Arlington House

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

We identified an area of practice that needed improvement. The information and assessments of risk in people’s care were not routinely kept up to date and relevant to guide safe practice. Medicines were overall safely managed and administered, and there were enough staff to ensure people’s safety and meet their needs. Staff received training to allow them to support people safely and effectively. People’s concerns were listened to and acted upon. Staff were trained in safeguarding and understood how to protect people from the risk of abuse. Staff knew people well and were confident and competent at keeping them safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us they had no concerns in the way the service managed transitions in people’s care, such as moving into the service and visiting other care settings, such as the hospital. A relative told us, “[Relative] was taken to an appointment at the hospital recently. The manager told us all about the appointment and how they got on.”

Staff told us that there were good working relationships with external healthcare professionals, to provide a good standard of care for people within the service. On the first day of our onsite assessment the manager had escorted a person living at the service to a health appointment. They told us, “It all went very well, [person] was a bit worried about it, but everything was fine.” The provider and manager agreed that professional input was important and will be utilising this going forward.

We spoke with the local stakeholders, including the local authority. They told us that the service engaged effectively with them to share information and best practice about people’s care to ensure they were safe.

Details of people’s medical appointments and input from community professionals was recorded, and staff were made aware of any changes to people's health or care needs.

People told us they felt safe living at the service and that staff supported them well. One person told us, "I’m not bored and no, they’re not abusing me, don’t be daft, I’d tell them."

Staff were all very clear about their role in safeguarding people. They had received training and felt confident about raising concerns and who to contact. A member of staff told us, “I know all about safeguarding and the MCA.”

We observed staff attended to people in a safe and timely manner. It was clear staff wanted to ensure people were kept safe and well supported.

Staff had received training in safeguarding and there was an up to date safeguarding policy in place. The organisation had followed safeguarding procedures and made referrals to the local authority as well as notifying the Care Quality Commission when required. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. The documentation supported that each DoLS application was decision specific for that person. For example, regarding restrictive practices such as locked doors and bed rails. We saw that the conditions of the DoLS had been met.

People told us staff involve them in decisions about their care and how to keep them safe. A relative told us, “He’s perfectly safe, in fact it’s reassuring. The new manager is very good, she’s very interested in learning about [relative] and us as well.” Another person described their risks to us and told us how staff had spoken with them about managing the aspects of their life where they required support.

We discussed with the manager how the risk assessments in people’s care plans had not been routinely reviewed. The manager was aware of this and an action plan with timescales had been developed to review all risk assessments for people. However, it was clear that the manager and staff knew people very well and understood how to manage and mitigate their risks. One member of staff told us, “I’ve looked at the care plans, but most of what we learn is from the handovers and meetings we have.” Another member of staff told us, “I always recognise if someone is unwell or upset, that’s because we know them so well, we are part of their lives.”

Our observations showed staff supporting people safely and managing risks to their welfare and safety. People were supported to mobilise and carry out tasks around the service that could place them at risk. We observed staff carrying out safe and sensitive moving and handling procedures. People appeared safe and were encouraged to be independent.

Care plans and risk assessments identified specific risks to each person and provided guidance for staff on how to minimise or prevent the risk of harm. These included risks associated with diabetes, mobility, skin integrity and eating and drinking. However, the reviewing and recording of people’s risks in their care plans had not routinely taken place, placing people at potential risk of harm. We were not assured that risks to people were accurately assessed and up to date in order to guide staff fully on how to keep people safe. It was clear the manager and staff knew people well and what was required to keep them safe, however, this was not formalised, up to date and recorded in people’s care plans for staff to refer to and follow. The manager was aware of the issues and an action plan with timescales and dedicated members of staff to review all risk assessments for people had been developed.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us there were enough staff to meet their needs. A relative told us, “The staff are lovely, they know what they’re doing I think and they’re always smiling, so is [relative] now as well. I’ve never seen an issue with staffing numbers, there’s always people here, they seem to like working here.”

Staff spoke positively about staffing levels and their training. One member of staff told us, “The training I had was very good. I am from a different country, and I learned the job, but also what English people like, their expressions and what makes them laugh. We have fun. My induction and training have been very helpful.”

We observed people being responded to promptly when they required support. Staff had time to spend with people, having time for conversations and laughter. We saw people were spending meaningful time with staff, such as being supported with an activity.

Staff rotas showed there were sufficient numbers of suitably qualified and trained staff consistently deployed to fully meet people’s needs. Staff deployment ensured people’s needs were met in a timely manner and in a way that met their preferences. The provider followed safe and effective recruitment practices. This included checks with the Disclosure and Barring Service (DBS), requesting references from previous employers about their conduct in previous jobs and health checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had received relevant training in looking after people. Staff completed an induction when they started working at the service and ‘shadowed’ experienced members of staff until they were assessed as competent to work unsupervised.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines in a way that met their individual needs and preferences. Staff showed kindness and respect to people within the service. One person told us, “I get my tablets every day without fail.” We observed a member of staff administering medicines to people. They did this sensitively and appropriately and stayed with people to ensure they had taken their medication. They described how they showed us how they recorded the medicines they had given. We saw these were accurate. They also showed us how they ensured that stock levels of medicines were accurate. We saw medicines were stored appropriately and securely, in line with legal requirements.

The manager told us how the system of administering medicines was a temporary system to reduce medicines errors they had found when they started at the service. The manager stated they will be returning to a regular medicines administration records (MAR) chart system when the service has stabilised. One member of staff told us, “I understand the meds system, it’s not the usual type I’m used to, but it works.”

The service had safe systems for appropriate and safe handling of medicines. However, these were not fully effective. The medicines system being used was safe, but unsustainable. It is understood this is an interim system to cut down on previously identified medicines errors. However, it is time consuming and relies on the manager either always being on duty, or ensuring that a daily record of medicines is printed and available for staff. The manager has developed an action plan with timescales showing when the service will start using a conventional medicines administration records (MAR) system. We have identified this as an area of practice that needs improvement.