Enter and view: The Arkley Nursing Home

Healthwatch Barnet carried out an announced Enter and View visit to Arkley Nursing Home on 12 May 2017 as a follow-up to an earlier visit in 2015 and against the backdrop of a recent CQC inspection that had rated the home as requiring improvement. Arkley Nursing Home, part of the BUPA group, provided nursing care for up to 51 residents and had 43 residents living there at the time of the visit. 

The inspection found that the home was generally well maintained, clean and welcoming. Residents had access to a central atrium, several small lounges, dining areas and attractive gardens. Bedrooms were ensuite and residents were able to personalise their rooms with their own belongings and furniture. 

Care planning processes were comprehensive and included detailed assessments before admission, involving residents, relatives and healthcare professionals. Care plans were reviewed monthly and included arrangements for end-of-life care where appropriate. The home had 17 residents subject to Deprivation of Liberty Safeguards (DoLS), and management expressed concern about delays in processing DoLS applications by local authorities, particularly Barnet. 

Residents’ health and wellbeing were closely monitored. New residents were assessed by a GP, weight and nutrition were monitored regularly, and specialist services such as speech and language therapy, tissue viability nursing, dietetics, chiropody and dentistry were available when required. The home also participated in Barnet’s Care Homes Enhanced Support Services (CHESS) initiative, which aimed to reduce unnecessary hospital admissions and improve resident care. 

Inspectors found that hydration was generally promoted, with water jugs available in bedrooms and drinks, snacks and cakes offered throughout the day. However, they observed that water jugs were not always positioned within reach of residents who were able to help themselves, and recommended that this should be addressed consistently. 

Staffing levels were considered adequate by management, with three nurses and nine care staff on duty during the day and two nurses and four care staff at night. Staff turnover had reduced, morale appeared positive and staff spoke favourably about the newly appointed manager, describing her as visible, organised, supportive and providing clearer leadership. Agency staff were used when required, but the home attempted to request familiar staff members. 

Training arrangements were robust and included both e-learning and face-to-face learning, supported by competency assessments, regular supervision and annual appraisals. Healthwatch found staff to be friendly, professional and knowledgeable. 

The home offered a varied programme of activities coordinated by a dedicated activities coordinator. These included one-to-one engagement for residents confined to their rooms, outings to local attractions, shopping trips, visits to the seaside, Kew Gardens and garden centres, trips to pubs, seasonal events and celebrations of residents’ birthdays. 

Food provision was viewed positively. Meals were prepared on site, special diets were catered for and residents’ individual preferences were accommodated. Inspectors noted that the chef demonstrated detailed knowledge of residents’ likes and dislikes. A tea room provided additional refreshments for residents and visitors throughout the day. 

Feedback from residents and relatives was generally very positive. People praised the staff, food and activities, and relatives reported receiving regular communication and updates about residents’ care. However, one issue repeatedly raised was the variable response time to call bells, with some residents reporting waits of up to 30 minutes on occasion. 

Overall, Healthwatch concluded that Arkley Nursing Home was providing good care in a supportive environment and that the newly appointed manager was already having a positive impact on standards and staff morale. The report recommended ensuring that all residents had access to drinks at all times, improving responses to call bells and increasing awareness among residents and relatives about care plans and how they could be involved in reviewing them. It also asked Barnet Council to examine ongoing delays in processing DoLS applications. 

Arkley Nursing Home accepted the recommendations and outlined actions already taken, including the introduction of a visual call bell monitoring system and increased involvement of residents and relatives in care plan reviews. Barnet Council acknowledged delays in DoLS processing and stated that it was reviewing systems and procedures to improve performance.