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.