About the service: Arden Lodge Residential Care Home for Elder Adults is a residential care home that was providing personal to 36 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The staff had an exceptional understanding of people's individual needs and they were fully involved in planning how they engaged with their interests. People were supported to have fun and enjoy a broad range of social activities. The staff were enthusiastic to provide people with personalised experiences that exceeded their expectations. The staff had developed positive relationships with local people and organisations to enhance experiences available to people living at the home.

Staff valued people's differences and responded to each person's individual wishes. People’s diversity was fully recognised and promoted by the staff; people were supported to follow their religious beliefs and to maintain important family relationships. There was a warm, welcoming and very friendly atmosphere.

People’s care needs were identified and assessed and there were risk management plans in place to help keep them from harm and support their independence. People were not restricted due to risk and were supported to try new and different experiences.

People were involved in decisions about their safety and people were confident they were protected from unnecessary harm by staff who knew them well. The staff understood how to recognise signs of abuse and knew how to report their concerns. The registered manager reviewed incidents that occurred in the home and within other services, to determine if lessons could be learnt.

People felt the staff were kind and caring. Positive and caring relationships had been developed between people and the staff. People were treated with dignity and respect by staff who understood the importance of this.

Care plans were developed with people and these were reviewed when their needs changed to ensure it reflected their wishes.

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.

There was suitable staffing to meet the support needs of people and the trained staff understood their role and how to support people safely. The staff received support from the registered manager to identify personal development opportunities and to raise any concerns they had.

People were encouraged and supported to eat and drink and there was a varied daily choice of meals. People’s special dietary requirements were met and where concerns were identified, people’s weight was monitored. Health care was accessible for people and appointments were made for regular check-ups as needed.

People and their relatives were encouraged to share their views to support the development of the service and share concerns. People knew how to raise complaints.

The registered manager and staff were committed to delivering a service that focused on providing a personalised service. There were processes in place for people to express their views and opinions. Quality monitoring systems were in place to ensure the service was reviewed and areas for improvement identified. The registered manager worked with other professionals to continue to raise standards in the home and to drive improvement.

Rating at last inspection: Good (Published in May 2016).

Why we inspected: This was a planned inspection based on previous rating of Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The inspection took place on 7 March 2016 and was unannounced. At the last inspection on 29 January 2015, we found that the provider was not meeting the regulation in respect of ensuring that any restrictions on people’s right were in line with the Deprivation of Liberty Safeguards. At this inspection we found that improvements had been made and all regulations were met.

The home is registered to provide accommodation to a maximum of 33 people. The people that lived there were older people who needed care and support with daily living tasks. On the day of our inspection there were 32 people that lived there.

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.

There were systems in place to monitor the quality of the service provided but they were not always stringent enough to identify shortfalls in the service so that actions could be taken to improve the service.

People who lived at the home felt safe and secure in the home. People were happy that there were sufficient staff available to support them when they needed support.

People received care and support that was safe and that met their individual needs.

People received their medicines as prescribed.

People were asked for their consent before support was provided. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People were supported to eat and drink sufficient amounts to remain healthy.

People were supported by caring and respectful staff that encouraged people to be as independent as much as possible.

People’s health care and support needs were assessed and regularly reviewed. There were no complaints about the service.

People were supported to maintain contact with people important to them and to be involved in activities that they liked to do.

Our inspection took place on 29 January 2015 and was unannounced so no one knew we would be inspecting. We last inspected the home on 25 August 2014 when we found that the registered provider was not meeting the regulations in respect of medicines management, safety and management of the home. As a result of that inspection we issued the registered provider a warning notice in relation to the shortfalls we had identified and that the registered provider was failing in their duty to ensure the service was adequately monitored and improved and ensuring that the needs of people were safely met. During this inspection we found that improvements to the service had been made but the changes in management was an on going issue.

The home is registered to provide accommodation to a maximum of 33 people. The people that lived there were older people who needed care and support with daily living tasks. On the day of our inspection there were 23 people living there.

On 29 January 2015 there was a manager who had been in post for two weeks. The manager had not yet applied to be registered with us. 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 who were not able to make decisions for themselves had not had the required assessments and best interest decisions carried out and recorded so that their rights were protected. Some people who wanted to leave the home were prevented from doing so but the appropriate authority had not been obtained to stop them leaving. This was a breach of Health and Social Care Act (Regulated Activities) Regulations 2010.

Interactions between staff and the people who lived at the home were friendly and polite. Relatives and most people told us they were happy with the care provided. We saw that sometimes staff were not responsive to people’s needs and did not get the appropriate support to eat, drink and receive personal care when people were not able to request it.

People and their relatives told us they felt people were safe in the home. All the staff spoken with understood their responsibilities to protect people from harm and abuse and had received training to provide them with the skills and knowledge to support people safely.

On occasions the staff numbers fell below the required levels and this meant that staff were busy and people could be overlooked from getting the support they needed.

People’s personal care needs were met; there were some opportunities for recreational activities on a group and individual basis. Food and drink was available throughout the day but people were not always adequately supported or monitored to ensure that they received sufficient food and drink to remain healthy.

Relatives told us that they felt their family member’s needs were met and they felt listened to and could raise any concerns they may have with staff who they found approachable.

We found that some quality monitoring systems were in place but this was a work in progress and systems were not fully embedded to ensure that the service was monitored for quality and improvement.

We last inspected this service on 29 November 2013. At that time we found that the provider had not ensured that all the required maintenance had been carried out to ensure that equipment was in good working order and people were protected from unnecessary risks. At this inspection we found that this issue had been addressed.

The registered managers (as detailed on the front of the report) and the nominated individual no longer worked for the company. The process to cancel the registration of the managers has been started by the provider. The deputy manager worked a three day week. The deputy manager told us the home had nine care staff and two senior care staff. There were three vacancies. There were no other senior managers who offered support within the home.

The home was laid out over three floors. Some people were unable to communicate with us verbally. We found that most people had some dementia or frailty and chose not to speak with us. During our inspection we spent time in the communal areas of the home observing people to see how they spent their time, and how staff interacted with them.

On the day of our inspection we talked with the deputy manager and looked in detail at the care records for three people. We observed how people were being cared for in the home and sat with 13 people in the lounge area. We talked with five people who lived there. We visited on a weekday and we spoke with one relative. We talked with two staff members and a visiting nurse and a visiting pharmacist undertaking an audit of medication. There were 29 people who lived at the home when we visited.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The deputy manager had an understanding of these safeguards. There was no evidence of any capacity assessments or best interest meetings being conducted with people in the home, to support people with day to day decision making.

Risk assessments and health and safety measures were in place but had not been regularly reviewed. People were not protected from the risks of exposure to chemicals and fire. This meant that people were not kept safe.

People were sometimes cared for by an insufficient number of staff. The staff turnover was high and there was very little management time available. The service had some people who were living with dementia and were at risk of becoming disorientated by having an inconsistent staff team to support them. Risks to people's health, safety and welfare had not always been assessed and remedial action had not been taken.

Is the service effective?

We checked people's care plans and found them to be detailed and relevant to the person. Care plans were linked to people’s individual needs, for example, in relation to nutrition and mobility. There were risk assessments in place in relation to each of the areas on the care plan.

The care plans and risk assessments for people had not been reviewed and were not up to date. We found there was a lack of information to support staff in managing some people's behaviour. This meant that some people were at risk of receiving inadequate or inappropriate care.

Is the service caring?

A relative told us staff were caring and respectful. They said, “I think it’s excellent. The food is good and everywhere is kept nice and clean.” One person told us, “It’s alright here the staff are fine.” We saw that staff were kind and concerned for peoples well-being. We spoke with kitchen staff who were very aware of peoples choices and requirements relating to food. Everyone we spoke with said the food was good.

Is the service responsive?

A person told us; “If a carer is rude or something the manager deals with it quick. I’ve no complaints about the staff. They are all polite.” The visiting health professional told us that when advice and guidance had been given to staff it was complied with.

We saw that the deputy manager had tried to obtain support from other professionals in relation to some people’s behavioural needs. However on the day of our inspection we found that people’s behaviours were not being supported appropriately. We saw that a report relating to changes that were needed within the home to protect people from the risks of fire had not been responded to and the suggested changes had not been implemented.

Is the service well-led?

The service did not have an effective quality assurance system in place to ensure that people received safe and appropriate care at all times. One person said, “We need a decent manager who cares about the place. We’ve had too many managers.” People we spoke with and staff felt that the home had been through many staff changes and a period of stability was needed. The limited number of management hours available within the home meant that some key areas of people’s well-being were being overlooked. A visiting health professional told us that staff felt that the home did not have enough staff on duty and that some staff were frightened by some people's behaviour.

At our inspection of 9 April 2013 we saw that the systems in place to monitor the quality of the service were not robust enough to identify the shortfalls we had found.

During this inspection we looked at the systems that had been put in place by the provider and spoke with four people living in the home and a visitor.

All the people we spoke with told us that they enjoyed their meal and we saw that people had a choice of meals. The choices were displayed on a board in the dining room. This showed that people were able to choose what to eat.

One person told us, "It's lovely here, never had any problems. We have activities such as bingo and play your cards right." Another person told us, "I'm not going anywhere, I want to stay here." The visitor we spoke with told us, "It's very good and the staff are good." This showed that people were happy with the service provided.

We saw that meetings had been held every two months to enable people to have an opportunity to comment on the service and make suggestions for improvements, for example about the food and activities.

We saw that the provider's representative carried out monthly visits to the home to ensure that improvements were made and took actions where improvements were not happening as required.

We saw that there was a system in place to ensure that maintenance issues were raised and addressed in a timely manner.

There were twenty nine people living at the home when we visited. Some people needed help with all their care needs whilst others needed minimal support from staff. We spoke with five people living in the home, two relatives and four staff members during our inspection. One person living in the home said, “The carers are good.” The two relatives we spoke with told us they were happy with the care provided by the staff.

We saw that people's needs were planned to ensure that care received was safe and appropriate and met the individual needs of people. We saw that people were able to make choices about the food they ate and how they occupied themselves. This meant they could maintain control over some aspects of their lives.

People’s health needs were met by a variety of health professionals who attended the home or by people being taken to the professionals to be seen. People received their medicines as prescribed by medical professionals.

People were protected from harm because staff had the skills and knowledge to protect them.

We saw that people’s health and welfare needs were met by competent staff. People spoken with told us that they received care and support in the way they preferred and in a respectful and timely manner.

There were systems in place to monitor the quality of the service and ensure people’s views about the service were sought. However these needed to be strengthened to ensure that action was taken in a timely way.

There were 30 people living in the home at the time of our visit. We did not tell them we were visiting. We spoke to two people receiving a service, the provider’s representative and the acting manager.

We saw that people looked happy, were appropriately dressed for the weather and in individualised styles. The two people we spoke with told us they were happy with the care they received.

We looked at the management of medicines and found that people were receiving their medicines as prescribed.

We saw that sufficient staff were on duty to meet people’s needs. We saw that staff responded appropriately to people’s needs. People told us that staff responded quickly to the emergency call bells.

We saw that there were systems in place to monitor the quality of the service.

We found that care records did not always record what actions had been taken in relation to some healthcare needs. We found that records were stored securely but were not able to be located. People told us they knew staff recorded information about them and that they could look at their records if they wanted to.

We visited Arden Lodge as part of our scheduled programme of inspections on 2 May 2012. During this visit we also checked compliance on the shortfalls identified during our visit on 5 May 2011.

During our visit on 2 May 2012 we spoke to eight people receiving a service. People told us that they were happy at the home. They told us that they were happy with the food and that care workers were kind and respectful. Comments we received included:

“Nice here but rather be at home.”

“Very good here.”

“They’ve done it nice.”

Care workers showed respect to people by speaking to them politely. When people were taken to the toilet, they were asked so no one else could hear. We saw care workers reassure one person who was upset about not having a visitor. Later the same person was assisted to have their dinner after other people had eaten. This showed that people’s individual needs were met appropriately.

We spoke with two care workers and the deputy manager. They all felt that the home was well managed and they received the training they needed to carry out their roles

As part of our inspection we spoke to the relatives of four people receiving a service. They all said they were happy with the service being provided. They told us that they had been involved in identifying people’s needs and the setting up the care plans. Care plans are records that tell care workers about people’s likes and dislikes and how they needed to be assisted. One relative was no sure that the person receiving a service was having their dietary needs adequately met.

Relatives were happy that people’s health needs were being met and that they (the relatives) were kept informed about people’s health.

Relatives told us that they were told about the service and what they could expect when they visited the home. They did not receive any written information. This would help people to make informed choices when deciding which home to move into.

Relatives told us that the service responded quickly to any issues raised. One person commented: “The home is quite open and friendly. My relative looks happy.”

They were happy with the care that they receive. They had choices about the meals and their lifestyle. The staff were "pleasant" "caring and motivated." The home has a "relaxed", "laidback atmosphere." Although there had been building work for some time we were told "I have been here during the changes and have been happy." Records and surveys told us that people appreciated the improvements to the environment.

We spent two hours in the main lounge with people who live in the home. We spoke to four people whilst we looked around the building. We spoke to 2 relatives about the care given in the home.

We saw that people were treated kindly and that there were good interactions between careworkers and the people in the home. Sometimes careworkers did not take sufficient care that information about people wasn't overheard.

People said that they were happy with the care or indicated by a thumbs up sign that they were. We found that there were delays in updating records. Staff spoken to were able to tell us how to care for the person despite the delay in recording. People were seen to have their needs anticipated and met.

We were told that there were problems with infection control at the home. We found that there had been recent improvements in this area when we visited. The providers told us that they are also checking to ensure that risks of infection reduce.

People told us they were happy with their individual bedrooms. Some people like to spend most of their time there. We were told that the refurbishment was taking too long and there were risks to people living in the home. We found that the environment was much improved. A lot of areas needed final finishing's to be useable such as hoists in new bathrooms. A new extension is being built. There have been delays in building work. This has meant that people have been living to an unfinished building longer than they should. The garden area remains unavailable.

We were told that zimmer frames and a wheelchair were not in good working order. We found that this had been put right when we visited.

There were enough careworkers available. There was not enough skilled and competent management time to identify issues within the home. This has lead to records not been up to date, delays in training, lack of oversight of infection control and the impact of the building work on people living in the home.