Arboretum Nursing Home

On this page

• 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

Our rating for this key question has changed from requires improvement to good. However, checks and audits carried out concerning the home environment needed to be more robust to identify window restrictors that were not fully compliant with current standards and risks posed by unsecured furniture. Improvements were also needed to ensure staff recruitment processes were fully documented and staff training was up to date. People felt safe and staff understood their responsibilities to raise concerns they had about people’s safety. The staff and management team assessed people’s risks and knew how to support them safely. People received their medicines as prescribed, and improvements had been made to medicines administration to ensure people received their medicines in a timely way.

This service scored 69 (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 about actions that had been taken following incidents and events. Most of this feedback was positive however, one person felt there could be some improvement in the feedback shared when things went wrong or were reported as complaints. One person said, “There’s scope for training and lessons to be learned. I think [this incident] is bringing down very good care otherwise.”

Staff told us when incidents took place, they took steps to reduce the likelihood of it happening again. One staff member said, “I think people are safe here, in the event of an accident we will first check the person for injuries and if necessary, seek medical support. We then document the details of the accident. We will then review any risk assessments applicable and try to identify ways to prevent it from happening again.” Another staff member said, “Any accidents or incidents are recorded, and we review risk assessments for the person involved to ensure we haven’t missed anything or could do something safer.” Staff shared an example of a person who fell regularly trying to reach objects. Staff introduced a ‘falls mat’ but also made regular checks to ensure items that were important for the person were close to them. This had reduced the number of falls. Leaders told us any learning that had taken place from incidents and events was included in the handover between each shift. Details of any changes to people’s planned care as a result of learning were also added to the staff communications book, so all staff were aware. They shared an example with us of learning following an incident that involved all staff completing refresher training to ensure their skills and knowledge were up to date.

There were systems in place to share learning from incidents, events and concerns raised by people, staff and visiting professionals. These included verbal handovers and recordings in communication records. However, we found where concerns had been raised with the management team, although actions had been taken, these were not always consistently recorded to ensure they could be reviewed and analysed to identify any themes or trends. This potentially limited the action that could be taken to identify and drive improvements within the home.

People spoke positively about their transition into the home. One person described how staff had been caring and supportive during their move and had taken into account their individual needs, including dietary preferences. One person told us the staff at the home were ‘excellent’ and ‘went out of their way’ in how they personalised their care in response to their explanation of their own needs.

Staff told us the admissions process for the home varied according to people’s needs. They said that where information about people’s needs was lacking, they worked alongside the person and their family members to gather details about how to support people safely, giving consideration to their individual preferences. One example shared with us was how staff had requested specific support from hospital consultants to ensure if a person moving into the home required urgent care. This ensured there was a plan made in advance, reducing the amount of time the person would be required to wait for medical support. Leaders told us there were clear processes for assessing people’s needs when they moved into the home. These had been developed depending on people’s needs and took account of the amount time available prior to people moving in.

Feedback about transitions from partners who responded to our request for feedback was positive.

There were established processes in place to ensure people’s transitions into and out of the home went as smoothly as possible. People’s initial information was reviewed by the nursing team and any queries or questions were clarified prior to admission. Daily ‘flash meetings’ had been recently introduced, which enabled the management team to share information about the needs of people who were moving into the home that day.

People told us they felt safe. One person described feeling happy living at the home, they told us, “It’s how they [staff] talk to me, they’ve got the time, they’re lovely."

Staff understood their responsibilities concerning safeguarding and knew how to raise any concern about people’s well-being or safety. One staff member said, “I have done safeguarding training, and I would have no hesitation in reporting somebody to either management or the local authority if I had concerns. There is information around the home about how to report it.” Staff told us they considered people’s capacity to make decisions about their care. One staff member told us “We will identify if someone has capacity when they first move to the home, where we feel they don’t, we will always ask what their choice is and hold a best interest meeting. We will try to get the views of people that know the person such as families, friends and GP’s to help make a decision in their best interests.” The management team were aware of their responsibilities to keep people safe and protected from avoidable harm. They told us they acted on any information reported to them and referred to the local authority as required.

We observed care was delivered safely. We did not observe any safeguarding concerns during our visit.

Systems were in place to ensure any information of concern was shared with the management team and referred to external agencies where required. There was a safeguarding policy in place and information about how to report concerns was available for staff to refer to. Information gathered when people moved into the home included assessments of people’s capacity to make decisions about their care, and processes were in place to monitor the application and review of any Deprivation of Liberty Safeguards to ensure these were up to date and lawful.

Relatives shared how they felt confident in how people’s risks in relation to isolation, nutrition and hydration were monitored. They told us they had access to their family member’s records and so could see when care and support were provided. One person shared with us how staff managed risks to their health, "…Particularly their manual handling, given my condition. They know how exactly to do a bed transfer for me. Every time, if they have any doubts…they’ll get other staff in or ask.”

Staff we spoke with were aware of risks to people’s individual safety. They shared examples of how they managed people’s risks in relation to nutrition, fluid intake, mobility and skin integrity. Staff told us information about people’s risks was shared with them when the person moved into the home. Leaders told us the reviewed people’s risks as part of their initial needs assessment. They told us information to enable to staff to support people safely was included in people’s care plans and also shared in handover meetings. Staff told us they reviewed risks when accidents and incidents occurred. One staff member said, “We will complete accident report and share information with families. We then review any relevant risk assessments to see if risks can be reduced further.”

We observed staff supporting people safely during our visit. Staff knew people well and understood their needs.

There were systems in place to manage risks and support staff to provide proactive, safe, care and support. Care plans and risk assessments were in place, although they required review to ensure they were easy to read, and person centred. The management team were aware of this and a review process was already underway at the time of our visit. Handover meetings between staff as well as a daily ‘flash meeting’ promoted the sharing of essential information and provided opportunities for information about risks and changes in people’s needs to be share across the staff team.

People and relatives raised no concerns about the environment. One relative commented that cleanliness levels were high, and beds were checked weekly to ensure their safety.

Members of the management team advised that other than checks on mattresses there were no other audits carried out to monitor the safety of furniture or fixtures, such as window restrictors. Staff spoke openly about the improvements that were needed to the home environment. One staff member said, “I think the environment could be improved and work is being carried out. I think the environment is safe though and we have the right equipment to support people safely. If we need any equipment we can ask and we normally get it straight away. I regularly see equipment being serviced.” The nominated individual told us they planned to update the carpets in the reception areas of the home. They told us they had made arrangements to ensure there was no impact on emergency evacuation plans.

We found some issues with the environment which could pose a risk to people’s safety. Window restrictors in both communal and bedroom areas were in place but were not fully compliant with Health and Safety Executive standards. We also found in some bedrooms freestanding wardrobes were not secured to the wall, meaning there was a risk they could fall on top of people. We also found chemicals stored in a room that did not have a lockable door, which may place people at risk. The provider took action without delay to address these concerns. Following the assessment visit we received assurance from the provider of the actions taken.

While checks and audits were carried out in relation to fire safety, emergency lighting and the safety of mattresses; other checks on the safety of furniture and window restrictors were not formally carried out or recorded. Handover meetings and communications logs were in place and used by staff to share concerns identified about the environment. These were then shared with the maintenance team for action.

People and relatives spoke positively about the staff. One person said, “Staff will always ask a senior if they’re not sure of something. The best thing about this is that staff have a vocation, they’re monitoring me all the time, makes it more bearable.” People told us there were enough staff to meet their care needs and also spend time with them.

The management team told us they used a dependency tool to calculate staffing levels, but this had not been updated recently. However, they said they observed staffing levels throughout the home and carried out informal checks on the time taken by staff to respond to call bells. The provider acknowledged that some staff needed to update their training, and they were taking action to address this. Staff told us they thought there were enough staff to support people safely and meet people’s needs. One staff member said, “I think there are enough staff, there is always someone to help or assist people if they need it. I like that I can stop and have a chat with people.”

We observed staffing levels throughout the day and saw there were enough staff to respond to people’s needs as well as support them with planned care tasks, such as personal care.

Systems used for the safe recruitment of staff were not always effective. Some staff files did not contain a full employment history, or details of qualifications held by the staff member. However, the provider had carried out pre-employment checks, including Disclosure and Barring Service (DBS) checks, to ensure staff were safe to work with people. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staffing training records showed a number of staff had not completed some required aspects of their training. Most staff had previously completed the learning, but required refresher training to ensure their knowledge was up to date with current practice. There were enough staff to safely support people. The management team used a dependency tool to calculate staffing numbers, however this had not been recently updated.

People told us they were pleased with the standards of cleanliness throughout the home. One person said, “The home is very clean, and the en-suite bathroom is cleaned every day."

Staff were knowledgeable about infection control and were able to explain to us their areas of responsibility. One staff member told us, “We ensure that the environment and equipment are suitable in relation to infection control. We always have adequate supplies of personal protective equipment. If I see staff not following guidelines, I can address it straight away. We support complex needs here and it is essential that infection control is managed well.” The management team told us they were making improvements to the environment and following a recent visit from the local authority Infection Control Team, had now completed most of the required actions.

We saw aspects of the home environment required updating to enable effective cleaning to take place. For example, the flooring at the entrance of the home was scheduled to be replaced shortly after our visit.

There were systems in place to monitor infection control. Cleaning schedules were used to monitor daily and weekly cleaning tasks and staff received training to ensure they were aware of their individual responsibilities. Audits we reviewed showed progress had been made in improving standards.

People told us they received their medicines as prescribed. One person told us, “I asked for pain relief…they gave me what the GP had prescribed for me. Doesn’t come more important than that.”

Staff shared with us the recent improvements that had been made in relation to medicines. They told us they had been working alongside partner agencies to reduce the amount of time it took to administer people’s medicines. They told us this had improved people’s experience as there were fewer delays in people receiving their medicines. The management team told us they had taken advice from the local Integrated Care Board (ICB) and changed the way staff conducted medicines rounds. They confirmed this had been a positive change which improved medicines administration for both people and staff.

Systems used for the safe management of medicines were effective. Medicine administration records we reviewed reflected people had received their medicines as prescribed. Where people’s medicines were required to be given at a specific time, records showed they were consistently administered within the timeframe. Medicines storage areas were well organised and secure, including the safe storage and management of controlled drugs. There was guidance in place for staff to follow to ensure people’s ‘as required’ medicines were consistently available. Protocols were also in place where people’s medicines were given covertly, to ensure this was in line with both the GP’s instructions and pharmaceutical advice.