CQC report explained · a nursing home
What the CQC found at Arden Grange Nursing & Residential Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were supported by enough staff and staff recruitment had improved. However, medicines were not always given safely, and some environmental and risk-management issues remained.
- Effective?
- Requires improvement
- People received support with food, drink and health needs, and staff had relevant training. However, the home did not consistently follow the Mental Capacity Act, and fluid guidance was not always specific.
- Caring?
- Requires improvement
- Inspectors saw kind and positive interactions, and people and relatives praised staff. The rating remained Requires Improvement because concerns about medicines and consent could affect people's rights, dignity and safety.
- Responsive?
- Requires improvement
- Care plans had been updated and people were supported with activities, family contact and end-of-life planning. However, some records were generic or incomplete, and communication plans sometimes contradicted other records.
- Well-led?
- Requires improvement
- Management systems had improved, including checks on cleaning, equipment and staff practice. They still did not reliably identify problems with medicines, care records and mental-capacity decisions.
What inspectors found, July 2023
Rated Requires Improvement; inspectors found kind staff and progress since the last inspection, but medicines, consent and quality checks still had serious shortfalls.
This was an unannounced follow-up inspection on 14 and 16 March 2023. Inspectors spoke with people, relatives and staff, observed care, and checked care plans, medicine records, recruitment files and management records.
The home had improved since its previous inspection, which was rated Inadequate. Staff numbers, recruitment, infection control, care planning and the home environment had improved. People and relatives generally described staff as kind, supportive and respectful.
However, some medicines were given incorrectly. Records did not always give clear guidance about people's risks, fluid needs, communication or preferences. The home also did not always follow the legal rules about consent and mental capacity.
All five areas were rated Requires Improvement. The home had been in Special Measures, but it left Special Measures because it was no longer rated Inadequate overall or in any key question. The provider remained in breach of Regulations 11, 12 and 17.
Enough staff
Inspectors found enough staff to support people safely. Staff were not rushed and people did not report waiting for help.
“People were supported safely by enough staff. Staff were not rushed, and people told us they did not have to wait for support.” from the report
Kind relationships
Staff had built positive relationships with people. Inspectors saw attentive and caring interactions, and relatives spoke positively about the support given.
“Staff were attentive to people's needs and we saw positive, caring interactions between them throughout our inspection.” from the report
Health support
Staff referred people to health professionals when their needs changed or they had health concerns. Records showed these referrals and support.
“People's care records showed how staff had made referrals to external professionals for additional support and assessment when a person's needs had changed.” from the report
Progress since the last inspection
The home had improved its environment, care planning, recruitment checks and several monitoring systems. It was no longer rated Inadequate or placed in Special Measures.
“The provider had responded positively to our previous inspection findings and at this inspection we found improvement throughout the whole service.” from the report
Consent and mental capacity
seriousSome care plans assumed people lacked capacity because of their health conditions. The home also used relatives' permission for photographs where relatives did not have legal authority to give consent.
“Where people lacked capacity to give their informed consent, no capacity assessments or best interest decisions had been completed and staff instead had sought consent from relatives who had no legal right to make decisions on people's behalf.” from the report
Records and checks were incomplete
needs fixingSome care records contradicted each other or did not give enough detail about risks, fluids, medicines, communication and personal preferences. Management checks had not reliably found these problems.
“People's care records had been reviewed and updated but more work needed to be done to ensure these matched people's care needs.” from the report
- 01What has changed to make sure medicines are not crushed when the care plan or manufacturer's instructions say they must not be?
- 02How do you now check that instructions for creams and other topical medicines are complete and followed?
- 03How do you assess a person's capacity for each specific decision and record best-interest decisions?
- 04How do you make sure relatives are only asked for consent when they have the legal authority to give it?
- 05What checks now identify contradictions or missing information in care plans, especially about fluids, medicines and communication?
This was an unannounced follow-up inspection covering all five key questions, with infection prevention and control also checked as part of the inspection; it followed an Inadequate inspection published on 28 December 2022. This explanation was written from the published report of 5 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2022
Arden Grange Nursing & Residential Care Home was rated Inadequate and placed in special measures after inspectors found people were at risk of harm and leadership was not effective.
This was an unannounced comprehensive inspection on 20 and 24 October 2022. Three inspectors attended on the first day and one returned on the second day. They spoke with staff, observed care and reviewed care plans, medicines records and management records.
Inspectors found serious and repeated problems with safety. Risk assessments and care plans were often not detailed enough. Hazards included unlocked cupboards with harmful products, unsafe equipment, scalding risks, poor management of Legionnaires' disease and inadequate support with eating and drinking.
The home was not consistently meeting people's needs or respecting their choices, dignity and communication needs. Some legal authorisations had expired, some end-of-life forms were invalid, and care plans were generic. Inspectors also found that checks by the provider had not led to timely improvements.
The overall rating fell from Requires Improvement to Inadequate. Safe and Well-led were rated Inadequate, while Effective, Caring and Responsive were rated Requires Improvement. The home was placed in special measures and will be kept under review.
Medicines
People received their medicines as prescribed. Records had no gaps, medicines were stored securely and temperatures were checked.
“People received their medicines as prescribed and these were administered by trained staff.” from the report
Infection control improvements
Inspectors saw better cleanliness and more complete cleaning records than at the previous inspection. They were also assured about several infection prevention arrangements.
“At this inspection we saw improvements to both the cleanliness in the home and cleaning records.” from the report
Protection from abuse
Staff had safeguarding training and understood what abuse was and what action to take. Improvements meant the home was no longer in breach of the regulation on restraint and improper treatment.
“Staff received training in safeguarding people from the risk of abuse.” from the report
Activities and accessible information
People had been asked what activities they wanted, and the activities offered had been changed. Pictorial menus and activity timetables had also been introduced.
“At this inspection we found that this had improved, and people had been consulted about what activities they would like to take place at the home.” from the report
Risks and unsafe surroundings
seriousRisk assessments and care plans did not cover important health conditions. Inspectors also found hazardous products in an unlocked room, unsafe window arrangements, faulty wheelchair footplates, scalding risks and poor management of Legionnaires' disease.
“Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people using the service” from the report
Legal consent and liberty safeguards
seriousThe home had not completed capacity assessments properly. Some Deprivation of Liberty Safeguards authorisations had expired, including one that was not renewed for three years.
“This meant some people were being deprived of their liberties unlawfully.” from the report
Basic care and dignity
seriousPeople were sometimes left waiting, including in wheelchairs after lunch. Staff did not always provide the support needed with meals, communication, glasses and hearing aids, or explain delays.
“People were not consistently treated with dignity and respect.” from the report
Personalised care
needs fixingCare plans were generic and did not include enough information about personal history, preferences, religious or cultural background. Relatives and friends were not always involved in planning care.
“People's plans of care were generic and were not personalised to the individual.” from the report
Weak oversight
seriousThe provider's checks repeatedly missed problems or failed to ensure they were corrected. This included risks involving care plans, recruitment checks, equipment, the environment and mealtimes.
“The providers governance and quality systems were not effective.” from the report
- 01Which risk assessments and care plans have been rewritten, and how are staff checked to ensure they follow them?
- 02How are you now checking window restrictors, hazardous products, wheelchairs, hot water, pressure mattresses and Legionnaires' disease risks?
- 03How do you ensure capacity assessments, Deprivation of Liberty Safeguards renewals and DNAR or RESpECT forms are legally valid and up to date?
- 04What has changed to ensure people receive timely help with meals, drinks, communication aids and personal care?
- 05Who is responsible for quality checks now, and what evidence can you show that previous inspection concerns have been corrected?
This was an unannounced comprehensive inspection covering all five key questions and infection prevention and control, with improvements checked against the provider's previous action plan. This explanation was written from the published report of 29 December 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Arden Grange Nursing & Residential Care Home
3 rated inspections over a year: the service has held its Requires improvement rating throughout.
- July 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
Read what inspectors found at Arden Grange Nursing & Residential Care Home →
- December 2022Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
Read what inspectors found at Arden Grange Nursing & Residential Care Home →
- August 2022Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- October 2021
Registered with the Care Quality Commission on 28 October 2021.
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