Archived: Aston Grange Care Home

Updated 10 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 26, 27, 28, 29 September and 3 October 2016 and was unannounced. The inspection was planned to follow up on the comprehensive inspection completed in March 2016 when the service was rated as inadequate and special measures were extended.

Before the inspection feedback was requested from local authority commissioning teams and the local Healthwatch. We reviewed the information we already held about the service, including statutory notifications we had received and previous inspection reports.

The inspection team consisted of three inspectors and an expert-by-experience with experience of caring for someone living with dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

During the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 11 people who lived in the home, three relatives and three friends of people who lived in the home. We spoke with 12 staff including the operations manager, the quality manager, the deputy manager, the chef, the activities coordinator, the housekeeper, three care assistants and three trainee senior care assistants. We viewed six care files including support plans, risk assessments, reviews, and health and medicines records. We looked at six staff files including recruitment records, training, supervisions and appraisals. We viewed a range of audits, various meeting minutes, incident and accident logs, safeguarding records and policies and procedures for the home and other documents relevant to the management of the service.

Updated 10 February 2017

The inspection took place on 26, 27, 28, 29 September and 3 October 2016 and was unannounced. The service was last inspected in March 2015. At the last inspection CQC extended special measures. This inspection found there was not enough improvement to take the provider out of special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Aston Grange Care Home provides accommodation for people who require nursing or personal care to a maximum of 45 people. At the time of our inspection 30 people were living at the home. The home is a purpose built care home and arranged across three floors. During the inspection only two floors were in use.

There was a registered manager in post although they were not available during the 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.

Care plans did not contain details of people’s preferences and lacked the detail required to provide good quality care. Risk assessments were not robust and did not contain measures designed to mitigate risks faced by people. Records showed that care plans and advice from professionals were not always followed.

The provider had not implemented sufficient measures to ensure that people’s nutrition and hydration needs were met. People told us they did not like the food, which looked unappetising and was undercooked.

The provision of activities had improved, but remained limited and were not dementia friendly. People told us they were bored and observations showed task focussed support and a lack of engagement with people living in the home. Working practices within the home meant that people were not consistently treated with dignity and respect.

The improvements in the management of medicines had not been sustained. Medicines were not managed in a safe way and people were not always getting their medicines as prescribed.

The service had taken appropriate action to address the concerns regarding the building. Improvements had been made to the physical environment. The service was now clean and had appropriate infection control practices in place.

The service had enough staff on duty and staff had been recruited in a safe way which ensured they were suitable to work in a care environment. Staff received the training they needed to perform their roles. Not all staff had received supervision and support to develop in their roles.

The leadership and governance of the service was ineffective. Audits and action plans had not improved the quality of care plans or risk assessments and people continued to receive support that was poor quality.

The provider was not consistently working within the principles of the Mental Capacity Act 2005. Records showed the service did not understand Best Interests principles.

Staff were knowledgeable about safeguarding adults and records showed the service escalated concerns appropriately.

The service had a robust complaints procedure and records showed this had been followed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service remains ‘Inadequate’ and the service therefore 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. 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.