Aston Manor EMI Residential Home

Aston Manor is registered to provide nursing and residential care for up to 32 people, at the time of this inspection there were 26 people living at the home. The home provides accommodation across the ground and first floors in single en-suite bedrooms.

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

We identified gaps in staff refresher training in subjects including dementia awareness, safeguarding and the Mental Capacity Act (2005). Prior to our inspection, some training had been booked to address this.

On the day of our inspection, we witnessed an avoidable accident, although appropriate action was taken by staff in response. Risk assessments were sufficiently detailed. Staff were not aware of personal emergency evacuation plans, but were able to describe action they needed to take in the event of a fire.

Staff received regular supervision as well as meetings for them to raise issues and receive feedback.

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.

The administration of medicines was managed safely.

There were sufficient numbers of suitably deployed staff to meet people’s needs. The process followed for recruiting new staff was safe.

People felt safe and protected from harm living at this home. Staff knew how to identify abuse and told us they would report this.

People’s dietary needs were met. Mealtime audits had identified the need for staff to provide condiments. This was an issue found at our last inspection and remained a concern. Records showed people’s healthcare needs were met by a range of professionals.

Staff were caring in their interactions with people. Relatives confirmed this routinely happened. Staff respected people’s privacy and dignity as well as their equality, diversity and human rights.

Care plans contained enough information to guide staff. Relatives were involved in people’s care and told us staff knew their family members and their preferences well. One person’s end of life care needs were being well managed.

No complaints had been received at the time of our inspection. The registered manager told us activities were difficult to provide for the group of people they cared for. Some evidence of stimulation provided was evident.

A system of audit was taking place on a regular basis. The registered manager had actively looked to work in partnership with other services. Relatives and staff gave positive feedback about the registered manager.

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 16 August 2018) and there were multiple breaches of regulation. The registered 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 from the last inspection. However, a new breach of regulation 18 (Staffing) was found.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Aston Manor is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Aston Manor is registered to provide nursing and residential care for up to 32 people, at the time of this inspection there were 26 people living at the home. The home provides communal areas to the ground and first floor as well as single en-suite bedrooms.

The service had a registered manager in place. 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.

During this inspection, we identified that the service was breaching regulations related with person centred care, dignity and respect, consent, safe care and treatment and good governance.

We found staff recruitment was safe. Not all staff training was up to date however, we saw a number of training dates had been booked for the coming weeks. Staff received management supervision. We observed there was sufficient staff on duty to meet people’s needs although we noted people’s needs were not always met in a timely manner at mealtimes

The atmosphere at breakfast and lunch was calm, people received support and were enabled to make choices about where they sat and what they wanted to eat and drink. We saw examples of good practice but we also saw examples of where staff needed to improve their engagement with people. This was particularly evident where people’s ability to verbally communicate was compromised. We saw staff showed people two plated up meals so they could choose which they wished to eat but we did not see any other alternative form of communication being used. This meant people were not always supported to have maximum choice and control of their lives.

We found people who had recently been admitted to the home did not have risk assessments, care plans or capacity assessments in place.

Relatives told us their family member was safe, staff were aware of how to raise any safeguarding concerns. Medicines were stored and administered safely.

The home was clean and odour free. Some improvements had been made to the lounge and dining room. We identified areas where improvements were needed to fire safety.

We saw evidence staff spent time with people but the provision of meaningful activities for people remained inconsistent and records were not always accurate. There was little evidence that life history work commenced earlier in the year had been progressed.

Relatives and staff were positive about the input and support they received from the registered manager. An operations manager had been employed since the last inspection. A range of audits had been completed, including one by the operations manager; an action plan had also been devised to address the identified shortfalls. We were not able to evidence the effectiveness of this plan as it was not implemented until after this inspection.

This is the second time the service has been rated Requires Improvement. We found five breaches 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.

Aston Manor was last inspected in April 2017, at that time we identified multiple breaches of regulation. As a result, the home was rated as 'Inadequate' overall, as it was deemed to be 'Inadequate' in the key questions of Safe, Effective and Well-led, and 'Requires Improvement' in the key questions of Caring and Responsive. The home was placed in Special Measures on 6 July 2017. We also took enforcement action to cancel the registration of the registered manager and vary a condition of the provider’s registration.

We kept Aston Manor under review and inspected the service again in August 2017. We identified continuing breaches of regulation. As a result, the homes overall rating remained unchanged; 'Inadequate', as it was deemed to be 'Inadequate' in the key questions of Safe, Effective, Responsive and Well-led, and 'Requires Improvement' in the key question of Caring. The home remained in Special Measures. We therefore, took further action in line with our enforcement procedures to prevent the registered manager and registered provider from operating this service.

The inspection on 26 and 29 March 2018 was to see if any improvements had been made to the quality of care people received. During this inspection, we identified the service was breaching regulations related to person centred care, dignity, staffing and governance.

Aston Manor is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Aston Manor is registered to provide nursing and residential care for up to 32 people, at the time of this inspection there were 24 people living at the home. The home provides communal areas to the ground and first floor as well as single en-suite bedrooms..

The service had a registered manager in place. 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.

Risks to people were assessed although further work was needed to ensure they provided sufficient detail and were updated to ensure they were reflective of peoples current support needs. Accidents and incidents were recorded and analysed but the system in use did not enable the registered manager to easily identify patterns occurring over a period of months.

There was a system in place to ensure the premises and equipment were safe to use. Previous concerns regarding cold water temperatures and personal emergency evacuation plans had been addressed. Staff had received fire training but had not practised a simulated fire drill or been trained in how to use evacuation sledges.

There were no concerns raised regarding staffing levels at the home. There was no system in place to regularly check the professional qualifications of nursing staff employed at Aston Manor and personnel records did not always evidence the rationale for gaps in candidates employment history.

People’s medicines were stored and administered safely; improvements had been made to the management of creams. Where medicines were prescribed 'when required' all but one of the medicines we reviewed contained a protocol to reduce the risk of unsafe or inconsistent administration.

Relatives told us they felt their family member was safe and staff were clear about the types of abuse and their responsibilities in reporting any concerns.

New employees received induction when they commenced work at Aston Manor. Training involved both e-learning and face to face training. The training matrix evidenced not all staff had completed all the required training and records of staff supervision were inconsistent although most staff had recently received an appraisal of their performance.

People were supported to eat and drink although; people were not always supported to make their own choices. We noted staff were more likely to ask people when they were able to respond verbally to the options available to them. People were weighed at regular intervals and the registered manager monitored this, although the system in place did not enable them to easily identify people who may have gradual weight loss.

Information was shared between staff at handovers and we saw people received input from other health care professionals as needed.

People were not always supported to have maximum choice and control of their lives, we found records in peoples care plans did not evidence a robust and person centred approach to meeting the requirements of the Mental Capacity Act 2005. Staff knowledge and understanding of the MCA was limited.

Relatives told us staff were caring. The interactions we saw between people and staff were predominantly caring and kind although we also saw examples which showed further work was required to ensure this approach was truly embedded.

Staff were aware of how to maintain people’s privacy and dignity and we saw examples of this during the inspection. Staff were respectful people’s individuality. Support to access advocacy services was readily available.

The registered manager had taken steps to involve relatives in the review of their family members care plan but work was still needed to enable people who lived at the home to be part of this process, where possible.

Relatives told us people were not provided with sufficient activity to keep them engaged. The head of care whose role involved organising activities had not received training specific to providing meaningful engagement for people living with dementia. The head of care was due to go on a period of extended leave but at the time of the inspection no alternative arrangements had been made to provide activities for people.

People had a number of person centred care plans in place, although we identified one person’s care plan was not reflective of their current support needs. Support for people when they experienced behaviours that may challenge others and the records kept about such behaviours had improved since the last inspection.

Where people had communication difficulties information was not provided in an alternative format. Feedback from relatives and staff regarding the management of the home was positive.

Regular audits were completed at the home but these had failed to provide an in-depth assessment of the quality of the service provided. The registered provider visited the home on a regular basis and completed a monthly report however, not all aspects of the audit were completed and they had failed to identify or address issues raised in this and other CQC inspections.

Regular staff meetings were held and action had been taken since the last inspection to implement meetings for relatives but there was still no system to gain feedback from people who lived at the home. Feedback surveys were available for relatives to complete but this was ad hoc and there was no evidence to suggest feedback had been reviewed or followed up. Although a recent complaint had been addressed by the registered manager.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us improvements have been made and are no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found a continuing breach 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.

Aston Manor is a care home registered to provide nursing and residential care for up to 32 people. It consists of one building with two floors, although the upper floor has a split level. All bedrooms are single with ensuite facilities. At the time of this inspection there were 24 people living at the home.

On the ground floor there is a communal lounge and separate dining room. On the upper floor there is a communal lounge with dining area. Both floors have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

Aston Manor was last inspected in April 2017. At that time we identified multiple breaches of regulation. As a result, the home was rated as ‘Inadequate’ overall, as it was deemed to be ‘Inadequate’ in the key questions of Safe, Effective and Well-led, and ‘Requires Improvement’ in the key questions of Caring and Responsive. This inspection found some improvement had been made at the home but it was not sufficient to change the overall rating from the last inspection. The home is therefore still inadequate and remains in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Feedback from people and their relatives about safety at the home was mixed. People were seen using labelled walking frames, an improvement from the last inspection, but risk assessments and care plans had not been updated for people supported to transfer by staff using handling belts.

Most aspects of the building and its facilities, utilities and equipment were safe. However, personal emergency evacuation plans had not been updated for several months and a risk assessment of the water system in July 2017 concluded people were at risk of Legionella and effective action had not yet been taken.

People’s moving and handling risk assessments and care plans lacked the detail staff would need to support them safely to mobilise, and to bathe and shower. One person with swallowing problems had no choking risk assessment in place. Care plans to manage risk to people’s skin integrity were not clear. These were all issues raised at the last inspection.

Most medicines were managed and administered safely. However, medicine administration records for people’s topical creams were not always completed; some care plans for ‘when required’ medicines were missing or lacked person-centred detail.

Staffing levels had improved since the last inspection. We observed people’s personal care and nutrition/hydration needs were met; however, people’s social interaction with staff was limited.

Staff had undergone some training since the last inspection; however, there were still gaps in the training matrix for courses such as the Mental Capacity Act, first aid and food hygiene. A care worker new to health and social care at the last inspection who had not been enrolled on the Care Certificate had been enrolled since, but had only completed a small part of it.

About half of the staff had received one supervision since the last inspection; however, records showed this had not included discussion around their training needs or personal and professional development, in accordance with the provider’s policy.

The registered provider and registered manager were still not compliant with the Mental Capacity Act 2005. People had not been assessed for their capacity to make specific decisions relating to their care and treatment. This was a finding at the previous two inspections.

Feedback about the food and drinks served at the home was positive. We observed people were not always given a choice about the food and drinks they received and the support to eat provided by staff was not always person-centred. The detail of food and fluid records had improved, however, on the first day of this inspection, records for breakfast, lunch and snacks had still not been completed by 2.45pm.

Care plans for people who had lost weight did not always include information about the action taken to manage their nutritional risk. This was a finding at the last inspection in April 2017.

People had access to a range of healthcare professionals to help support and maintain their wider health needs. Relatives told us they were kept up to date about their family member’s wellbeing.

Most interactions between staff and people at Aston Manor were respectful, but some were not. The registered manager had deployed a ‘dignity champion’ to challenge poor practice after concerns were raised at the last inspection, but there was still more work to do.

At the last inspection we found no evidence people had been involved in developing and reviewing their care plans. At this inspection we could find no evidence this had changed in the care files we sampled.

Information about people was not always stored securely.

People’s care plans and daily records were not always an accurate and contemporaneous record of their care needs or of the support they received from staff.

People who experienced behaviours that may challenge others did not always receive person-centred support in accordance with their care plans. Some behaviour care plans we sampled lacked detail about triggers for behaviours and suggested de-escalation techniques.

One complaint had been managed by the registered manager since the last inspection. There were no records to show how it had been investigated or responded to.

People’s access to meaningful activity was limited. This was a concern raised at the last inspection.

Although some improvement had been made to the audit process at Aston Manor, the registered manager and provider still lacked oversight of safety and quality at the home.

An action plan provided in June 2017 by a consultancy contracted by the provider had failed to result in significant improvement at the home as we identified new and continuous breaches of regulation.

Relatives had been asked to complete a survey about the service but people who lived at the home had not. There had been no residents’ and relatives’ meetings since the time of the last inspection in April 2017.

As at the last inspection, information about advocacy, the complaints procedure and the home’s CQC inspection ratings was located in the entrance lobby to the building where people could not access it.

When asked, care staff at the home could not describe what good person-centred dementia care should involve.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Aston Manor is a care home registered to provide nursing and residential care for up to 32 people. It consists of one building with two floors, although the upper floor has a split level. All bedrooms are single with ensuite facilities.

On the ground floors there is a communal lounge and separate dining room. On the upper floor there is a communal lounge with dining area. Both floors also have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

At the time of this inspection there were 24 people living at the home; one person was in hospital.

Aston Manor was last inspected in July 2016. At that time it was rated as ‘Requires Improvement’ overall. It was deemed to be ‘Requires Improvement’ in the domains of Safe, Effective, Responsive and Well-led, and ‘Good’ in the domain of Caring. A warning notice for a breach of regulation relating to good governance from the previous inspection was re-issued. We asked the registered provider to send us an action plan to tell us how they were going to tackle breaches of regulation relating to safe care and treatment, safeguarding service users, receiving and acting on complaints and staffing. At this inspection we found on-going and multiple breaches of the regulations in relation to safe care and treatment, staffing, safeguarding service users and good governance and further breaches in relation to consent and dignity. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Not all incidents of abuse involving people living at Aston Manor had been reported to the local authority safeguarding team and to CQC, as is required.

One person was using mobility equipment they had not been assessed for. Care staff were assisting another person to move using equipment they had not been trained to use and which the person had not been risk assessed for thereby placing them at risk of falls and injury.

Risks to people, such as skin integrity, choking, bedrail use, and the support required to move safely to bathe or shower, had not been assessed.

People were supported to take their medicines in a person-centred way, however, we found concerns with the way medicines were stored and their administration recorded.

Most parts of the home were clean, but some were not. We observed poor infection control practice during the inspection. The temperature of water in shared bathrooms and toilets had not been tested to make sure it was at a safe level.

Feedback about staffing levels from people, their relatives and care staff at Aston Manor was mixed. Rotas showed day and night shifts were regularly understaffed according to the levels required based on the home’s dependency tool.

Staff had not received the training they needed to support people effectively. A care worker new to health and social care had not been enrolled on the Care Certificate or equivalent training.

People’s care records showed some decisions had been made for them in their best interests when an assessment of their capacity to make these decisions for themselves had not been made. This was a finding at the last inspection in July 2016.

One person admitted to the home in 2012 who lacked capacity to consent to their living arrangements did not have a Deprivation of Liberty Safeguards authorisation in place.

People’s nutritional documentation did not always contain a complete and accurate account of the care and support they received. During mealtimes we observed people in the dining area had a better dining experience and received more support than those served their meal in the lounge area, who lacked support to eat and drink.

The majority of interactions we observed between care workers and people at the home were positive. We also witnessed interactions which were less positive, when people’s dignity had not been maintained or promoted.

The quality of care plans in place at Aston Manor varied. Some care plans were individualised and contained person-centred detail, whereas others we saw were either generic or missing altogether. People told us they had not been involved in designing or reviewing their care plans; we saw no evidence in people’s care plans as to how they had taken part in the care planning process.

Concerns raised at the previous two inspections relating to the registered provider and manager’s oversight of the quality and safety of the service remained. We found issues which had not been identified by audit and multiple breaches of regulation were repeated.

Recruitment records showed most checks had been made to ensure staff suitable to work with vulnerable people had been employed. Gaps in two care workers’ employment history and the reason one care worker’s last employment contract had been terminated had not been documented, as is required by the regulations.

People’s access to meaningful activities was limited. We recommended the service source nationally available guidance on activities for people living with dementia and use it to update their activities provision.

Some aspects of the home had been adapted to better meet the needs of people living with dementia. We recommended aspects, such as the contrast in carpeting and between walls and handrails, were improved.

Of the people and relatives we spoke with, only one relative had raised minor concerns about the service. They said these had been acted upon. Records showed all official complaints were now recorded, investigated and responded to appropriately. We recommended the complaints policy be displayed where people living at the home could access it.

This inspection found improvements had been made in each of these areas. However, there were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, good governance and staffing. New breaches of the regulations were found in relation to safeguarding and the management of complaints.

Aston Manor is a nursing home, registered to provide care for up to a maximum of 32 older people. The home has two floors and provides care and support for people with nursing and residential needs, including people who are living with dementia. There were 27 people living at the home at the time of this inspection.

The service had a registered manager in post at the time of our 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 2008 and associated Regulations about how the service is run.

The registered manager and staff were aware of relevant procedures to help keep people safe and were aware of signs that may indicated someone was at risk of abuse of harm. However, on the day of the inspection, we identified a safeguarding concern that had not been reported and investigated. Not all staff had received up to date safeguarding training.

Risks to people had been assessed and risk reduction measures had been considered.

People were weighed regularly and appropriate referrals were made to healthcare professionals regarding diet and nutrition when necessary. People received appropriate support in order have their nutrition and hydration needs met.

Some moving and handling equipment was used for people whom had not been specifically assessed for the equipment.

The number of staff identified as being required were not always deployed. There was an instance of a nurse working a 24 hour shift.

Medicines were administered safely by staff who had received appropriate training to do so.

Improved practices were observed in relation to cleaning and the prevention and control of risks associated with spread of infection.

Staff had received induction to prepare them for their role, which included shadowing more experienced members of staff. Staff received regular supervision and told us they felt supported in their roles. However, not all staff training was up to date.

Where people lacked capacity and were deprived of their liberty, the registered manager had made appropriate applications to the supervisory body in order for this to be authorised. However, the registered manager did not always act in accordance with the Mental Capacity Act 2005. Decision specific mental capacity assessments had not always been completed when decisions were made in people’s best interests.

People were given choices throughout the day and we saw staff sought consent from people prior to providing care and support.

People’s rooms were clean and personalised. Pictorial signage was used throughout the home, to assist people to navigate around the home.

People told us and we observed staff were caring. People’s privacy and dignity were respected.

Care plans were person centred and contained information to enable staff to provide care and support to people. Appropriate information was shared between staff to enable continuity of care.

Records of complaints were disorganised and complaints were not managed and responded to effectively.

The registered manager was visible throughout the home and knew people’s needs. Relatives and staff told us the registered manager was approachable.

The registered manager undertook regular audits in order to improve provision of service.

You can see what action we told the registered provider to take at the back of the full version of the report.