June 2013. At that inspection we found that the provider had not always met people’s individual needs. For example, people had not always received the equipment they needed to eat independently. We also noted that some people’s care records had not been kept up to date and some important information was missing. This meant that there was a risk that staff could have provided unsafe or inappropriate care to people.

During our inspection of 12 December 2013 we spoke with five people who lived at the home, three members of staff and a volunteer.

Each person we spoke with told us they were well looked after. One person said “I’m very satisfied” and another told us “They’re brilliant, I have no complaints.” The staff we spoke with told us that they thought people were well cared for. For example, one staff member told us “I am here because I care.” We observed staff practices and saw that people’s care needs were met.

During our inspection we identified some concerns in relation to how the provider monitored the delivery of care to people living at Arbrook House.

We looked at seven people’s care records and found that five of these had out of date and missing information. For example, fluid and food charts had not been completed and weight charts had not been updated.

During our inspection we spoke with three members of staff, the registered manager and deputy manager and we gave questionnaires to five staff. We carried out observations and spoke to three people who used the service.

We saw that staff asked people for their consent before providing any care or support.

During our inspection we saw that staff provided appropriate support to most people. However, we observed that for three people, some of their individual needs were not met.

People told us that they felt safe at Arbrook House. We saw training records that showed staff had received training in safeguarding adults.

The provider had followed their recruitment policy and had completed relevant checks on staff before they started work.

We looked at records held by the provider and found some omissions and discrepancies in recording of patient and staff records.

People and their carers said that the staff are caring, polite and that their privacy is respected. Two people described the staff team as “Always happy”. Another person said that the staff are “Lovely”.

People and carers we spoke with were generally happy about their care and support. Two people said that little things could be improved such as carrying out more checks.

Some people and their carers could not recall being consulted about their plan of care.

A majority of people said that they enjoyed their meals and that they can choose what they like. Two people said that there could be more choice at suppertime. A person’s carer said that staff are aware of their relative’s likes and dislikes.

We spoke with eight people who were using the service and all were complimentary about their standard of care. People told us the staff were very kind and helpful. We were told nothing seemed too much trouble for them. People all confirmed that they were receiving the care they needed.

We were told that people felt there were enough staff and bells were answered fairly promptly. People told us that their rooms were cleaned everyday and that they had no concerns regarding the cleanliness of the home. We asked if people thought there were offensive odours in the home and all told us it always smelt fresh.

People confirmed they would know how to make a complaint but only one person told us they had raised a verbal concern but it had been acted upon swiftly, and the issue had never recurred.