CQC report explained · a residential care home
What the CQC found at Arnold
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found risks from defective fire doors, unsafe waste storage, poor maintenance, unlocked cleaning cupboards and inconsistent use of face masks. Staffing, medicines, safeguarding and individual risk assessments were otherwise found to be suitable.
- Effective?
- Requires improvement
- This question was not inspected during this focused inspection, so no new rating was given.
- Caring?
- Good
- This question was not inspected during this focused inspection, so no new rating was given. Inspectors did observe kind and compassionate care as part of the visit.
- Responsive?
- Good
- Care plans had improved and were personalised. Staff understood people's needs and supported communication, relationships, activities and choices.
- Well-led?
- Requires improvement
- The quality monitoring systems did not identify or resolve important property problems quickly enough. Staff said they felt supported and saw improvements under the registered manager.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found kind, personalised care but fire doors, waste and maintenance were not always safe.
This was an unannounced focused inspection over three visits. One inspector observed care, spoke with 11 staff and reviewed care, medicines, staffing and management records. Feedback was also received from one relative and eight staff.
The home had enough staff, suitable care plans and safely managed medicines. People were treated kindly and supported with their communication, choices, relationships and community activities. Care planning and meeting people's needs had improved since the previous inspection.
However, some fire doors were damaged or wedged open. Waste bins were overflowing and rodents were seen around them. Some rooms and floor coverings needed repair, cleaning cupboards were unlocked, and staff did not always wear face masks correctly. The home was in breach of Regulation 15, and its overall rating remains Requires Improvement.
Personalised care
Care plans were reviewed and contained detailed information about people's needs, preferences, independence and goals. Staff understood the people they supported.
“Care plans contained detailed information about each person's individual needs and preferences, their level of independence, and where support from staff was required.” from the report
Kind and respectful support
People received kind and compassionate care. Staff respected privacy and dignity and supported people in the least restrictive way possible.
“People received kind and compassionate care. Staff protected and respected people's privacy and dignity.” from the report
Staffing and medicines
There were enough staff to meet people's needs at the time of inspection. Medicines were administered, recorded and stored safely.
“People living at the care home at the time of the inspection were supported by enough staff to meet their care needs.” from the report
Improved responsiveness
The home had improved since the previous inspection and was no longer in breach of the person-centred care regulation. People's individual needs were being met more effectively.
“At this inspection, we found enough improvement had been made and the provider was no longer in breach of regulation 9.” from the report
Fire safety
seriousTwo fire doors were damaged and another was routinely wedged open. Inspectors said this increased the risk of harm if there was a fire.
“Two fire doors were damaged and could not be easily closed; and another fire door was routinely wedged open.” from the report
Waste and property condition
seriousWaste bins were open and overflowing, with rodents seen inside and around them. Parts of a bedroom, bathroom and communal flooring were also in poor condition.
“External waste bins were open, overflowing, and rodents were observed inside and around the bins.” from the report
Infection control practice
needs fixingCare staff were seen without face masks or wearing them incorrectly on each inspection visit. Inspectors said this increased the potential risk of infection spreading.
“On each of the inspection site visits care staff were initially seen not wearing PPE face masks when the inspector arrived at the premises, or not wearing their face mask properly.” from the report
Family communication
minorOne relative reported difficulty getting through to the home and not always being told the outcome of medical appointments. The manager said this would be reviewed.
“A person's relative told us it was often difficult to get through to the care home on the telephone” from the report
- 01Have all the damaged fire doors been repaired, and is the door that was wedged open now kept closed?
- 02Have the overflowing bins and rodent problem been dealt with, and how are waste arrangements checked now?
- 03Which bedroom, bathroom and communal flooring repairs have been completed, and what work is still outstanding?
- 04How do managers check that cleaning cupboards are locked and that staff wear face masks correctly?
- 05How will the home keep relatives informed about medical appointments and make telephone contact easier?
This was a focused inspection of Safe, Responsive and Well-led, with infection control also considered; Effective and Caring were not inspected and the overall rating used the previous ratings for those questions. This explanation was written from the published report of 29 November 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.
What inspectors found, December 2019
Requires Improvement; improvements ended Special Measures, but inspectors found ongoing shortfalls in person-centred care and some medicine checks.
This was an unannounced, comprehensive inspection on 11 November 2019. Inspectors reviewed care records, medicine records and service records. They observed care and spoke with people, staff, managers and relatives.
The home had improved since its previous Inadequate rating. Safety checks, staffing, incident monitoring and management oversight had improved. People were treated with kindness, dignity and respect, and were supported to make choices and take part in activities.
Important problems remained. People's individual needs were not always met, some health concerns were not followed up promptly, and medicine records had errors. The home remained in breach of Regulation 9 on person-centred care.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were also Requires Improvement. Caring was rated Good. The home was no longer in Special Measures.
Improved risk management
People's risks had been reassessed and staff had current guidance on how to reduce those risks. Staffing levels and staff skills had also improved.
“Risks associated with people's needs had been assessed and staff had guidance on the support required to manage and mitigate risks.” from the report
Kind and respectful care
People were positive about staff. Inspectors saw respectful interactions, choice and support for independence.
“Staff were attentive and responsive and included people in discussions and choices in activities and other daily living decisions.” from the report
Activities and community life
People were offered daily activities and support with interests, goals and contact with family and friends.
“People received opportunities to participate in social activities, interests and hobbies.” from the report
Better oversight
Incident recording, audits and senior management checks had improved. An action plan was being used to track further work.
“The systems and processes used to assess, monitor and review safety and quality had improved, with increased oversight by senior managers.” from the report
Medicine checks were not consistent
needs fixingInspectors found an expired topical cream, missing medicine signatures and an incorrect name on a medicine protocol. They said these problems had not affected people's safety at the time.
“One person's prescribed topical skin cream was being used, despite it exceeding the recommended expiry date.” from the report
A DoLS condition was not met
seriousOne person's authorisation required staff training about a particular mental health diagnosis. This training had not been obtained.
“One of these conditions was found to have not been met.” from the report
Care was not always person-centred
seriousThe home did not always assess and plan for people's changing needs. This included a skin condition and significant self-neglect.
“The provider failed to ensure people's individual needs were consistently met.” from the report
Health concerns were not followed up promptly
needs fixingManagers had not always escalated concerns to outside health professionals. Inspectors also found that important medicine information was missing from one hospital transfer document.
“The management team had not always followed up or escalated concerns with external healthcare professionals, when concerns were experienced about the support provided.” from the report
Leadership was still settling
minorA new manager and regional manager had recently taken responsibility. Inspectors said more time was needed for leadership improvements to become established and consistent.
“Further time was required for improvements to be fully embedded and sustained.” from the report
- 01What action has been taken to make sure care plans and risk assessments respond quickly when someone's health or behaviour changes?
- 02How do you now follow up and escalate concerns with GPs and other health professionals?
- 03What checks are used to prevent expired creams, missing signatures or incorrect medicine protocols?
- 04Has the staff training required by the DoLS authorisation now been completed?
- 05What has changed since the inspection to make management and staffing more consistent?
This was an unannounced comprehensive inspection covering all five key questions, with the previous Inadequate ratings reassessed. This explanation was written from the published report of 18 December 2019 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 Arnold
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2019Requires improvementup from InadequateSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2019Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- April 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014Inspected but not rated
- May 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 8 November 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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