We carried out a planned unannounced inspection in January 2011 at Arthur Roberts when we made compliance actions for the home to complete in order to achieve compliance with the Health and Social Care Act 2008. We carried out this responsive unannounced inspection on 14 July 2011 to check on the compliance actions that we had made after the previous inspection. Devon County Council has kept us up to date with their revised improvement plans, which demonstrated how they have addressed the concerns from our visit in January 2011.
Our visit took place over eight hours. We spoke with seven people living at the home, five staff members and four people visiting the home. During our visit, we completed a SOFI 2 observation, which helped us to make judgements about people's well-being, and how staff interacted with them. We used this because some people were unable to answer specific questions about their care.
We met with people either in their rooms or in communal areas, and we spoke to them individually or in pairs when they were sitting with friends. We spent time in communal areas, which enabled us to observe people's care and hear conversations between staff and people living at the home.
We used pathway tracking to see how three people's care and social needs were met. Where possible, we met with the person. We looked at their care records and spoke to staff about how they met their care needs. We also looked at records relating to staff training and induction, as well as audit and quality assurance records. We spoke to staff about the management of complaints and staffing levels.
When we visited the home on 14 July 2011, 20 people were living at the home. We were told that since our last visit nobody had moved to the home on a permanent basis, which was a decision made by the provider.
We were told by staff that there was one person whose health had declined and was being monitored. We were told that there was nobody living at the home with a pressure sore and no one receiving end of life care.
The home does not currently have a registered manager but an application has been submitted by Devon County Council and a manager is in post. The manager was on annual leave when we visited but we spoke with them on the telephone on 27 July 2011 to confirm information and to receive an update on further work that had taken place.
We were told by staff that several people enjoyed being outside in the garden. We saw that one person appeared to like to be busy and we saw them sorting out the cushions on outside seats and then sitting down to relax in the sun. The second person appeared to enjoy just standing outside and commenting to staff on their surroundings.
Throughout the day, all the staff interactions we saw respected people's dignity and independence. Staff were sensitive to people's needs, for example taking time to make sure that the choice they were offering was meaningful to the person. We saw that staff knew people's like and dislikes with regards to drinks and meals but still checked to make sure they had remembered correctly. Staff were discrete in offering support, including asking about pain relief.
We saw that staff valued people's friendship and recognised the importance of the camaraderie between people living at the home. This was particularly noticeable during the lunchtime meal but also helping people to find a seat next door to each other.
People appeared relaxed with staff members and there was a calm and positive atmosphere. We saw that staff were able to change their approaches according to the individual. For example, some people obviously appreciated a tactile approach, some people responded well to jokes and other people were more formal and anxious to maintain their independence.
We saw that some people were keen to maintain their independence and that staff were sensitive to this. For example, staff were careful to check when people needed assistance with their meals or drinks. Sometimes people did not want to have help but then struggled. We saw staff going back and using a different approach, which was then successful and enabled the person to accept help on their terms.
In the afternoon, a group of people sat with a staff member who encouraged them to reminisce about their childhood, which resulted in laughter and contributions from people living at the home. It was managed well by the member of staff who created an inclusive atmosphere and ensured people were comfortable. Later the staff member used well known catch phrases to instigate discussion, which was also well received by the people in the group. Some people came and went, but were welcomed on their return, and the provision of a hot drink and biscuits added to the friendly atmosphere.
We saw that staff were observant at noticing both physical and mental changes in the people they supported, and this was generally reflected in the care records that we looked at and in our discussions with staff. We saw from records, that concerns were followed up, and that staff were pro-active in ensuring that people received the level of health care support that they required. We told by one relative that 'the care is great and the way people are treated is great' and two other relatives said that in their opinion the care could not be faulted.
We saw that people enjoyed their lunchtime meal from their expressions and their comments such as 'lovely' and 'very nice'. Staff took care to ensure that the portion size reflected people's preferences and we saw that the food was well presented. Throughout the day, we heard people being encouraged to drink and we saw this happening as staff took time to explain it was a hot day and to offer a drink that was acceptable to the person.
Staff were clear that medication administration could not be rushed and that it was vital for people to be given the time to make decisions. They gave the example of pain relief, and we saw staff checking with individuals in a discrete and unhurried manner. When people said 'no', we saw staff checking the person's body language for signs of pain and they reminded people of where the pain may be as a prompt. A member of staff was clear about the significance of pain relief and the impact pain could have on people's well-being.
People that we met during our visit were unable to comment directly on the safety and suitability of the premises. However, during our visit we saw that people were able to move around the communal areas safely and we saw that there were no hazards in these areas.
Most of the people we met during our visit were able to move around independently or with minimal assistance. One person had become frailer since our last visit, and we heard staff confirming with a senior staff member about the way they should be moved. We heard staff checking with people if they needed help to get out of chairs and we heard them listening to people's responses.
We observed that staff responded to people in an appropriate caring and respectful manner. They appeared to know people well. We saw how an agency member of staff diffused a situation in a competent and non-threatening manner, which showed an understanding of people with dementia.
Staff and a visitor told us about the residents' meetings that had taken place and what had been achieved by them. We looked at the minutes for these meetings, which were on display in communal areas, and saw that people were being asked to share their opinions about the service, and we could see examples of how concerns or suggestions had been followed up by staff.
Nobody that we spoke to raised any concerns about their experience of living at Arthur Roberts.