About the service:

Arlington House is a residential care home providing personal care to a maximum of 33 people in an adapted building combining four terraced houses over three floors. At the time of the inspection 25 people were living at the home. The people living there are older people with a range of health and mental health needs including people living with dementia.

People’s experience of using this service:

• People were not always protected from abuse. The action staff may need to take to identify and raise safeguarding concerns had not always been taken and was not consistently understood.

• People and their relatives told us they felt safe. A relative told us, “My relative is safe because it’s secure. I feel confident with the people looking after them. I also feel if they have concerns they get the doctor in.”

• People’s access to timely care and support, and access to meaningful activities that reflected their diverse needs was not always supported by a sufficiently deployed staffing. The provider had implemented changes that required further time, guidance and training for staff before they could be introduced and the impact on people’s day to day experiences minimised.

• There were proactive quality assurance processes in place to drive improvements to the service. A relative told us, “The home is definitely getting better, you can see the improvements. They’re doing a grand job.” These improvements needed further embedding to robustly address inherited environmental and restrictive practice in relation to the use of CCTV as identified at the inspection.

• We have made a recommendation that the service seek suitable guidance on the use of CCTV.

• There was no registered manager at the time of the inspection. The provider had put measures in place to support the day to day management of the home.

• The provider needed to make further improvements to their oversight of the governance of the service to ensure the changes they were making continued to support safe practices in relation to recruitment, medicines administration and care planning for people with diverse needs.

• People were cared for in a clean and hygienic environment. The provider had worked hard at resolving inherited environmental health issues. A health professional told us, “The environment is improving, it was tired before, now it’s really improving.”

• Systems were in place for the recording of incidents and accidents. They were monitored and analysed over time to look for any emerging trends and themes.

• People’s needs, choices and preferences were known by staff and their care plans were personalised.

• People were comfortable with staff and were cared for in a safe, friendly and calm manner. Staff and managers were approachable and knew people well.

• People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

• People and relatives were encouraged to express their views. Staff were asked for their opinions on the service and felt supported within their roles.

• People were supported to maintain a healthy nutritious diet and had access healthcare services and professionals as and when needed.

• The provider and care manager were keen to develop team work, reflective practice and training in relation to dementia and end of life care.

• The physical environment was under a continual cycle of refurbishment with a clear focus to improve people’s day to day experiences at the heart of the home’s value base.

Rating at last inspection:

This was the first inspe