Archived: Aaron Manor

Aaron Manor is registered to provide accommodation and support for up to 21 people. There were 16 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were also living with dementia. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors.

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

Although regular quality audits were completed to manage oversight of the service, we found improvements were needed for the documentation that supports best interest decisions and for medicine record keeping. For both these concerns, we considered the risk and impact on people to be mitigated during the inspection process. The registered manager acknowledged these were areas for improvement and immediately took steps to rectify these shortfalls.

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by suitably trained and knowledgeable staff, who had been assessed as competent.

Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s really lovely here, everyone works as a team to make sure we support people in the safest and best way. We got lots of training to do this.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One visitor said, “Very kind and polite staff, the atmosphere is good, I feel welcomed every time I visit.” People were relaxed, comfortable and happy in the company of staff. People’s independence was considered important by all staff and their privacy and dignity was promoted.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.

There was a stable staff team who were knowledgeable about the people they supported and had built

trusting and meaningful relationships with them. Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with family and members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as method sign language, pictures and objects of reference, to gain their views.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. End of life care was delivered empathetically and with respect and dignity.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

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

Rating at last inspection:

Good. (Report published on 14 January 2017)

Why we inspected:

The inspection was prompted in part due to concerns received about staffing deployment, risk of falls and medicine management. A decision was made for us to inspect and examine those risks.

Whilst the overall rating has remained Good, we have found evidence that the provider needs to make some improvements. Please see the well-led section of this full report.

Follow up:

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

There were 19 people using the service on the day of our inspection which included two people receiving respite care.

We inspected the service in October 2013 and found the service met all of the regulations inspected with the exception of the management of people’s medicines. We returned in March 2014 and the service had met the regulation.

The registered manager was in day to day charge at the service and was supported most days by the responsible person. 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.

Everyone gave us positive feedback about the responsible person and the registered manager and they were very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff. They felt this was then the culture in which staff cared for people at the service.

People were supported to follow their interests and take part in social activities. The management team recognised the importance of social events for people. External entertainers were arranged and staff supported people with individual social support. Outings were arranged so people could go out into the local community. People spoke very positively about the activities arranged at the home and gave us many examples of activities they enjoyed. In particular the monthly ‘pub evening’, where families, friends and staff joined together for an evening of fun.

Staff demonstrated great skills in anticipating people’s needs. They were respectful, discreet and appropriate in how they managed those needs. They liaised with people’s families and went above and beyond in their actions to support them. For example, the staff helped a person be able to attend a family members wedding. They assisted with deciding appropriate meals options and a staff member accompanied the person to ensure they had their needs met appropriately.

There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff were compassionate, treated people as individuals and with dignity and respect. Staff knew the people they supported, about their personal histories and daily preferences. Staff showed concern for people’s wellbeing in a caring and meaningful way. Where possible, people were involved in making decisions and planning their own care on a day to day basis. People and relatives said staff were caring and compassionate and treated everyone with dignity and respect at all times. The service made sure staff knew how to manage, respect and follow people’s choices and wishes for their end of life care and as their needs changed. There was a clear message given to us from staff that they treated everyone at the service as their own family.

The management team and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People were supported by sufficient staff who had the required recruitment checks in place, were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were supported to eat and drink enough and maintain a balanced diet. People and relatives were very positive about the food at the service. People were seen to be enjoying the food they received during the inspection.

Medicines were safely managed with the exception of prescribed topical creams which records did not demonstrate had always been applied as prescribed.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people where able and their families had been involved in their development. Accidents and incidents were reported and action was taken to reduce the risks of recurrence.

People were referred promptly to health care services when required and received on-going healthcare support. Healthcare professionals were very positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.

The premises were well managed to keep people safe. The home was cleaned and decorated to a good standard and homely features made it welcoming. Systems were used to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment. There were emergency plans in place to protect people in the event of a fire or emergency.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives, staff and outside professionals. There was a complaints procedure in place, and amendments were made during our visit to included external agencies people could contact.

During the inspection we looked at the management of medication within the home. We looked at care documentation, competency assessments and policies. We found that the provider had systems in place to ensure the safe storage, administration and disposal of medication.

During our inspection we found that people and their relatives/next of kin (NoK) had been involved in decisions about their care, and chose how they spent their time.

Care plans documented the needs of people living in the home. Risk assessments had been completed when required.

Cleanliness and infection control systems were in place, with a good standard of cleanliness observed throughout the home.

We looked at the systems and processes in place for the safe management of medicines and found that there were shortfalls in the safe handling and storage of medicines.

Peoples care needs were reviewed and updated regularly, this meant that staffing levels could be assessed to ensure that there were sufficient staff to meet the needs of people living in the home.