Arbory Residential Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment we found a number of improvements had been made. However, some time was still needed to ensure all shortfalls were addressed and newly introduced ways of working became embedded in practice. Therefore, the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service now met legal requirements relating to safeguarding, safe care and treatment, staffing and premises and equipment. They continued to be in breach of legal regulations in relation to the pre-employment checks required when recruiting staff.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Improvements had been made following our previous inspection. The service had a proactive and positive culture of safety. Relatives and social care professionals were kept informed of accidents and incidents and communication was good. Staff knew how to raise concerns and incidents and felt very confident leaders would take action to keep people safe. Incidents were reviewed by management and lessons were learnt to continually identify and embed good practice. The manager was working on refining the incident monitoring system to, for example, ensure all falls were included to enable a comprehensive analysis.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between the service and the hospital. Daily meetings took place to discuss any new admissions and to review the care of people returning from hospital to ensure their changing needs would be met. One person was returning from hospital with an infection. Staff had prepared all personal protective equipment and liaised with the GP and local infection control team to ensure they could support the person safely and reduce the risk of the infection spreading.

Improvements had been made following our previous inspection in identifying, investigating and acting upon safeguarding concerns. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns with the local safeguarding team, investigated appropriately and put plans in place to keep people safe. However, safeguarding incidents had not always been notified to CQC as required to enable appropriate oversight of the quality of care at the service. We identified 5 incidents which had not been notified to CQC as required by the regulations.

Improvements had been made following our previous inspection. Relatives told us their loved ones were safe living in the service. The service worked with people and their relatives to understand and manage risks by thinking holistically. Risk assessments had been completed in good detail. Staff understood people’s risks and could explain the action they needed to take to keep people safe such as providing modified food for those people at risk of choking. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Pressure relief was managed in line with care plans and people were consistently provided with drinks to prevent dehydration. A daily meeting chaired by the manager and attended by her senior team ensured any new or emerging risks relating to people’s care were discussed and actions agreed to keep people safe.

Improvements had been made following our previous inspection. Decoration and refurbishment had taken place in some areas and there was a schedule in place to complete the outstanding work. Doors were locked where required to keep people safe. A range of environmental checks were completed, however further improvement was needed to some of the environmental check records, including records related to temperature checks and fire safety to better support the provider to detect and control potential risks in the care environment.

Issues identified at the last inspection related to pre-employment checks had not been resolved. Some pre-employment checks were being completed but these were still not sufficiently comprehensive to meet the requirements of the regulation. Full employment histories were still not sought for staff. This also meant gaps in employment could not be identified and reasons given, and evidence of conduct in all previous relevant roles could not be obtained. We found improvement had been made in relation to staff training and deployment. The service made sure there were enough qualified, skilled and experienced staff to meet people’s needs promptly. Activities were provided and plans were in place to develop this further with activity staff. Staff had completed the provider’s mandatory training. Plans were in place to complete dementia training in 2025 to further develop staff’s skills and knowledge in providing care to people living with dementia. Staff had received some supervision and told us they received sufficient support to undertake their roles. Senior staff were being trained to complete supervision going forward; some time was needed for this to embed.

Some checks were in place to prevent and detect the growth of legionella bacteria. However, these did not include all the checks required by the provider’s policy or in line with national guidance for care homes which put people at increased risk of infection from legionella bacteria. Since the onsite visit, the provider sent us a new form which will be used to check and record the temperature of the hot water flowing within the water system. A comprehensive health and safety audit was also planned for January 2025 to review legionella risk management. We observed cleanliness throughout the service had improved. Staff used personal protective equipment appropriately to reduce the risk of infection spreading. Food safety had improved including the recording of opening and expiry dates for food products. New monitoring arrangements were put in place to ensure kitchen checks were completed as required, some time was needed for this to embed.

The service used a new community pharmacy and medicines management had improved. People received their routine medicines as prescribed from appropriately trained staff. Some PRN protocols did not contain comprehensive information to support staff to administer when required medicines safely. This related to medicines which posed a significant risk of harm if administered incorrectly. The provider started to address this during our assessment.