This inspection took place on 2 December 2014 and was unannounced.
Aylesham Court Nursing and Residential Care Home is a care home that provides residential and nursing care for up to 60 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. There were 46 people living at the home when we visited.
At the last inspection on 27 June 2014, we asked the provider to make improvements to the management of medicines, management of risks, provide an environment that was safe and secure, and improve the systems to effectively assess and monitor the quality of care provided. The provider sent us an action plan outlining how they would make improvements. During this inspection we found that the provider had made improvements in all of the identified areas.
A registered manager was 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.
Since the last inspection in June 2014 a number of concerns had been brought to our attention with regards to the health, safety and wellbeing of people who used the service. The local authority’s safeguarding team were continuing their investigations into concerns about the quality of care provided. The provider was working with the local authority to ensure that people’s needs were met and improvements were sustained.
People we spoke with told us that their care needs and support were provided safely. However, the staffing levels did not always ensure people’s care needs could be met safely and in a timely manner because there were not enough staff available.
People’s needs and associated risks in relation to their care and support needs had been assessed and plans of care detailed the support required.
People were supported by staff that had been checked as to their suitability to work with people and nurses were registered with the relevant professional body. Staff had undergone training relevant to their job role and their competency assessed in relation to meeting the needs of people in their care.
People told us they felt safe and protected from harm and abuse. People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. Staff had a good understanding of what abuse was and their role in reporting concerns.
People lived in an environment that was comfortable and promoted their safety and wellbeing. The provider had taken steps to ensure each room had suitable secure storage and locks were fitted to bedroom doors to promote people’s privacy. All areas of the home including the outdoor space were made safe and accessible.
Medicines were managed safely and steps had been taken to ensure the storage, ordering and receiving of medicines into the home and administration of medicines were safe.
People’s assessments and plans of care had been reviewed regularly, which provided staff with guidance as to the needs of people and their role in delivering the appropriate care and support. Staff had a good understanding of how people wished to be supported even though individual preferences were not recorded in people’s plans of care.
People told us they enjoyed their meals which were nutritionally balanced and met their dietary needs. Drinks and snacks including fresh fruits were readily available. Staff monitored people’s health and wellbeing and were referred to relevant health care professionals when there were any concerns about their health. People had access to health care support in order to meet their health needs.
Staff had undertaken training in promoting people’s dignity and rights. We observed staff treating people with care and compassion throughout our inspection visit.
The management team and staff knew how to protect people under the Mental Capacity Act, 2005 and the Deprivation of Liberty Safeguard and were complying with the conditions authorised. Records showed that people made decisions on occasions about their care and support needs. Although a person’s family or their representatives and other healthcare professionals had been consulted with regards to any best interest decisions those discussions were not always recorded clearly.
People were supported to take part in hobbies and activities that were of interest to them, which helped to protect people from social isolation. Staff had a good understanding of people’s individual interests and offered a choice of activities that they enjoyed.
People were encouraged to develop and share their experience of the service at meetings to review their care needs, ‘resident’s meetings’ and through satisfaction surveys. The provider’s complaints procedure was accessible to people who used the service, relatives and other visitors to the home. Advocacy services were available to people if they needed support to make comment or a complaint. The provider took action in response to concerns and individual issues raised about any aspects of the care delivered.
The registered manager understood their responsibilities and demonstrated a commitment and clear leadership to continually improve the service. The registered manager was supported by the deputy manager and senior staff. They had an ‘open door’ policy and welcomed feedback from people who used the service, relatives of people who used service, health and social care professionals and staff. The registered manager works with the commissioners such as the local authority that monitors the service for people they fund to ensure people received care that was appropriate and safe.
Staff knew they could make comments or raise concerns about the way the service was run with the management team and knew it would be acted on. There was a clear management structure and procedures in place to ensure concerns were addressed. Staff received support and training for their job roles to ensure their knowledge, skills and practice in the delivery of care was in line with best practice.
There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment, which was well maintained and safe. Monitoring systems were in place to check the quality and safety of the service provided and action was taken to address any deficiencies found and was monitored to ensure the steps taken were effective. The provider’s internal inspections helped to ensure them that people received quality care.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to inadequate staffing. You can see what action we told the provider to take at the back of the full version of this report.