Arbory Residential Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed a total of 3 quality statements from this key question. We identified 1 continued breaches of the legal requirements. During our assessment of this key question, we found systems in place did not always ensure people’s capacity and ability to consent had been adequately assessed and planned for. People’s needs were not always assessed and reviewed to ensure they were up to date and contained current information. The provider informed us of the action they were taking to make improvements. You can find more details of our concerns in the evidence category findings below.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from relatives was mixed. Some relatives felt the staff had the right skills and knowledge to support their loved ones to achieve the best outcomes for them. Other relatives told us staff could be insensitive at times. Relatives told us they felt staff did not all have the skills and knowledge to manage both diabetes or dementia, supporting people to drink enough and when delivering personal care. Some relatives told us they were involved in people’s care assessments when they first moved into the home but had not been involved after that. Others told us they had been involved and this had been an ongoing process.

We were not assured everything was being done to involve people when assessing needs. The management team said they would look at ways to improve this. The deputy manager told us people were not involved in their assessments. They told us they did not share care plans and assessments with people living at the service. They said, “We contact family members, they are more involved, we ask if they want to go through care plans, we ask if they are happy and want anything added or changed.” Staff confirmed they had access to people’s care plans on handheld devices. There was mixed feedback about whether people’s care plans supported staff to understand the person and what was important to them. For example, 2 staff felt care plans could be improved to reflect people’s needs and personalities. One staff member said, “The care plans should include a lifestyle story from when they were little to when they reach the care home,” A senior care worker told us they were working to make care plans more person centred. They said while updating care plans, they asked relatives questions, they told us they had updated one person’s care plan to reflect their job and what they liked to do. Overall staff felt there were systems in place to provide updates about changes to people’s needs. For example, 1 staff member told us any major changes were given at hand over in the morning. One staff member commented that the writing on the electronic version of the care plans was very small and that it was not always possible to have time to read these in full. A senior care worker told us care plans were improving but remained a work in progress. They told us training on writing care plans would be helpful, but believed this was due to take place in May 2024. We were concerned staff were tasked with updating care plans without training.

Some care plans contained conflicting information or lacked clarity about assessed needs. For example, whether people have dentures or teeth and people’s capacity to understand their care and support needs. One person’s activity plan stated they will not engage in activities, but then goes on to say they enjoyed colouring and listening to music. Their support plans contained conflicting information about whether people would try and mobilise independently. Where people were unable to verbally communicate their choices or decisions, care plans lacked suitably detailed and personalised information about how else the person might indicate they are in pain for example. Death and dying plans were in place for some people but varied in the level of detail and personalisation with regards to the person’s decisions and what mattered to them at the end of their life. One person who was on the end-of-life pathway did not have an end-of-life plan in place. Following the inspection the provider told us staff had completed care plan and risk assessment training to improve people’s care documents.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Relatives’ views were mixed when we asked do staff understand your relative’s health care needs. Some relatives were concerned about the management of people’s diabetes. Some relatives felt people received the care in the way they wanted it.

We were not assured staff and managers understood how to fully support people with diabetes to eat healthy. Staff could describe signs to look out for if people had low or high blood sugar and when to o seek appropriate medical attention. Staff recognised when people were unwell and contacted the GP when needed.

People had oral health risk assessments and support plans, however there was no evidence they had been supported to see a dentist regularly. We spoke to the management team about this. They told us they are in the process of trying to ensure everyone is seen by a dentist. The provider used tools such as National Early Warning Score (NEWS ) which is a tool which improves the detection and response to health deterioration in people. We saw this had been used effectively for 1 person which resulted in a referral to a dietician. A GP told us, there had been improvements in how staff now prepared for ward rounds. They told us they were emailed a list of patients to be reviewed prior to their weekly visit and weekly phone call and staff were aware of their issues and had taken basic observations.  They said, “I think there has been an improvement in staff's ability to recognise changes in residents' health or wellbeing, and to seek help appropriately…There is a general understanding of the need to check observations and use these to assess and monitor deterioration.”

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Most relatives told us they had not been involved in mental capacity assessments or best interest meetings other than when people first moved into the service. One relative told us they were informed they could give consent for their relative to be assessed for DoLS. Relatives told us they did not know if staff sought people’s consent before supporting them. This was because they were not always around when personal care was being provided.

A member of the management team told us they needed to do some work around improving consent processes. They told us they sought consent from people’s relatives when they were not able to consent for themselves. They did not understand that consent could not be given by relatives if there was no Lasting Power of Attorney or deputyship in place and a mental capacity assessment indicated a person lacked capacity to consent to a specific decision. We asked when they might need to undertake a mental capacity assessment. They told us for night checks and CCTV however, there were no mental capacity assessments or best interest decisions in place for night checks and CCTV and these were the 2 areas we had previously discussed with the management team as areas lacking mental capacity assessments. Therefore, we are not assured they understood their responsibilities around the Mental Capacity Act (MCA). Staff were able to demonstrate they understood the importance of seeking consent and described how they sought people’s consent to care. Staff were less confident describing how the MCA was relevant to their role. This meant people were not always enabled to take part in the decision-making process and their rights were restricted.

At the last 2 inspections the provider failed to ensure consent was sought in line with the Mental Capacity Act (MCA). At this assessment we found the same concerns, meaning there was a continued risk people’s legal rights would not be upheld in line with the principles of the MCA. There was no evidence people had consented to closed-circuit television and audio systems (CCTV). Some people had hourly safety checks throughout the day and night. There was no evidence of how these decisions had been reached and why it was in peoples’ best interests. A member of the management team signed consent forms for some people. They told us they sought consent from relatives because the people lacked capacity and had signed on behalf of relatives. They lacked understanding relatives could not consent on behalf of people without appropriate legal authority. One person had a wheelchair safety lap strap. There was no mental capacity assessment or best interest consultation recorded nor was this included in their DoLS (Deprivation of Liberty Safeguards) authorisation. One person had signed their consent form but there was a mental capacity assessment saying they lacked capacity to consent to care and treatment. The person disagreed to the use of CCTV in communal areas. There was no evidence of further discussion with this person. Where mental capacity assessments and best interest decisions were in place, they either lacked detailed about how it had been decided the person lacked capacity, did not adequately document views of those consulted or had not ensured that all appropriate persons had been consulted. An action plan the provider produced following the last inspection said, “Further training for managers on MCA/BI will be completed and all consent forms will be reviewed for their appropriateness.” This was not completed effectively. This meant people's legal rights had not always been upheld and the provider had not been working in line with the principles of the MCA.