This was an unannounced inspection which took place on 22, 23 and 24 November 2016. We last inspected the service in January 2015 At that inspection we found the service was not meeting all the regulations that we reviewed.
At the last inspection on 5, 6 and 7 January 2015 we rated the service as ‘Requires Improvement’ At that inspection we identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to good governance. This inspection was to check improvements had been made and to review the ratings. We saw evidence to confirm that action required had been taken.
Arbour Court is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 60 older people living with dementia. The home is owned and managed by Barchester Healthcare Homes Limited. Accommodation is on two floors all bedrooms are single and have en-suite facilities available. Car parking is at the front of the building. At the time of this inspection 58 people were living at the home.
A registered manager was not 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.
The location has a condition of registration that it must have a registered manager, but it does not have one. However steps were being taken by the provider to recruit one within a reasonable timescale.
Following this inspection the registered provider notified us that a registered manager was in post from 17 January 2017.
People who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. They told us they were happy with the service provided and overall their needs were being met. They also told us the registered nurses and care staff treated people caringly, sensitively and with respect.
People were supported by sufficient numbers of suitably trained staff. We saw that recruitment procedures helped to make sure staff had the appropriate qualities to protect the safety of people who used the service and we saw they received the training and support required to meet people’s needs.
Care staff and nurses we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was always available to them. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.
Individual staff training records indicated that all care staff had received appropriate training to carry out their roles effectively. Some staff were working towards a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care and the Care Certificate. The Care Certificate is a professional qualification which aims to equip health and social care staff with the knowledge and skills they need to provide safe care and support to people using the service. This qualification helped them to carry out their roles effectively. Staff members confirmed they had received safeguarding and whistle blowing training and knew who to report to if they suspected or witnessed abuse or poor practice.
Care records were in place to reflect peoples identified care and support needs. Information about how people wanted to be supported, their likes and dislikes, when support was required and how this was to be delivered was also included in the care records we examined. Information regarding people’s dietary needs was included in their care records and clear guidance for staff members helped make sure these requirements were met.
We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review.
Medicines were stored safely and administered by registered nurses (RN) who were trained appropriately to ensure medicines were given safely. Any specific requirements in relation to medicines to be taken when required (PRN) such as paracetamol, were clearly documented so that staff members could administer the medicine appropriately and were aware of any risk following administration of such medicines.
Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).
Staff members received regular supervision to help make sure they were carrying out their duties safely.
Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives was addressed by the registered provider. People spoken with knew how to make a complaint and felt confident to approach any member of the staff team if they needed to.
The registered provider had systems in place to monitor the quality of the service such as service user and relative surveys, to ascertain their views and opinions about their satisfaction of the service provided. Any feedback received was noted and used to make improvements to the service and the care and support being provided.