This inspection took place on 27 July and 02 August 2018 and was unannounced. Arden House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 14 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, physical disabilities, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

At a comprehensive inspection in July 2017 the overall rating for this service was requires Improvement. We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service had sustained the improvements. The overall rating for Arden House has been changed to good.

The service had a registered manager in place. 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.

Whilst there were systems and processes to assess and monitor the quality of the service provided and ensure that the premises were safe and well maintained, there were some areas of essential maintenance that had been overlooked and needed to be addressed. For example, ensuring that fire risk assessments were updated by a competent person. The yearly legionella test had not yet been undertaken and the five year electrical safety certificate was slightly out of date. Following the inspection, we received written confirmation that these had been taken forward with urgency with timescales for completion by the end of August 2018.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with specific health problems such as diabetes. Formal personal development plans, including regular supervisions and annual appraisals were in place. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation. People were encouraged and supported to eat and drink well. There was a varied daily choic

We inspected Arden House on the 13 October 2017. This was an unannounced inspection.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 16 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

There was no registered manager in post. The previous registered manager de-registered in January 2017. The current manager has submitted their application and an interview arranged. 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.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016. We undertook an inspection in May 2016, to see if improvements had been made. We found that considerable improvements had been made and the provider had met four of the five previous breaches of Regulation.

We undertook an inspection in July 2017 to see if the improvements made had been sustained and embedded into everyday practice. We found that not all improvements had been sustained: the management of medicines were not always safe, the premises were not always clean and hygienic and risks to people were not always mitigated. We also found that further improvements were needed to ensure management oversight of care delivery and documentation. At this time we served warning notices to ensure peoples safety and well-being.

This focussed inspection was specific to the safe and well-led questions to see if the necessary improvements to people’s safety had been made and systems to sustain improvement had been put in place.

At this inspection there was strong managerial oversight to ensure documentation was kept up to date and ensured people received safe, effective, caring and responsive care. A range of audits had been introduced and completed monthly. When audits had identified issues there was evidence of recorded actions taken to address the issues. For example, poor recording of medicines administered had led to the further training and competencies. We still found some inconsistencies in medicine records and these will be addressed further within staff's individual performance supervisions.

At this inspection the management and storage of medicines were safe. There were areas to further develop in respect of the management of 'as required' (PRN) medicines and these were immediately actioned. Risks related to infection control and lack of cleanliness had progressed with new house keepers and more in-depth audits.

Accidents and incident reporting had been completed and there was management overview of audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure learning and preventative measures had been taken.

Staff had training on keeping people safe and understood the process of reporting concerns. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. There were sufficient staff at this time to meet peoples’ needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We al

We inspected Arden House on the 10 and 14 July 2017. We also visited on the 26 July 2017 to feedback about the inspection and its findings to the provider as she was on leave during the inspection. This was an unannounced inspection.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 20 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, mental health illness, alcohol dependency, diabetes, Parkinson’s disease and heart disease.

There was no registered manager in post. The previous registered manager de-registered in January 2017 and whilst another manager had been in post until March 2017 they had not registered with CQC. The current manager has submitted their application. 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. The provider has arranged for the manager of a sister home in the organisation to provide regular support for the acting manager. The provider confirmed that she is visiting or in contact daily to provide support and guidance.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016. We undertook an inspection in May 2016, to see if improvements had been made. We found that considerable improvements had been made and the provider had met four of the five previous breaches of Regulation. Further improvements were needed to ensure management oversight of documentation.

This inspection in July 2017 was to see if the improvements made had been sustained and embedded into everyday practice. We found that not all improvements had been sustained.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits had not been undertaken for four months. This had impacted on the safety and well-being of people. The premises were not clean and placed people at risk of cross infection. Laundry facilities were not kept clean and procedures for soiled linen were not followed. The washing machine had not worked for up to six days. The premises had areas of poor maintenance that had not been identified and reported for repair. Whilst there were procedures for the safe management of medicines, these had not been consistently followed. The staff deployment had not enabled staff to care for people, clean the premises, undertake laundry chores and provide activities. The maintenance cover for the organisation and for three premises was provided by one maintenance person over three days which was not sufficient to keep the premises well maintained for people.

Whilst the provider had arrangements in place for the management of medicines, we found the administration and recording of medicines were potentially unsafe. There were some people at risk of not receiving their prescribed medicines, as there were a large number of staff signature omissions (identified as gaps) in medication administration records (MAR). Staff had not completed the MAR record to state why the medicine had not been given. Identification photographs of some people were missing from the medicine administration charts (MAR), as were details of allergies.

Whilst people received support in a person centred way and were treated with dignity and respect there was

We inspected Arden House on the 25 and 26 May 2016. This was an unannounced inspection

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 14 people living in the home. The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, diabetes, Parkinson’s disease and heart disease.

There was no 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. The management team had been unstable due to senior staff leaving employment over the past few months. The area manager had also left the organisation since our last inspection. An acting manager had been in post for three weeks. We have been informed that once her role is established she will be submitting her application to be registered with CQC. The provider has arranged for the managers of the sister homes in the organisation to provide regular support and meetings with the new acting manager. The provider confirmed that she is visiting or in contact daily to provide support and guidance.

At a comprehensive inspection in July 2015 the overall rating for this service was Inadequate and it was placed into special measures by the Care Quality Commission (CQC). Five breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The inspection in July 2015 found significant risks to people due to the poor management of medicines and people not receiving appropriate person centred care. This was because where people’s health needs had changed considerably, care plans had not been updated. Staff therefore did not have the most up to date information about people’s health. This meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wounds and pressure damage. Accidents and incidents had not been recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. Risks associated with the cleanliness of the environment and equipment had been not been identified and managed effectively. People had not been protected against unsafe treatment by the quality assurance systems. We also found that training had not been delivered where identified as needed and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by April 2016.

During our inspection on 25 and 26 May 2016, we looked to see if improvements had been made.

At this inspection we found that considerable improvements had been made and the provider was now meeting four of the five previous breaches of Regulation. We could see that action had been taken to improve people’s safety. Whilst improvements in the management of medicines had not been sustained fully, this service in no longer in special measures as the risk was reduced immediately with support from the GP, pharmacist and district nurse. .

People were supported to access health professionals or appointments. However, there was an on-going need to ensure the relationship between the service and health professionals was improved in order for people to get the support required to manage changes to their heath in a safe way.

The training plan we first saw during the inspection was not clear or up to date. The provider then showed us an up to training plan with the confirmation that the training had been undertaken. Staff said they fel

At the time of our inspection the provider did not have a registered manager in post.

There were 23 people living at the home on the day of our inspection.

We spoke with seven people and six staff. We spoke with two relatives. One person told us, “The staff are always very welcoming to my family.”

We found that people were shown respect and dignity. There was a range of activities for people to engage with.

We looked at four care plans and saw that they reflected the care that was provided to people. The home had systems in place to ensure people’s individual needs were met.

We found the home to be clean and tidy. One person told us, “My room is kept nice and clean.”

The home had effective staff recruitment systems in place.

The home had an effective complaints system. People we spoke with were aware of how to make a complaint.

People told us that they were well cared for and that staff met their needs. One person told us, "The staff here are very good". Another told us, “Staff do their best and we have very good food."

People were supported and encouraged to be independent and have choice over their daily living routines. We saw that food was well presented and people were seen to enjoy their meals.

We saw records that showed that people were involved in decisions about their life and that people were treated with dignity and respect. We looked at training records that showed that staff received development to help them perform their roles safely and well.

On the day of this visit we spoke with 10 people using the service. All the people said they were happy, that staff respected their wishes and privacy. People told us that the food in the home was good and that they were offered choices for each meal. All people were happy with their bedrooms and the way in which they had been able to personalise them.

Two relatives told us that they were ‘more than grateful’ to the home for the way in which their mother had been looked after.

The inspection took place on 23, 24 and 28 July 2015 and was unannounced. Arden House was last inspected on 5 November 2013 and no concerns were identified.

Arden House is a care home for up to 35 older people that require support and personal care. At the time of the inspection there were 20 people living in the home.

The people living at Arden House all lived with a degree of physical frailty. There were also people who were living with a dementia type illness, diabetes, Parkinson’s disease and heart disease.

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. The registered manager was on extended leave and there was an acting manager in post.

People spoke positively of the home and commented they felt safe. However, we found that there were some shortfalls that could potentially impact on people’s safety and well-being.

People were at risk of not receiving appropriate care and support because guidance about how people should be supported was not always in place where needed. Two people did not have a care plan in place. Where people’s health needs had changed considerably, care plans had not been updated. Staff did not have the most up to date information about people’s health which meant there was a risk that people’s health could deteriorate and go unnoticed. Risk assessments did not reflect people’s changing needs in respect of wound and pressure damage. Accidents and incidents were not all recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future.

People were not protected against the risks of unsafe medicines management. The staff were not following current and relevant medicines guidance. We found issues with how medicines were managed and recorded. The risks we found with medication practices were identified immediately to the provider. Appropriate steps were then taken to safeguard people from potential harm of unsafe medicine practices. This included involvement from the dispensing pharmacy and GP.

Risks associated with the cleanliness of the environment and equipment had been not been identified and managed effectively. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff, however the evacuation plans did not reflect the decrease in staff in the afternoon and night.

A quality monitoring system was in place but was not effective. It did not enable the provider to highlight the concerns identified at this inspection, such as unwitnessed incidents and accidents, inaccurate and incomplete care plans and medicines administration shortfalls.

Mental capacity assessments did not always meet with the principles of the Mental Capacity Act 2005, as they are required to do so.

Training had not been delivered where identified as needed and administrative processes to support training, staff supervision and appraisal were inaccurate and incomplete.

Care plan records did not always reflect that people were involved or had agreed to decisions and changes made about the care and treatment they received.

People were encouraged to express their views and completed surveys, and feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, they sort it out quickly.” However, staff said their feedback was not always taken forward and actioned.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the home. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

People were encouraged and supported to eat and drink well. One person said, “I like the food and I can choose what I want”. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People told us they enjoyed the activities, which included singing, films, and trips out. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat us well, we are looked after very well, plenty to eat and my room is kept clean and tidy.” A visitor told us, “Kind and helpful, we know our relative is safe and happy.”

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of 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 this report.