Arbory Residential Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed a total of 3 quality statements from this key question. During our assessment of this key question, we found staff promoted independence and treated people as individuals. We observed staff treating people with dignity and respect. Although staff knew people their care plans did not show how their care had been planned to ensure staff could meet their individual needs and preferences.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us, “I like it here. It’s nice to see other people,” and “The staff are quite amenable. They usually ask if everything is okay and if there is anything you want.” A third person told us, “I like it here. I like it all. No complaints. The staff are nice. I’m happy just sitting here and looking at the pictures [in a magazine]. The best thing is the food.” Relatives told us they thought staff knew people well and treated them with dignity and respect.

The deputy manager told us if people needed additional support or more time to do something it would depend on the day and if staff had time but told us they and their seniors would jump in and support the care team where needed. A member of the management team said they would be happy for their relatives to receive care from the home. They told us, “I know the carers care here, they genuinely care about the residents. I see the way the staff interact with residents.” They told us, “As [a member of the management team] it is important to maintain confidentiality. I am more involved in things now.” They told us they observed staff’s interaction with people to ensure staff always sought consent and to make sure people were treated with kindness. Nine staff we spoke with could explain how they promoted people’s dignity and privacy. All staff felt this was managed well in the service. Comments included, “Yes, the carers are brilliant at their jobs, they always promote dignity and respect. I will hear them laughing and joking with the residents, I do not feel the care they provide can be faulted”, “We always protect dignity. When giving personal care we will close the door and the curtains to their room and will only start their care at that point,” and, “Yes one hundred percent dignity and welfare is promoted.”   We were assured the staff were kind and compassionate and treated people with dignity.

We received positive feedback about staff’s interaction with people from 1 person’s advocate, the GP, and 2 community nurses that worked closely with the service. They told us they had no concerns in relation to the staff who were friendly, organised, professional and interested in the residents and their health needs. One professional commented, “I was heartened by my observations of the quality of care being provided to the residents, residents all looked well cared for, there were interactions with residents and the home felt completely different.” We had feedback from the local authority quality team who told us staff have always been present and engaged with people. They told us, “I have observed positive interactions between staff and residents during mealtimes and with engaging to support a person who appeared distressed.”

Throughout our site visit we observed friendly and respectful interactions from staff. Staff addressed people by name as they cleared the tables after lunch. We saw staff showed interest in what people were doing and offered support to enable people to complete their chosen activities. One person was sitting in an easy chair with a table in front of them which had a range of books about trains and countries. A staff member sat next to them and asked how they were. They showed interest in what the person was doing and spent some time looking through the books with them. Another staff member asked a person if they would like to do their colouring. The person replied yes, and the staff member found a box of coloured pencils from a cupboard and a colouring book from the person’s bedroom so they could complete this activity. Staff were considerate and promptly responded when people asked for support. One staff member was offering a person some food from a small container. They told us the person’s spouse often bought treats in for them and if they did not eat them whilst their relative was visiting, the staff would try and give them to them at another time as they knew they liked the treats. After eating a few treats, the staff member held the person’s hand and supported them to stand and walked the corridor with them when the person indicated this was what they wanted to do. Another person gestured for help in unwrapping a chocolate mini roll. A staff member swiftly responded with a smile using the resident’s name “Would you like help with that. I’ll fetch you a plate too.”

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

Relatives told us people could not always do what they wanted due to the lack of an activity’s coordinator. They were concerned people did not get enough opportunity to do the things they enjoyed. Most relatives told us there was a lack of engagement and a lack of activities for people. They said people did not go out, there was a lack of stimulation and activities people used to love just did not take place anymore. A person told us they enjoyed using the garden and most relatives told us people’s choices, where they were able to make them, were respected.

Staff told us people were supported to see friends and family. However, of the 8 staff members we spoke with 5 told us they thought there were not enough activities on offer to support people’s independence, interests and wellbeing. One staff member felt food choices were concerning stating the quality of the snacks was not the best, were not always available and there was limited choice for people living with diabetes. The manager told us staff regularly involved people in making choices throughout the day. They said, “Staff regularly sit with residents to prompt engaging conversation to support exercising choice.” The activity coordinator role had been vacant since the beginning of April 2024. The provider was working towards recruiting another activity coordinator and staff had started conducting activity surveys to find out the residents' likes and dislikes. Staff worked with Occupational Therapists ’s and mental health teams to support setting individual goals. We observed people using appropriate equipment to maximise their independence such as walking frames. A member of the management team told us they used verbal communication when speaking to people but also observed facial expressions. They also used pictures for reference when speaking about people’s family members. People were supported to maintain relationships by offering quiet areas to use and encouraging people to use the Lodge during visits.

A staff member showed us the outside area. We noted there was a potential ‘kitchen garden’ currently under repair which had rhubarb growing. There were also some raised flower beds. This enabled people to be more independent in the garden. However, a staff member told us people had not been able to be involved in gardening. In the lounge-diner, we observed a number of people were sitting at tables with items of personal interest e.g. picture books, word searches, colouring books. At teatime, we saw a staff member reading through a book which played bird songs with 1 person. At other times, we observed staff encouraging individual interest (e.g. colouring). We heard the radio playing quite loudly on floor 3 which made it difficult at times to hear people or for people to have a meaningful conversation with others. We did not see an activity board listing any regular weekly activities. While we observed staff doing their best to support people with individual activities, we did not see any planned organised activities taking place to ensure people who could not initiate activities had a meaningful day and had the opportunity for social interaction.

People’s care plans were outcome focused, however, planned outcomes were not always realistic or did not effectively highlight how the goal might be achieved. For example, 1 person lived with dementia, they were noted to lack capacity to consent to care and support needs and could only communicate basic choices however, the goal was for them to be able to communicate effectively. There was no information about how their communication might be promoted, for example, information being provided in alternative formats. Whilst there was some improvement in the care plans which now included information about people's preferences, the things or people that were important to them and their beliefs, there continued to be limited evidence in daily notes of these being followed in practice. Daily notes did not provide assurances people were supported to maintain their independence and complete tasks for themselves. Daily notes indicated people were having bed baths / personal care very early in the morning, often around 6.30 am. It was not clear this was their choice as their preferences were not recorded. Daily notes did not provide assurances that sufficient meaningful activities were taking place especially for people that required 1 to 1 activity.

Relatives told us staff were quick to respond to people’s needs. Comments included, “Oh I think they respond quite quickly,” and, “I think so, quite quickly and call a GP if needed.”

Staff told us how they responded to people’s immediate needs. They told us people had call bells and bed alarms to alert staff when they needed support. One staff member told us, “The staff on each floor make sure that they are spread out everywhere so that we can respond to the residents immediately.”  Staff used the shift handover meetings to share new information about people’s changing needs and alert seniors or managers of any concerns. A member of the management team told us how they ensured staff responded to people’s needs and acted to minimise any discomfort or distress. They said, “Staff are constantly managed and observed, and any concerns addressed via meeting or supervision or ad hoc. Staff are inducted to look for signs of pain/ discomfort. For example, non-verbal signs and facial expressions, not just verbal communication.” They told us they lead by example and senior staff demonstrated good practice, following risk assessments and ensuring the care staff were reading them. A member of the management team described how they had supported a person to regain their independence in the hope they could move back home. Staff were informed of people’s changing needs by ensuring the information was handed over to senior staff. Questionnaires were completed with staff about people and new arrivals to ensure staff were up to date about people’s needs. Crib sheets were used with important information for each resident and that this was updated if anything changed.

We observed staff responding promptly to people’s needs throughout the assessment. For example, we observed 1 person slumped over their partly finished meal. A staff member swiftly intervened and knelt down next to the person asking if they were okay; realising they were sleeping, she gently woke them using their name, assisted them to take a drink and then asked if they would like to go and lie down on their bed. We also saw when a person said they were cold; a staff member offered to close a window and went to get the person a cardigan. The person said they felt much better. We were assured staff responded to people’s immediate needs.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.