Aaron Court Care Home

We found the following examples of good practice.

There were robust policies, procedures and good practices in place to manage risks associated with the COVID-19 pandemic which were regularly reviewed and updated following any changes in national guidance. These included the management of people with a COVID-19 positive diagnosis, staffing, admissions of people to the home, visitors and PPE.

People living in the home and their family were supported to maintain contact. This included designated essential carers. Residents had a contact and visitors plan in place. Visiting was by appointment only. In the event of COVID-19 visit restrictions people were supported to maintain contact by the telephone and video calls. Relatives of people coming to the end of their lives were supported to visit safely. People were admitted safely and in accordance with national guidelines to the home from the community or from hospital.

The home had good supplies of Personal Protective Equipment (PPE) for staff and visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE, and we observed staff wearing it correctly during our inspection. Clear signage, information and personal support was in place throughout the home to remind and educate staff and visitors of their responsibilities.

A programme of regular COVID-19 testing for people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including visiting professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed. The provider was meeting Covid-19 vaccination requirements for staff, residents and visitors. Documentation was in place and retained for a specified period.

The home appeared clean and hygienic throughout. Daily cleaning schedules were implemented by housekeepers. These have been reviewed and enhanced. All staff were involved in undertaking extra cleaning throughout the day and night.

Staff and management were well supported to be resilient and manage IPC risks effectively.

Aaron Court is a residential care home providing personal and nursing care to 52 people aged 65 and over at the time of the inspection. The service can support up to 73 people. The building accommodates people over four wings in one adapted building.

People’s experience of using this service and what we found

At our last inspection in June 2018, we found the home was in breach of regulations.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

People were not always able to tell us specifically about their experiences of living at Aaron Court. Our observations of the support provided found that people were relaxed, comfortable with the staff team and used the staff team as a point of reference to assist them in their daily lives. People experienced genuine and dignified support at all times with their independence encouraged.

Relatives were happy with the support their relations received telling us that “staff are kind”, [name] is safe living here”, “I can walk away knowing [name] is being looked after and is receiving a well led service”.

People received care in a safe environment with appropriate equipment. Risks associated with their care was fully taken into account. People received medication safely and, in a person-centred manner. There were sufficient staff available to meet people’s needs and attend to them. New staff were recruited robustly. Systems protected people from abuse.

The building was clean and hygienic with staff having access to suitable equipment to limit the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received training and supervision in order for them to perform their role. The environment was tailored to take people’s needs into account.

People’s nutrition and health were supported and promoted.

People were supported in a dignified and caring manner, enabling them to have their privacy respected. People were enabled to communicate in their preferred manner and were given time to express themselves.

Care plans were person- centred and included the needs of people in all aspects of their daily lives. Activities were in place and sought to reduce the risk of social isolation.

The service had responded to breaches at the last inspection and had employed a quality lead to oversee aspects of quality of care. Audits supplemented the drive for improvements. People were invited to comment on the quality of care provided. Links with the local community were established.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was requires improvement (published 5 June 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aaron Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to accommodate up to 73 people in one adapted building. At the time of the inspection there were 58 people using the service. The service consists of three units which provide a mixture of nursing care, and care for people living with dementia.

There was a registered manager in post within the service. 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.

The inspection was unannounced and took place over two days on the 21 and 22 March 2018. At the last inspection in February 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvement had been made, however we identified a continued breach of Regulation 17 and an additional breach of Regulation 18. You can see what action we told the provider to take at the back of the full version of the report in response to these issues.

Quality monitoring systems were being completed, however they had failed to embed quality into the day-to-day running of the service. We identified that a sluice room had been left unlocked and the tap in this room was dispensing very hot water. Pull cords had been tied up in some bathrooms which meant they were not accessible should people need these. We also found that care records did not always include consistent information about people’s needs.

We followed up on concerns raised by the local Clinical Commissioning Group (CCG) regarding the medication audit process used by the service. We found that this has been improved in response to issues they had raised.

Training was not being kept up-to-date within the service. Records provided by the registered manager showed that training was overdue in areas such as infection control, moving and handling. It is important that staff skills and knowledge are maintained to ensure they can carry out their role effectively.

Whilst people’s personal care needs were being attended to, we noted that they were not always being given the option of having a bath, where this was their preferred choice. Baths within the service all contained a layer of dust which showed they had not been used, and this was confirmed by records which showed people were predominantly offered a ‘wash’. We have made a recommendation to the registered provider in relation to the provision of person-centred care.

In a majority of cases the service was compliant with the requirements of the Mental Capacity Act 2005 (MCA); however we identified examples where mental capacity assessments had not been completed, and in one instance an application had not been made to deprive a person of their liberty as required. We looked into these examples and found that there had been no impact on the people being supported. We have made a recommendation to the registered provider in relation to the MCA.

We checked a sample of people’s medication and found that these were being administered appropriately. Medication records were being filled in as required by staff when these had been given, and the quantities of those medications that we looked at were correct and all accounted for.

We looked at a selection of staff recruitment records which showed that a robust process was in place. Staff had been subject to a check by the disclosure and barring service (DBS) and had also been required to provide two references, one of which was from their most recent employer. This helped ensure staff were suitable to work with vulnerable people.

People were protected from the risk of abuse. Staff were aware of how to report any concerns they may have and were aware of the different types of abuse that might occur.

People had been supported to access health professionals where required. This helped to ensure that their health and wellbeing was maintained.

Positive relationships had developed between people and staff. We observed examples where people had felt confident and able to challenge staff which showed that they were comfortable in their company. We also overheard a lot of laughter and discussion between them.

People’s family members commented that their relatives were well cared for during the end stages of their life. Where required people had appropriate paper work in place from their GP outlining their wish not to be resuscitated. This was clearly displayed at the front of their care records which ensured it was accessible.

Activities were in place for people using the service. During a recent meeting with people using the service and their family members a request had been made for further activities to be made available. In response to this issue an additional activities co-ordinator had been employed. During the inspection we saw people joining in activities as a group and in one-to-one sessions.

The inspection was unannounced and took place on the 7 & 8 February 2017. A previous inspection was carried out in February 2015 during which the service was found to be ‘requires improvement’. The follow up inspection completed in July 2015 found that action had been taken to address the issues that had been identified, and the service was rated as ‘good’.

There was a registered manager in post who had been registered with the CQC since December 2010. 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.

At this inspection we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Pressure relieving mattresses were not always on the correct setting which placed people at risk of harm. In addition, we observed that mattress settings did not always correspond to checks that had been carried out by staff and staff had failed to identify where the setting specified by records was not correct. This showed inaccurate recording of information and demonstrated that this system was not robust.

A bathroom tap dispensed water at 50 degrees Celsius, which is above the maximum limit of 44 degrees Celsius set by the Health and Safety Executive, where outlets are accessible to people. This place people at risk of scalding. This had been identified as an issue, as demonstrated by signage which warned that the water was hot. However appropriate action had not been taken to address this issue.

A majority staff treated people with dignity and respect, however we observed occasions where staff were task-led in their approach, or did not speak to people in a dignified way. This had not previously been identified as an issue, and therefore action had not been taken to address this. We have made a recommendation to the registered provider around the appointment of dignity champions to assist staff with recognising poor practice.

Audit systems had failed to identify and adequately address the issues found during the inspection visit. This showed that these systems needed to be more robust.

Some positive relationships had been developed between people and staff. We observed examples where they laughed and chatted together. Staff also acted to relieve people’s distress, for example by offering reassurance where people experienced episodes of anxiety. People’s family members also told us that they were made to feel welcome when they visited the service. People told us that a majority of staff were kind.

The environment was clean, safe and well maintained. However little consideration had been given to how the environment could be adapted to enhance the experiences of people living with dementia or a sensory impairment. For example, food menus were written in small writing and were not up-to-date, and there were no distinctive markers in corridors to help people find their way around. The registered provider had plans in place to carry out a refurbishment of the service.

People were protected from abuse. Staff had received training in safeguarding vulnerable people and were aware of the signs and indicators that may show abuse is taking place. Staff were aware of whistleblowing procedures and when they should use these.

Recruitment processes were robust and helped ensure that people’s safety was maintained. Checks were carried out prior to new staff starting to ensure they were not barred from working with vulnerable adults. References were also sought from their most recent employers. This helped inform the registered provider about the suitability of candidates.

People were given their medicines as prescribed. Medication administration records (MARs) were completed as required by staff. Medicines were stored at the correct temperatures in line with manufacturer guidance. This helped ensure that medicines maintained their efficacy.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received support in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training and were aware of their roles and responsibilities in relation to this. People had been given the opportunity to challenge restrictions placed upon them as required by the MCA.

People had been supported to access input from health and social care professionals where required. People’s family members gave examples where their relatives had been referred to their GP for support due to poor health. This helped ensure that people’s health and wellbeing was maintained.

Care records were personalised and contained information around what staff needed to do to support people in relation to their individual needs. These also contained information around people’s life history which enabled staff to get to know the people they were supporting. This helped to facilitate positive relationships between people and staff.

The registered provider had recently employed two activity co-ordinators to support people engage in activities. We observed people being engaged in one-to-one chats and group activities, including a game and sing-a-long. This helped ensure that people were protected from the risk of social isolation.

Audit systems were in place and carried out by both the registered manager and the registered provider. These systems looked at areas such as accidents and incidents, weight monitoring and complaints. This had ensured that these aspects of the service were being carried out to a good standard.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and the required authorisations had been obtained. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights were upheld.

The registered manager set the staff rotas, making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

However, we found that improvements were needed in the recording of medicines and the management of creams and ointments.

Is the service effective?

There was an advocacy service available if people needed it, which meant that when required people could access additional support.

People's health and care needs were assessed with them. People who used the service and their relatives said that they had been involved in writing their care plans and they reflected their current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us that they were happy with the service and well cared for. One person said "I chose to come here because they looked after one of my relatives very well". We also spoke with six relatives whose comments included: "The care is wonderful, spot on"; "The care is excellent and it's very homely"; "I'm 90% satisfied, my relative is well looked after and well nourished".

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service and their relatives completed an annual satisfaction survey. The vast majority of people were satisfied with the care provided.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly and a residents' committee had been set up to plan further activities.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and had a good understanding of the ethos of the home. They said they felt well supported and had access to vocational training.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. However, the system had not been effective in picking up the shortfalls we identified in the management of medicines.

We looked at menus and food that was available to people who lived at Aaron Court. We found there was a good variety of meals available and people said the food was good and plentiful.

We spoke with four people who used the service, two relatives, the visiting hairdresser and six staff members. People who used the service said: 'The staff are nice', 'I like the food' and 'The staff are kind.'

Relatives commented: 'The home is always clean, they keep it nice', 'The staff treat my relative very well', 'There always seems to be staff around' and 'The standard of care is very good.' They didn't have any concerns or complaints about the home.

Staff commented: 'The manager is very good. She listens to the staff and acts for the welfare of the service users', 'We have regular staff meetings', 'I like supporting people and making them comfortable' and 'The training is good here.' All the staff said they got good support from the management team and that the registered manager was good and care for the staff team as well.

We looked at the staff rotas and the staffing levels in general for the home. We discussed staffing issues with the manager and they confirmed that the current staffing levels met the needs of the people who lived at Aaron Court.

Many of the people who lived at Aaron Court were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

'I'm warm at night everything is fine'; 'I'm well looked after, lunch was good' and visitors told us 'Staff have told us we can look at our relatives care plans at any time but we haven't bothered, everything is fine.'

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We noted that everyone was well dressed and well groomed. We saw many examples of good communication and patience by care staff, who interacted with people in a positive manner. Staff were friendly and respectful to the people they were supporting. We observed staff quietly talking to people at eye level. Staff took the opportunity to generally communicate and initiate conversations during every interaction they had with people they were supporting.

Recent training had been provided to all staff on 'Dementia care.' The manager advised on recent training from their local hospice regarding specialised support for 'End of life care.' Updated training and support helped staff to meet the diverse needs of the people living at Aaron Court.