The inspection took place on 26th February 2018 and 5th March 2018 and was unannounced.

The Arbory Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The Arbory Residential Home accommodates up to 60 people who are living with dementia. Accommodation is in two adjoining buildings, the Court, a purpose built three storey extension and the Lodge, an adapted building over two floors both were accessible with stairs and passenger lifts. There are extensive accessible grounds and gardens. When we inspected 58 people were living at the service.

There was a registered manager in post. A registered manager 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.

People were kept safe from harm and staff were trained in safeguarding and knew how to report concerns. Risks were assessed and actions taken to minimise residual risks without impacting on people’s rights.

There were sufficient trained staff deployed to support people and provide high quality care. Recruitment practices were robust and appropriate checks and training were in place before staff commenced in post.

People were supported to maintain their health and well-being and their nutritional needs were met.

People were given choices and control over their lives. The service complied with the principles of the Mental Capacity Act and Deprivation of Liberty Safeguarding. Controls in place were in the best interest of people and were the least restrictive option.

Positive working practices were in place with other professionals such as district nurses, community psychiatric nurses and GP’s. A multi-disciplinary approach was taken when risk assessing and care planning.

Medicines were safely managed. Staff were trained in giving medicines and were checked for competence before administering them unsupervised.

There were activities to involve and entertain people both within the home and the local community that were appropriate to their needs.

People received person-centred care that was delivered with kindness and compassion. Staff were caring and empathetic towards people. Behaviours were managed as ‘fear behaviours’ and staff changed their approach to support people.

There was a positive and inclusive culture in the service. The service’s ethos was to provide a home, not a care home and people were friends and not patients. This was embedded in and evident in staff practice.

The inspection took place on 19 and 20 January 2016 and was unannounced.

The Arbory Residential Home is a care home on the outskirts of Andover, Hampshire. The home is registered to provide accommodation and personal care for up to 60 older people who may be living with dementia. The home is made up of two buildings; The Court and The Lodge. At the time of our inspection 58 people were living at the service.

There was a registered manager in post. 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.

Although staff were able to tell us about the strategies used to keep people safe, risk assessments relating to behaviours that challenged were not always robust and require improvement.

People told us that they felt safe. Staff had a good understanding about the signs of abuse and had confidence in their manager to take concerns raised seriously.

People were supported by staff that had the skills and knowledge to meet their assessed needs. Staff received a thorough induction before they started work.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Information regarding diagnosed conditions was documented in people’s files.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted good quality of life.

The provider had appropriate arrangements in place to assess people’s capacity to make decisions about their care and treatment. Staff were knowledgeable about the requirements of the Mental Capacity Act 2005. Fifteen people were subject to DoLS at the time of our inspection and the registered manager was in the process of making more referrals to the local authority for DoLS assessments.

People who required assistance to eat and drink were supported effectively. Appropriate assessments had been conducted for anyone who had difficulty in swallowing their food. Interactions between staff and people during meals times were respectful and dignified.

Multi-disciplinary teams including mental health workers and occupational health were involved in reviewing and updating people’s risk management plans.

Medicines were managed safely. Any changes to people’s medicines were prescribed by the service’s GP and psychiatrist. People were involved before any intervention or changes to their care and treatment were carried out.

People had access to activities that were important and relevant to them. Records showed people’s hobbies and interests were documented and staff accurately described people’s preferred routines. There was a range of activities available within the home and community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager and said the management and leadership of the service very good and very supportive.

At our inspection of 5 December 2013 we found that where people received one to one support to eat their meals this was provided in a patient and sensitive way. However people were not always provided with appropriate support to eat and drink sufficient quantities. The provider wrote and told us that they had reviewed their mealtime routines and the level of supervision required to provide people with sufficient support at mealtimes.

At this visit we saw that people were supported patiently and sensitively to eat and drink sufficient quantities. We spoke with two people who used the service and the relatives of three people who all commented positively about the standard and choice of meals. One person when asked about the food at Arbory said: “It is extremely good we couldn’t get better, we’ve got a new chef and he is absolutely great.”

The mealtimes we observed appeared well organised with sufficient staff available to provide support for those people who could not eat or drink independently.

At our last inspection in September 2013 we found that the provider had not acted in accordance with legal requirements when people did not have the capacity to consent. We also found that odours in parts of the home indicated that an appropriate standard of cleanliness had not been maintained. We carried out this inspection to review the improvements that the provider told us had been made.

At this inspection we saw that there had been appropriate assessments of people’s capacity. Where there had been doubt about a person’s ability to make a particular decision at a certain moment in time a Mental Capacity Act 2005 (MCA) assessment had taken place.

We had received concerns about the care being provided at the home. This led us to look at the way people's care had been assessed planned and delivered. Staff we spoke with demonstrated their knowledge of the care and support plans and people’s individual needs. This included social, emotional and health related needs. We observed that staff interacted positively with people using the service and communicated effectively with them.

During our observations at this inspection we became concerned about the how people were being supported at mealtimes. Where people received one to one support to eat their meals this was provided in a patient and sensitive way. However people were not always provided with appropriate support to eat and drink sufficient quantities.

At this visit we looked at all areas of the home and looked at how the infection control systems were working. We found that the provider had completed all the improvements they told us about in their action plan. Floor coverings had been replaced in some areas and new cleaning equipment had been purchased.

Our inspection of 15 and 17 October 2012 found areas of non compliance with the Health and Social Care Act 2008. The provider wrote and told us of the actions they would make to address the areas of concern. At this inspection we found that the provider had completed their action plan and could demonstrate how they met the essential standards.

We used a number of different methods to help us understand the experiences of people using the service because the people had complex needs which meant they were not able to tell us their experiences. We observed interactions between staff and the people living at the home.

Staff told us that they had put a lot of work into developing care plans. One member of staff told us: “We have worked hard to make improvements, the biggest improvement is with the care plans and risk assessments, they are all reviewed and audited.”

Staff we spoke with were clear about how to recognise signs of abuse and how they would report any concerns they may have. Overall staff were very positive about the support they received and felt they could discuss any issues they may have with the registered manager. One staff member said of the registered manager: “Their door is always open.”

Relatives had been asked to complete a questionnaire about the service. Comments were generally positive about the care and support provided by the home. We saw that the registered manager had taken action to address any concerns that had been raised.

We spoke to two relatives during our visit. One relative told us “I think the home is quite good in many ways, I find it quite an easy going place.” Another relative told us “I have no complaints or concerns.”

One resident told us about living at The Arbory. “It’s very nice, I like it, the staff are respectful and courteous."

Another said “I find it quite pleasant; the staff are always very helpful. You feel part of it all. They do things for you.”

Residents told us they were involved in their care and treatment.

Everyone we spoke to told us they were happy with the care and support received.

Some people were aware of their care plan.

People said they had the help they required and they were encouraged to be as independent as possible.

One relative said they were happy with the care their relative received and had been involved whenever care needs had been reviewed.

Residents told us their home is kept clean and tidy.

People told us that the care staff brought them their medicines to take when they needed them.

We observed that staff checked with people before providing any care or support to make sure that they were happy with what was planned. Staff demonstrated they were aware that people could withdraw their consent to care at any time. However we did not see any record of best interests decisions being discussed or recorded. There was no reference, within care plans, that the Mental Capacity Act 2005 (MCA) had been used to arrive at decisions about people’s care and support.

We spoke with seven people who lived at the home and six relatives. Everybody was very positive about the care that was provided at The Arbory. One of the people we spoke with told us: "I have been here about a year and we are well looked after". One of the relatives we spoke with told us: "There is nothing here to find fault with".

We carried out two visits, one during the week arriving while night staff were still on duty and one on a Saturday afternoon. This gave us the opportunity to see how the home operated at different times with different staffing levels. We judged that there were sufficient staff to meet people's needs. People were being supported in a calm unhurried way. Staff told us: "We work as a team now".

We were aware of odours that existed in parts of The Lodge. Staff told us that ‘deep cleans’ were carried out on a regular basis and at other times when necessary. Cleaning schedules showed that carpets were shampooed regularly however this had not effectively removed the odour.