Arbory Residential Home

Updated 14 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by an operations manager, 2 inspectors, a medicines inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Arbory Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. Arbory Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The provider has recruited a new manager, but their start date is yet to be determined.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since we last inspected. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 4 people living in the home and 5 relatives. We also spoke with the regional manager, home manager, regional support manager, maintenance person, administrator, 4 care staff, an agency worker, the chef and 2 members of the housekeeping team. We reviewed 11 people's medicines records and the recruitment records for 4 staff members. We also looked at records relating to the safety and management of the service.

Following the inspection, we reviewed 10 peoples care plans using the provider’s digital platform and continued to seek clarification from the provider to validate evidence found. We received feedback from a further 9 staff and 10 relatives.

Updated 14 October 2023

About the service

Arbory Residential Home is a care home providing accommodation and personal care to up to a maximum of 60 people. The home does not provide nursing care. At the time of our inspection there were 39 people using the service, most of whom were living with dementia.

The accommodation at Arbory Residential Home is arranged over 2 buildings. The Lodge has accommodation over 2 floors and is an older building that has been repurposed into a care home. The Court is a newer, purpose built building where the accommodation is arranged over 3 floors. There are communal lounges, dining areas and a garden area.

People’s experience of using this service and what we found

We continued to find concerns about how some risks were assessed, monitored, and mitigated. There were still insufficient numbers of staff deployed to meet people’s needs at all times. Staff understood how to protect people from avoidable harm or abuse. Some reviews and investigations into incidents could have been more thorough to help ensure every opportunity for learning was taken.

Legal frameworks regarding consent, were still not being implemented fully. The premises and equipment within it were still not well maintained. Staff did not consistently receive an induction or probationary reviews. Work was underway to embed a more comprehensive programme of supervision. Whilst the provider offered staff a range of training which most staff were up to date with, a number of staff told us they would value more face to face training. Some care plans lacked completeness or contained conflicting information whilst others were more reflective of people’s needs. Improvements were needed to develop better partnership working with healthcare professionals to meet people’s healthcare needs.

We have made a recommendation that staff inductions, and the supervision program are developed in line with best practice guidance.

People were not consistently receiving person centred support and did not have access to meaningful activities on a regular basis. Governance systems were in place, and there was evidence local leaders were working hard to deliver improvements, however, many of the required improvements had been hindered by continued shortfalls in staff across all departments. Improvements to the environment were underway, but more needed to be done to deliver these within a suitable time scale to ensure people’s care and support was provided in a safe, clean, and well maintained environment.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 February 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of people’s care, the cleanliness of the home and staffing levels. A decision was made for us to inspect and examine those risks. As a result, we undertook this focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains requires improvement.

We have found evidence the provider needs to make improvements. Please see the safe, effective, and well led key question sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arbory Residential Home on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified continuing breaches in relation to the suitability of the premises, consent, safe care, and treatment, staffing and governance. We identified 1 new breach in relation to person centred care.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.