CQC report explained · a residential care home
What the CQC found at Arrowsmith Lodge Rest Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were assessed and reviewed, medicines were managed safely, and staff understood safeguarding procedures. People had mixed views about staff availability, although calls for help were observed to receive prompt responses.
- Effective?
- Good
- Staff had training and supervision, and people's health and nutrition were monitored. Inspectors identified improvements needed to the dining experience and to parts of the building.
- Caring?
- Good
- People described staff as kind and caring, and inspectors observed respectful relationships. The lack of locks on most bedroom doors could affect privacy.
- Responsive?
- Good
- Care plans included people's preferences and were generally kept under review. People had activities available but said they wanted more, and some daily care records were not fully consistent.
- Well-led?
- Good
- The provider and manager had improved monitoring and acted on identified shortfalls. People, relatives and staff were able to give feedback, although one staff view was that some ideas were not acted on.
What inspectors found, October 2018
Rated Good; inspectors found kind and safer care, but staffing time, activities and privacy needed further attention.
Inspectors carried out an unannounced comprehensive inspection over 5 and 6 September 2018. They observed care, spoke with people, visitors and staff, and checked care plans, medicines, recruitment files, training, complaints and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found improvements since the previous inspection, including safer recruitment, better care records and stronger checks on the quality of the service.
People said staff were kind and that they felt safe. Medicines were managed safely, staff training was in place, and risks and health needs were generally reviewed. However, people had mixed views about staff availability, wanted more activities, and most bedroom door locks had been removed.
Kind care
People said staff were caring and kind. Inspectors also saw warm, respectful and patient interactions.
“During our visit, we observed staff interacting with people in a caring, affectionate and respectful manner; we observed lots of smiles, hugs and laughter.” from the report
Safer medicines
Medicines were ordered, stored, given and recorded through safe processes. Staff who gave medicines had training and checks on their practice.
“We found there were safe processes in place for the receipt, ordering, administration and disposal of medicines.” from the report
Improved management
Quality checks had improved since the previous inspection. The provider was identifying shortfalls, setting timescales and tracking actions.
“There were effective systems to assess, monitor and improve the quality and safety of the service.” from the report
Personalised care plans
Care plans included people's likes, dislikes, preferences and routines. Staff kept people's changing needs under review.
“The care plans were organised and included valuable information about people's likes, dislikes, preferences and routines” from the report
Staff time and availability
needs fixingPeople, relatives and staff gave mixed views about staffing. Some said staff were busy and did not have enough time for conversation or activities, although staffing was increased after the inspection.
“We received mixed views about the availability and numbers of staff.” from the report
Bedroom privacy
needs fixingMost bedroom door locks had been removed and suitable replacements were not yet in place. The provider said this would be discussed with people and relatives.
“However, we noted the locks had been removed from most people's bedroom doors.” from the report
Activities
minorActivities were available, but people and visitors said there was not always enough to do. Care staff covered activities when the activities coordinator was away and had time.
“There are evenings when I go home and I have not spent any time just talking to residents.” from the report
Dementia-friendly environment
minorSome areas needed redecoration and refurbishment. More work was also needed to help people living with dementia recognise bedrooms and use the outdoor areas.
“We found the home to be spacious and bright but found some areas in need of redecoration and refurbishment.” from the report
Some records needed improvement
needs fixingThere were gaps in some care plan review dates and personal care records did not always reflect the support given. The report also said the quality of daily records varied.
“We noted personal care records were not always reflective of the support people had received in relation to personal care and bathing” from the report
- 01What has changed in staffing numbers since the inspection, and how much time do staff now have for conversation and activities?
- 02Have suitable locks been fitted to bedroom doors, and how are residents able to control access to their rooms?
- 03What activities are available each day, including when the activities coordinator is away?
- 04What improvements have been completed to make the home more suitable for people living with dementia?
- 05How are care plan reviews and personal care records checked to make sure they are complete and accurate?
This was an unannounced comprehensive inspection covering all five quality areas and the premises, care and records. This explanation was written from the published report of 4 October 2018 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, September 2017
Rated Requires Improvement; inspectors found kind care and safe medicines, but important problems with risks, records, recruitment and personalised care.
Inspectors visited on 19 and 20 July 2017. The first day was unannounced. They spoke with people living in the home, relatives, staff, the provider and the registered manager. They observed care and checked records, medicines, staffing, training, complaints, maintenance and quality checks.
People generally said they felt safe and that staff were kind and caring. Inspectors found good training and support for staff, appropriate health care, safe medicines administration and a range of activities. The home was clean overall, although there was a strong odour on the ground floor.
The main problems were unclear risk assessments, gaps and inaccuracies in care records, unsafe recruitment checks and weak quality monitoring. Care plans did not always give staff enough detail about people's individual needs. Some improvements had started under a new registered manager, but inspectors found that the service was still breaching four regulations.
The overall rating of Requires Improvement means the home was not consistently meeting the required standards at this inspection. Effective and Caring were rated Good. Safe, Responsive and Well-led were rated Requires Improvement.
Kind and respectful care
Inspectors saw staff treating people in a friendly, caring and considerate way. People were supported without being rushed and their choices, dignity and independence were respected.
“Staff responded to people in a friendly, caring and considerate manner and we observed good relationships between people.” from the report
Medicines
Medicines were stored, administered and disposed of safely. The administration records inspected were accurate and staff responsible for medicines had suitable training.
“People's medicines were managed safely and administered by trained staff.” from the report
Staff support and health care
Staff received a wide range of training, regular supervision and yearly appraisals. People's health needs were monitored and health professionals were involved when needed.
“People's health and wellbeing was consistently monitored and they had access to healthcare services when necessary.” from the report
Activities and community links
People could join group or one-to-one activities, including crafts, dog walking, trips to local places and church visits. A dedicated activity coordinator supported this work.
“People were able to participate in activities in small groups or on a one to one basis.” from the report
Safeguarding awareness
Staff understood how to recognise and report abuse. Safeguarding and whistleblowing procedures were available and staff said they would report concerns.
“They were clear about what to do if they witnessed or suspected any abuse and indicated they would have no hesitation in reporting any concerns.” from the report
Risk assessments and incident records
seriousDifferent risk assessment systems gave inconsistent risk scores. Guidance about behaviours that challenged the service was limited, and incident records did not always contain enough information to show whether people were protected.
“The provider had failed to ensure people were protected against the risks to their health, safety and wellbeing.” from the report
Care plans did not give clear instructions
seriousSome care plans did not accurately describe the care being given or explain how staff should support particular needs. This was a continued breach from the previous inspection.
“We found there was still a lack of clear instruction for staff which could result in care not being provided as needed.” from the report
Recruitment checks
seriousTwo recruitment records did not show that all required checks had been completed before staff started work. This included employment histories, references, photographs and a health assessment.
“The provider had not followed safe and robust recruitment processes.” from the report
Quality checks were not effective
seriousNew audits had been introduced, but they had not found several problems identified during the inspection. Records were not always accurate or reflective of the care provided.
“The provider failed to operate effectively systems or processes to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service.” from the report
Some complaints and mealtime arrangements
needs fixingOne complaint was still being followed up and its acknowledgement had been delayed. Some relatives said they had to repeat issues. Inspectors also identified improvements needed in the mealtime experience.
“We noted one complaint was still being followed up and an acknowledgement had been delayed.” from the report
Privacy and environmental issues
needs fixingSeveral bedroom doors had unsuitable locks or no locks, which could affect privacy and safety. There was also a strong odour on the ground floor, although carpet replacement was planned.
“We found a number of the bedroom doors were fitted with unsuitable locks.” from the report
- 01What has been done to make risk assessments consistent and to review high risks at the right frequency?
- 02How do you now make sure every care plan gives clear instructions about a person's needs, preferences and changing circumstances?
- 03Are all employment histories, references, photographs and health checks completed before new staff start work?
- 04How do you decide whether there are enough staff on each shift, and do you now use a recognised staffing tool?
- 05What changes have been made to the quality audits, complaint follow-up and bedroom door locks since this inspection?
This was a planned inspection covering all five key questions; the first inspection day was unannounced, and inspectors reviewed records, observed care and spoke with people, relatives and staff. This explanation was written from the published report of 1 September 2017 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 Arrowsmith Lodge Rest Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- October 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- June 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 11 March 2011.
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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85 live-in carers within about an hour of Lancashire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 78 can care for a couple. 11 years' experience on average.
“She understands the needs of an elderly person in the early stages of dementia and has treated my mother with great kindness and skill.”
“Thanks to Tracy, Dad was always immaculately dressed and clean, his meals were all home cooked and nutritionally well balanced and his home was always kept really clean and tidy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.