Arbory Residential Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed a total of 4 quality statements from this key question. We identified 1 continued breach of the legal requirements. During our assessment of this key question, we found sufficient improvement had not been made following our previous inspection and the service continued not to meet the legal requirements. Care plans and risk assessments had not been regularly reviewed in line with the provider’s policy and did not always contain all of the required information. Action plans were in place to update support plans and risk assessments; however, this work had only just started. Monitoring systems and processes were not effective in identifying the concerns we found at this assessment in relation to infection prevention, and control and safe recruitment of staff in line with Schedule 3 of the Health and Social Care Act. Systems and processes failed to identify that people were not always receiving person centred care and their care plans were not always person centred. Concerns relating to the principles of the Mental Capacity Act not being followed had not been identified. Robust or effective improvement had therefore not taken place. You can find more details of our concerns in the evidence category findings below. Following the assessment the provider told us they had made changes to the management team to ensure the required improvements would be made. The local authority also provided feedback about improvements they had found in the management of the service.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were not always clear on the visions and values of the service They also told us they did not always feel comfortable approaching members of the management team and did not always feel listened to. When we asked staff, ‘Are you confident your colleagues and the organisation promote high quality compassionate care, and if this was people’s experience at all times?’ Staff gave us mixed feedback. We asked a member of the management team ‘What are the visions and values of the service? How do you know what they are and demonstrate them in your role? They told us, “I don’t know, I don’t think we’ve got one.” We were not assured enough work had taken place around shared direction and culture.

The management team told us they had just implemented a resident’s survey which included a question about how people were cared for. They told us this survey had just been sent to head office for analysis. Systems and processes had not been effective in identifying the lack of knowledge around shared direction and culture. Therefore, no work had taken place to drive improvement in this area. We did not see a vision or values statement or policy and were not assured the provider’s visions and values were embedded within their staff team.

We received mixed feedback from staff as to whether the management team had the necessary skills and experience to lead the home. Concerns raised by staff related to lack of communication skills, lack of continuity of managers, poor confidentiality, lack of visibility and poor organisation. Feedback about whether staff felt valued in their role was also mixed. Other staff members, however, were positive when asked if they found the management team knowledgeable. One staff member said they felt able to ask questions when necessary. Other comments included, “The management team are knowledgeable and well trained,” and, “When you do speak with them, they do deal with the issue.” Some staff did not always feel leaders respected or valued them. Other staff members did however answer they felt supported, and the management team were approachable. In response, a member of the management team told us, “We always want the best outcome for our staff members. We aim to keep people safe and protected. We meet these aims and objectives doing supervisions” However, records showed a shortfall in the frequency and quality of staff supervisions. The nominated individual told us the home had an unsettled period with managers leaving. They were aware work was required and told us they were confident this would improve with the appointment of the new manager starting in May 2024.

At the time of the assessment a registered manager was not in place. There was a senior manager in the interim who was acting as the manager. This had not always been effective. The Nominated Individual told us a new manager was starting in May 2024 and told us they were working to improve the service. We received positive feedback from a range of professionals. They told us staff were invested in delivering good care and support, improvements had been noted in recent months and they had a good working relationship with the provider. Professionals felt improvements would continue to be made with the recruitment of a new manager. One professional wanted to keep an open mind to assess how the provider would sustain improvements when the home was at full capacity.

Staff gave mixed feedback about whether their voice was heard, they gave examples of their feedback not acted upon to drive improvements. A member of the management team told us an example of when something had changed as a result of feedback from staff. Staff members told us their suggestions were not always listened to. Other staff members felt the management team were approachable and tried to listen to concerns, were easy to talk to and dealt with issues. They said a recent meeting was a good experience, staff could discuss concerns and talk about improvements. This was confirmed by a second staff member who said a recent staff meeting had been, “Good and productive.” Other staff confirmed that staff meetings took place and were promised that this would be more regular however, told us this had not been the case. The deputy manager told us they ensured a culture of openness and transparency saying, “We have speak-up posters around the home, we also bring this up in staff meetings, we always try and promote this to staff and let staff know they can always be open and transparent.” However, as evidenced above staff did not feel this was achieved. The deputy manager told us in order to be more visible and accessible they had moved the location of their office. They said, “I always have my door open unless in meetings or having confidential conversations, so staff are always welcome to come in and see me.” They told us they were able to make suggestions to the senior management team and felt they were listened to.

We observed ‘Freedom to Speak Up’ posters on several notice boards. A member of the management team told us there was a ‘you say, we do’ document which showed how the provider listened to staff feedback. We reviewed this information which detailed staff raised concerns about the lack of supervision, appraisals, performance feedback and compliance with CQC. The provider documented they would ensure supervision, appraisals and feedback were given regularly and would diarise this. At the time of this assessment the concerns raised were still evident. The provider’s whistleblowing and Duty of Candour policy were robust and in date. We reviewed a duty of candour letter sent out by the provider appropriately.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

A member of the management team told us they completed observations of staff, spot checks, daily walk around and supervision to ensure staff followed the provider’s policies. Staff however, described shortfalls in the formal systems in place to provide them with support and to ensure managers were able to monitor their practice, behaviours and performance. Staff described a lack of supervision. Members of the management team were not always clear on their role and responsibilities. Concerns noted at the last inspection had not always improved which meant people remained at risk of harm in some areas. The service did not involve people in improving the service. A member of the management team told us they would look into ways to do this. The management team told us they kept written information stored securely so only approved people could access them. Following the assessment the management team had changed and the new manager informed us of the action they were taking to improve the service.

Some quality assurance and governance arrangements were still not always effective at identifying shortfalls, breaches of the fundamental standards or driving improvements. We identified concerns with the oversight of infection control. The last 2 IPC audits, both noted actions were required, there was no evidence this had been done. Records relating to people’s care lacked detail, risks were not always adequately assessed and planned for. These concerns had not been picked up by a robust audit or review. A dining experience audit were carried out on 4 separate dates however, all 4 audits were exactly the same, just with a different date. We were not assured these were meaningful or effective at driving improvements for people. Whilst surveys were undertaken to seek feedback from people, there was no evidence action plans had been developed to address areas where family members had noted improvements could be made. The provider carried out a staff survey in February 2024. This had an action plan to show what the provider was going to do in response. Staff had raised in this a lack of supervisions; however, we could not see any improvement in this during our assessment. Improvements had not been sustained to ensure safe medicines management, including the storage and administration of people’s medicines. The medicines audits being undertaken were not sufficiently robust, not always fully completed and had not been effective at identifying all of the areas where medicines safety was compromised. Whilst some improvements were being made to the premises, we continued to find areas where the premises and equipment were not being appropriately or safely maintained. We also found continued concerns with the safety of recruitment and how the principles of the MCA and its code of practice were being implemented. Following the assessment the new manager provided documentation of action being taken to strengthen quality and risk management in the service.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.