This inspection took place on 21 August 2017 and was unannounced.

Arboretum House is registered to provide residential care and support for up to 38 people providing care and support to older people, including those with a physical disability. At the time of our inspection there were eleven people using the service. People using the service were accommodated on the first floor. The ground floor of the service was used by Derby City Council to provide day care and operated independently of Arboretum House.

The overall rating of good, which was awarded following the CQC's focused inspection of 25 August 2016, was displayed throughout the service. Arboretum has retained its rating of good.

Arboretum House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had been in post for five weeks when the inspection visit took place. A number of changes had been introduced, which had had a positive impact on people using the service and staff. The registered manager spoke with enthusiasm and commitment to bring about further improvements to the quality of the service provided and had an action plan which outlined the changes planned to make.

People were protected from avoidable harm and abuse. Potential risks had been assessed to minimise incidents and accidents, whilst recognising people’s rights to make informed decisions and maintain their independence. People were supported by sufficient staff that had the necessary knowledge and skills to provide the care and support they needed, which included the management of all aspects of their medicine.

People health, welfare and independence were promoted, with referrals to relevant health care professionals being made when required. People had sufficient to eat and drink and their dietary needs were met.

People’s privacy and dignity was promoted by staff that had developed positive and caring relationships with those living at Arboretum House. People were confident to express their views about their care and support and had the opportunity to influence the care they received.

The registered manager promoted a positive and open culture for people using the service and staff. Positive comments were received about the registered manager and their impact on the day to day running of the service. The quality of the service provided was monitored by the registered manager, through a range of audits and consultation.

We undertook this unannounced focused inspection visit on 25 August 2016 to check that the provider had addressed the breach in regulation identified at our last unannounced comprehensive inspection visit on 4 & 5 November 2015. At our last visit we identified that the provider had not notified us of the outcome of referrals which they made to the supervisory body for authority to deprive a person of their liberty. We issued a requirement notice as the provider was in breach of the regulation regarding notifications of other incidents. We also found improvements were needed in medicines management, some staff raised concerns about staffing levels and there was no registered manager in post.

After the last comprehensive inspection visit, the provider did not write to us to say what they would do to meet legal requirements in relation to the breach.

This report covers our findings in relation to the breach and other areas that required improvements at our last inspection visit. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the 'all reports' link for Arboretum, House on our website at www.cqc.org.uk

Arboretum House is a care home which provides residential care for up to 38 people. The home specialises in caring for older people, including those with physical disabilities. At the time of this inspection there were 17 people in residence. Since the last inspection the provider was providing care to a younger adult. The provider told us they would change their registration details with us to reflect these changes. Since the last inspection visit the ground floor was being used by the provider in providing day care provision for younger adults. This provision was for people with profound and multiple learning difficulties and not part of the care provided by Arboretum House.

There was a registered manager in post, who registered with CQC on 5 September 2016.This is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When people lack mental capacity to take particular decisions, any decisions made on their behalf must be in their best interests and as least restrictive as possible. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). At our last inspection visit we had not received the relevant notifications. At this inspection visit we found another person had an authorised application in place to deprive them of their liberty but we had not been notified of this. The manager completed the relevant notification at the inspection visit and sent it to us.

At this inspection visit, we saw that improvements had been made to how people’s medicines were managed. This included the introduction of new medicines administration procedures.

There were enough staff on duty to meet people's needs. A staffing tool had been implemented to determine staffing levels at the service. People and most staff we spoke with told us staffing levels had improved.

People told us they were happy with the staff team. The staff provided effective care and understood the importance of offering people choice. The acting manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005.

We looked at three peoples care records and spoke with five staff. This is known as pathway tracking and helps us to understand the outcomes and experiences of a selected sample of people.

There were 22 people using the service at the time of our inspection visit. We spoke with six people about the care and treatment they received. We observed interactions between care staff and people who were using the service.

We used the information we gathered to answer our five key questions.

Is the service safe?

People told us they felt safe and had no concerns regarding the staff that supported them. Comments from people included, “I feel safe at Arboretum House,” “I have no concerns with the staff they are pleasant” and “They (staff) are very caring and helpful.”

The service were not clear about their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (Dols). Although no Dols applications had been made, some staff were not clear of the circumstances when an application should be made. Where people lacked capacity and decisions needed to be made in their best interests, the provider had not acted in accordance with legal requirements.

Suitable equipment was in place to support people in a safe way with their mobility needs. We saw that staff used the equipment confidently which indicated that moving and handling equipment was used frequently. Equipment was well maintained and serviced regularly to ensure it was safe to use.

Medication was not always being stored at the correct temperature and there was the potential for their efficacy to be reduced.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to capacity and best interest decision making and medication management.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place.

People told us that the staff supported them in a dignified way and ensured their rights were respected.

People had access to a range of health care professional which included doctors, opticians and dentists.

Is the service caring?

People using the service told us that they liked the staff and found them friendly and supportive. We observed a positive working relationship between the care staff and the people they supported.

People’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

Staff were attentive to people’s needs throughout our visit and we saw that people were provided with support as needed.

People told us that staff were responsive to their needs. One person said; “There are always staff around to help you.” Another person stated “The staff understand you’re nice, I wouldn’t want to be anywhere else.”

The service had a limited understanding on how to support people who could not make decisions for themselves when required.

Is the service well-led?

Staff understood their role and responsibilities for meeting people’s care needs and reporting any concerns or changes in people’s health and safety needs. Staff spoke positively about the management support they received.

Quality assurance systems were in place to demonstrate how the service provided to people was monitored and improved upon as needed. Satisfaction surveys were completed by people who used the service; we saw that any identified areas for improvement were acted upon.

There were 29 people using the service at the time of our inspection visit. We spoke with five people using the service, two staff, and one family member. Following the inspection visit we spoke with two staff and two health professionals.

People told us they were happy with the care and treatment they received at Arboretum House and felt staff treated them with dignity and respect. One person said "The care is very good; I came for respite and I am staying here permanently.” People that we spoke with confirmed that they felt safe and that staff supported them in a safe way.

A family member and health care professionals we spoke with were complimentary about the service provided and the staff.

We found that one person’s needs had significantly changed, however care plans and the associated risk assessments had not been updated to reflect the changes.

People who use the service, staff and visitors were generally protected against the risks of unsafe or suitable premises. The provider may find it useful to note that we did not see that a risk assessment had been completed, ensuring the safety of people using the service, staff and visitors whilst the refurbishment was taking place.

Staff we spoke with told us that recently there had been a reduction in the number of staff available in the afternoon. This meant that there were times when there were not enough on duty to ensure the safety of people using the service was maintained.

People told us they liked living at Arboretum House. They told us the routine at the service was relaxed and flexible. They told us they felt well cared for and were included in making decisions about their care and treatment. We saw people made decisions about their level of participation in their care. People were asked if they wished to manage their own medication or whether they wished staff to check on them during the night. People's individual preferences were recorded in their files. However, although people received their medication as prescribed, staff were not consistently signing the medication administration chart to indicate medication had been given.

People told us they enjoyed the meals provided. People told us there were two choices for each meal time, and they could always request an alternative if they wanted something different to the planned menu. One person told us "The food is marvellous."

People we spoke with told us they would raise any concerns they had with a member of staff from the office. However, they also told us they had no cause to complain whilst they had lived at Arboretum House.

People told us they liked living at Arboretum House and they felt well cared for. One person said “I love it here, it is the best decision I ever made.” People told us that the care workers were good, and knew about their individual care needs. People told us care workers had spoken to them about their planned care, and they had seen their care file.

People told us they were encouraged to remain as independent as possible, and care workers provided support and assistance where required. One person told us “I can do my own care, but staff help me with my creams and to have a bath.”

People told us the routine was relaxed and flexible. People said they were able to make decisions about their daily routine, such as the time they got up and went to bed. People told us care workers were always respectful when dealing with them, and knocked on their bedroom doors prior to entering. People told us their family and friends were welcome to visit at any reasonable time.

People said they felt staff listened to them when they raised any issues or made suggestions about their care or the running of the service. People told us they felt safe and had not seen any care practice that gave them cause for concern.

This inspection took place on 4 and 5 November 2015 and was unannounced.

Arboretum House is a care home which provides residential care for up to 38 people. The home specialises in caring for older people, including those with physical disabilities. At the time of this inspection there were 22 people in residence.

There was no registered manager in post. There was an acting manager at the service who was covering this position. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The provider’s legal responsibilities had not been met regarding statutory notifications as they had not notified us of the outcome of referrals to the supervisory body for authority to deprive a person of their liberty.

Staff understood how to protect people from abuse and were responsive to their needs. People were protected against the risk of abuse, as checks were made to confirm staff were of good character to work with people. Sufficient staff were available to meet people's needs.

Risk assessments and care plans had been developed with the involvement of people. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. People had equipment in place when needed such as a hoist or wheelchair, so that staff could assist them safely. Systems were in place to ensure people received their medicines in a safe way. Medicines were not always managed safely as they were accessible to unauthorised persons

Staff understood people’s needs and abilities and were provided with training to support them to meet the needs of people they cared for. Systems in place regarding consent were not always clear, this did not ensure decisions were made in a person’s best interest.

People’s needs and preferences were met when they were supported with their dietary needs. Relevant health care professionals were consulted to ensure people’s health care needs were met.

We saw staff positively engaging with people living at the service and staff encouraged people to participate in activities which interested the individual.

The provider’s complaints policy and procedure were accessible to people who used the service and their relatives. People knew how to make a complaint

Arrangements were in place to assess and monitor the quality of the service, so that actions could be put in place to drive improvement.

Staff told us that they received support from the acting manager. The management of the service were open and transparent.

You can see what action we told the provider to take at the back of the full version of this report.