Arrigadeen Nursing Home provides a service for up to 29 older people. The service is registered to provide the following regulated activities: Accommodation for persons who require nursing or personal care, treatment of disease, disorder or injury and diagnostic and screening procedures. It is also registered to provide personal care to people in their own homes. This was a combined inspection where we looked at the experience of people living in the home as well as people who used the domiciliary care service.

Arrigadeen Nursing Home is a nursing home for 29 people living with dementia. The home provides nursing care for people over 65 years who may have physical disabilities, sensory impairments or living with dementia. The home is a converted Victorian house set in its own gardens.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

Staff continued to ensure people were safe.

There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care.

People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to eat and drink according to their likes and dislikes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff continued to provide a caring service to people.

People and their relatives told us, and we observed that staff were kind and patient. People were involved in decisions about the care and support they received. People’s choices were respected.

Staff remained responsive to people’s individual needs.

People received care and support which ensured they were able to make choices about their day to day lives. People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home continued to be well led.

People and staff spoke highly about the management. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

Further information is in the detailed findings below.

We carried out this inspection on 10 February 2015 and this was an unannounced inspection. During a previous inspection of this service on 26 January 2014 we had identified concerns that people were not consistently involved in how their care was planned or provided. During this inspection we found the provider had made the appropriate improvements.

Arrigadeen Nursing Home provides personal and nursing care for a maximum of 29 people. At the time of the inspection there were 18 people living in the home. In addition to the nursing home, Arrigadeen Nursing Home is also registered to provide care to people in their own homes. At the time of our inspection the service was providing personal care to 9 people in the local community.

A registered manager was in post at the time of inspection. 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 and associated Regulations about how the service is run.

The provider had failed to notify the Commission, as required, of a serious injury sustained by a person who used the service.

People told us they felt safe and the provider had appropriate arrangements to identify and respond to allegations of abuse. Staff knew how they would report any safeguarding concerns internally or externally if they had any concerns over people’s welfare. A whistle-blowing policy was in place which provided information for staff to follow should they need to raise any concerns externally.

People told us their needs were met promptly and staff confirmed there were sufficient numbers of staff to enable them to perform their roles effectively. People told us they had no concerns with the numbers of staff on duty and that their call bells were answered promptly. Staffing levels set by the registered manager had been achieved to meet people’s needs. The registered manager adjusted staffing levels to meet people’s needs when required. Safe recruitment procedures were undertaken when staff were employed at the home.

People told us they received their medicines on time. The service had suitable arrangements in place for the ordering, storage, administration and disposal of medicines. Medicines were stored appropriately and records had been completed accurately. The provider had an auditing system to monitor people’s medicines.

People gave positive feedback about the staff at the home. They told us they were very happy with the standard of care they received. Staff said they felt had the knowledge and skills they needed to carry out their role effectively. Staff were provided with regular training and regular staff appraisal and supervision was undertaken to monitor performance.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and the service were currently completing applications where a need had been identified. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

People were provided with sufficient food and drink and positive feedback was received on the standard of food provided. People who were assessed as needing support to ensure they maintained a good intake of food and drink received the support they required. Arrangements were made for people to see their GP and other healthcare professionals when required.

Staff had developed caring relationships with people at the home and we observed friendly and positive interactions throughout our inspection. People and their relatives spoke highly of the staff at the home. Where possible, people were involved in making decisions about their care and treatment. People told us they felt their privacy and dignity was maintained and respected by staff.

People received personalised care that met their individual needs. We made observations throughout our inspection that people received care in line with their assessed needs. The provider had a complaints procedure and people felt confident they could complain should the need arise.

The registered manager was well respected was spoken of positively by staff and the people at the home. Staff felt they were able to raise suggestions or concerns and contribute to the way in which the home was run. The provider had systems to monitor people’s health and welfare and the quality of service provision and care was monitored.

During our inspection carried out on the 28 July 2013 we found that the service was not meeting five of the essential standards. The provider sent us an action plan detailing how they would ensure that these essential standards would be met. We carried out an inspection on 16 October 2013 to follow up one of the essential standards. We found that the provider had met this standard. During this inspection we checked what progress the provider had in meeting the other four essential standards that the provider was not meeting.

During our inspection visit we spoke with the registered manager and five members of staff. We also spoke with four people living at the home. Comments we received from people included “I’m quite happy here and have no reason to complain” and “I’m very happy here, I’m well looked after and we get good home cooked meals”.

We found that improvements had been made in how the home involved people in their care and support. However, the provider had not completed their action plan in this area and was not meeting this essential standard.

The home was found to be clean and free from odours.

The home had systems in place which ensured that people were administered their medication in a safe way.

The home had increased their staffing levels at the home. People and staff told us that the staffing levels had improved at the home.

We found that staff were provided with training and support which enabled them to carry out their roles effectively.

During our inspection we viewed records and spoke with five people who used the service the registered manager, matron, nurse and care staff .

People made positive comments about the support they were given. Comments included “it is quite satisfactory here, they do their best”, “the staff are polite and no one offends me” and staff do their utmost to keep me entertained”. Another person told us “I am only here on respite but the staff have been very kind”. Another person told us “I was quite poorly when I first arrived but now I am able to do most things for myself. Friends and family visit and I can go out with them for meals”.

One person told us “the staff are very patient and offer reassurance to people when they can be very aggressive towards them, the staff know the individuals and will spend time trying to offer reassurance”. The person told us that an individual would occasionally hit out at staff as part of their dementia. Staff confirmed this person could be aggressive and would hit out at them. We were told that staff would sit and talk with the person to offer reassurance and alleviate any anxieties.

We also spoke with three relatives. They told us they were happy with the care provided and were confident that staff kept them informed of any changes to their relative’s care.

The care we observed during the inspection was appropriate and safe for the people living in the home. We were also assured by the registered manager that the home was seeking to improve care plans.

We visited Arrigadeen Nursing home at 8:20am on a Sunday morning. At the time of our inspection there were 20 people resident in the home.

During our inspection we looked at the records relating to people receiving care in the home. We spoke with the four care staff on duty; a nurse and three care staff. We also spoke with the matron who arrived part way through the inspection, twelve people living in the home and two relatives. In addition to this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us to understand the experience of people who could not talk to us.

Through our observations we found that the provider had not ensured the dignity and independence of people living in the home and that people were not enabled to make, or participate in making, decisions relating to their care or treatment.

People’s needs were assessed by the home however the provider had failed to ensure that support plans reflected the people’s changing care needs. Care and treatment was not planned and delivered in line with people’s individual care plans and did not ensure people’s safety and welfare.

During our inspection we observed that there were not enough qualified, skilled and experienced staff to meet people’s needs.

At the time of our inspection there were 20 people living at Arrigadeen Nursing Home. During our inspection we spoke with people who lived in the home, a visitor to the home, a healthcare professional visiting the home, members of staff, the registered manager and the provider. We examined records, minutes of meetings and survey results. People told us "I always have someone on hand to help me, it’s like having a guardian angel" and "my friend feels reassured that they are safe here".

We found that people and their representatives had been involved in planning their care. The care plans we saw provided details of people's individual needs, wishes and preferences. The home sought advice from external healthcare professionals where necessary and this was recorded in people's care files. A range of activities were provided and people could choose whether they wished to take part.

The provider’s infection control procedures met the recommended guidelines for the prevention and control of infection within the home, which meant people were protected from the risk of infections.

We found that pre-employment checks were undertaken before staff began work and there were effective recruitment and selection processes in place.

The home's quality assurance systems ensured that the performance of the home was adequately monitored, and the views of people living in the home and their representatives were taken into consideration.

During our visit on 4 May 2012 we found that the home was not compliant with the regulation in the outcome area of supporting workers. The provider wrote to us following our visit and told us what they were going to do to make sure that they were compliant with the regulations in these areas.

Prior to our visit on 28 September 2012 we also received some anonymous concerns about nutrition, inadequate equipment, cleanliness and infection control and staffing levels within the home.

We visited the home on 28 September 2012 to check that the provider had made the improvements which they told us they would in respect of supporting staff and to follow up the concerns that had been raised with us.

We did not speak to people in depth during this inspection, but two visitors we spoke with told us that they were happy with the home.

The service cared for older people, many of whom were in an advanced stage of dementia. We were therefore not able to talk with the majority of people in any great depth about their care. We did speak to a few people who were able to tell us their views and we observed care and support delivered to people. We reviewed the information held about people and plans for their care, and talked with visitors to the home and members of staff.

People we spoke with and their visitors told us that generally they felt they were kept up to date with the care of their relative.

They confirmed that the staff were respectful towards them and that they felt consulted and involved in their individual care packages. They told us that the things that were important to them in relation to their care and support were established as part of their assessment, and that the support to meet those needs was provided in a sensitive caring manner.

One person told us “I get up when I choose to and go to bed when I choose. I spend my time watching TV and reading. I do not want to join in with activities as many people are confused”.

During our visit we saw that the majority of people were assisted with dressing and after they had breakfast they were supported to sit in one of the two lounge areas. People then stayed sat in the lounge for most of the day. We saw people engaged in activity in the morning and watching television in the afternoon. We saw staff monitoring people’s needs and assisting people with their personal care needs, but they did not have a lot of time to spend talking with people, except when they were engaged in providing care.

There was a complaints procedure in place and relatives’ views about the service were regularly sought by the management team. All visitors and staff spoke highly of the staff and management team who we were told were approachable.

We found the service to be compliant with four of the five outcome areas that we looked at, but we have issued one compliance action in respect of staff training which we felt had a minor impact on people who lived in Arrigadeen Nursing Home. There were also a number of improvements that the management team were in the process of addressing in order to maintain compliance.