Aarons Specialist Unit

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment to the service in March 2023, risk assessments were not always completed. The protocols for managing people’s medicines were not always in line with best practice. This was a breach of regulation as the care and treatment was not always safe. Although some improvements were still required, enough improvement had been made at this assessment and the provider no longer remained in breach of this regulation. Improvements were required to ensure safeguarding procedures were embedded in staff’s day to day practice. Risk assessments were completed but some lacked detail on how risks posed should be mitigated. De-escalation techniques were not routinely used or considered prior to the use of restraint by staff. There were enough staff deployed but people’s and relatives’ comments relating to staffing were variable. Minor improvements were required to some aspects of medicines management. Improvements were required to staff inductions, training and supervision. Following our assessment the above had been included for action to the service’s Home Action Plan [HAP].

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they felt able and comfortable to raise concerns.

Staff knew how to record accidents and incidents and were dealt with as an opportunity to put things right, learn and improve. A member of staff told us they would document information relating to the above and relay this to senior staff and/or management team.

Suitable arrangements were in place to record, investigate and respond to any concerns and complaints raised with the service. There were procedures in place to record incidents and accidents. The management team reviewed incidents and accidents to identify where actions where needed, for example, medicine errors.

Relatives told us an assessment was carried out by staff prior to their family member being admitted to Aarons Specialist Unit. They told us they were given an opportunity to visit the service and were actively involved in providing information to inform their family member’s care plan.

The registered manager told us about the provider's assessment and admission process. They confirmed that people’s care and support was planned where possible with the person, those acting on their behalf and other key partners to ensure continuity of care.

People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and risk assessments. The procedures in place for when people moved between services was robust.

People and their relatives considered themselves and their family member to be safe living at Aarons Specialist Unit. A relative told us, “Usually yeah, a couple of issues [relating to medicines management] but generally yes” when asked if their family member was safe living at the service. Other relative’s comments included, “Very safe with staff, sometimes overprotective” and, “100% X is safe here [Aarons Specialist Unit], I have total peace of mind when I am not here.”

Most staff had received training on how to recognise and report abuse. Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. However, this did not routinely happen in practice as there was an incident in December 2023, whereby staff failed to raise concerns with the management team at the earliest opportunity. Staff were confident any concerns would be taken seriously and acted on by the management team.

The registered manager was aware of their responsibility to notify us and the Local Authority of any allegations or incidents of abuse at the earliest opportunity. However, safeguarding procedures were not always followed as we found the management team had failed to inform the Local Authority and Care Quality Commission of an allegation of harm and abuse. Following our assessment, we were advised that a safeguarding concern relating to this incident had been retrospectively completed and forwarded to the Local Authority.

Relatives told us how staff knew the people they supported well and were able to identify risks to their loved ones and how staff supported them on a daily basis.

Staff spoken with demonstrated an understanding of the individual risks posed to people being supported. Specifically, staff were able to tell us how they supported people who could become anxious and distressed, the preventative measures to be taken for people were at risk of falls or who experienced difficulty mobilising and those people who were at risk of choking.

Personal Emergency Evacuation Plans [PEEPs] documented the level of staff assistance necessary to evacuate safely. No consideration had been made to identify people’s physical and neurological needs which could affect their ability to evacuate, their ability to communicate and understand instructions and where they could be anxious and distressed. This is a bespoke plan for people who may have difficulties evacuating to a place of safety without support or assistance from others. Following our assessment the above had been included for action to the service’s Home Action Plan [HAP]. Most risks to people's health and wellbeing had been assessed, which identified the risks they could be exposed to, and the support needed to minimise the risks. However, these lacked detail to provide staff with sufficient guidance as to how the risks posed should be mitigated. This meant we could not be assured staff had all information required to manage a person's risks in a safe and effective way. Where people exhibited behaviours that could be distressing to themselves and others, several records failed to demonstrate restraint must only be used by staff when absolutely necessary and only in exceptional circumstances. Records showed de-escalation techniques were not routinely used or considered prior to the use of restraint by staff. Observation data failed to provide necessary information detailing staffs’ interventions and outcomes when a person became anxious and distressed. It was also evident that some of the language recorded by staff relating to people’s anxious and distressed behaviours provided a negative inference. Following our assessment the above had been included for action to the service’s Home Action Plan [HAP].

Equipment utilised at the service for people’s use was clean and had been checked regularly to ensure it remained safe and in good working order.

There were systems and processes in place to ensure the environment was safe. Health and safety checks were in place and carried out regularly and where corrective actions were required, these were identified on the service’s Home Action Plan [HAP].

People’s and relatives’ comments relating to staffing were variable. A relative told us, “Most of the time there is” [enough staff] but explained to us there were occasions when there were not, and this could impact on staffs’ response time to provide personal care to people using the service. Additionally, they told us social activities for people using the service were “very hit and miss” suggesting there were at times insufficient staff available to initiate and ensure people were supported with their social care needs.

Staff confirmed they received regular formal supervision and were supported and valued by the management team. Staff told us they received both mandatory and more specialist training in key subjects and this consisted of both face-to-face and e-learning. A member of staff told us, “Yes, I think I am supported. I feel the training is really good, I have been really impressed.”

Our observations during the assessment demonstrated there were enough staff on duty in line with staffing levels stated by the registered manager. However, throughout the assessment, staff employed to provide 1 to 1 support to individual people, demonstrated very little engagement and communication with those being supported. Staff either stood or walked alongside people silently with little interaction. Following our assessment the above had been included for action to the service’s Home Action Plan [HAP].

Staff recruitment records demonstrated relevant checks were completed before a new member of staff started working at the service. This included an application form, written references, proof of identification and Disclosure and Barring Service [DBS] checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Newly employed staff received an induction and were given the opportunity to ‘shadow’ more experienced staff to ensure they understood the routines of the service and their roles and responsibilities. Not all staff employed at the service had attained up to date mandatory or specialist training relating to the needs of the people they supported. For example, the staff training matrix forwarded to us following our assessment to the service, recorded only 47% of staff had attained ‘practical’ moving and handling training and fire warden training and only 51% of staff had achieved fire drill training. A further six training courses recorded between 71% and 82% of staff had accomplished training in these areas. Although staff had received regular formal supervision, where areas for improvement were recorded relating to a staff member’s performance, there was a lack of information detailing how corrective actions were to be monitored and actioned. For example, a member of staff revealed a number of concerns that affected their emotional wellbeing. Others expressed concern about the challenges faced with using specific moving and handling equipment and supporting a person who used the service on a 1 to 1 basis without any prior experience or knowledge of that person. Nothing was recorded detailing the support to be provided and how this was to be addressed by the management team. Following our assessment the registered manager wrote to us and confirmed a new form had been devised and was to be introduced in July 2024.

People and relatives raised no concerns about the cleanliness of the service.

Staff were clear about their roles and responsibilities around infection prevention and control. The service had specific ‘champions’ ensuring important information relating to infection prevention and control was cascaded to staff and that they followed and adopted good practice guidelines.

Though not all staff had attained up to date infection prevention and control training, staff were observed using Personal Protective Equipment [PPE] appropriately and when required. Prior to people commencing their meals, staff were observed to offer people the opportunity to clean their hands. People were protected from the risk of infection because the premises and equipment were kept clean. Additionally, the service was odour free and equipment was found to be clean and in good working order.

There was an effective approach to assessing and managing the risk of infection at the service, which was in line with current relevant national guidance. Infection control audits were conducted at regular intervals, highlighting where the provider was compliant and areas for improvement.

Relatives spoken with told us they were generally satisfied with the management of medicines and stated where medicine errors had occurred, these had now been resolved by the management team.

Staff were able to competently describe how they supported people with their medicines management. Staff confirmed they had received appropriate medicines training and had their competency assessed at regular intervals to ensure their practice remained safe. Staff told us they had had their practice observed, ensuring they remained capable and knowledgeable when administering medicines.

During our assessment staff were observed to administer people’s medicines appropriately and in line with current guidance. The medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together or too late. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported. Medicine records were generally maintained to a good standard, and Medication Administration Records [MAR] demonstrated most people received their medicines as they should and in line with the prescriber’s instructions. However, not all people had been given their prescribed medicines in line with the prescriber's instructions. For example, some people were prescribed medicines which were to be administered in the morning 30 to 60 minutes prior to food, drink and all other prescribed medicines. Staff did not follow this instruction and the MAR showed these were routinely given at the same time as all other medicines at 8.00am rather than being administered earlier, for example, at 7:00am. As part of good practice procedures, handwritten MAR forms were not double signed to ensure its accuracy. None of the above had been picked up by the provider’s auditing arrangements.