Aarondale Care Home

Aarondale Care Home is a care home providing personal care for up to 48 older people, including those living with dementia. The service is purpose built and accommodation is over three floors. At the time of the inspection there were 38 people living at the service.

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

We found that people’s records did not always evidence their wishes and preferences for end of life care and support. We have made a recommendation about the recording of people’s end of life wishes.

At the last inspection we found the safety, effectiveness and oversight of the service was inadequate, and there were multiple breaches of regulations. Practices at the service placed people at risk of harm. Systems in place to monitor, assess and improve the safety and quality of the service being provided were not robust. People were not supported to have maximum choice and control of their lives and staff were not adequately trained or supported. There were failures in the provider's quality and assurance systems.

At this inspection we checked to see whether improvements had been made and found that they had.

People living at Aarondale Care Home benefited from a service that was committed to driving improvements in order to provide safe, high-quality care and support. The service had responded proactively to the findings at the last inspection and had worked hard to improve both the physical environment and the quality of care provided to people.

Regular health and safety checks were carried out to ensure the home was safe and suitable for people to live in. Risks to people were identified and managed and mitigated by staff to lessen the risk of harm to people.

People told us they enjoyed living at the home and appeared calm and at ease in their surroundings. Both people and their relatives were keen to tell us how well treated they were by staff who were respectful, kind and treated them with the utmost dignity.

Staff recruitment processes ensured staff were safe to work with people and staff received the necessary training and support to help deliver care to people which was tailored to their needs.

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.

A new registered manager had been reinstated since the last inspection and had overhauled governance processes and practices to help provide better oversight of the service, providing a more accurate picture of risks and areas for improvement.

Both the registered manager and the provider helped instil a positive culture which was committed to delivering high-quality care to people, and supported staff to ensure they understood, shared and practiced these values. The registered manager was not averse to challenge any shortfalls in practice that fell below these standards.

Since the last inspection, the management team had worked in collaboration and partnership with other relevant organisations to improve the service and help achieve better and more positive outcomes for people.

Although the service had made significant improvements and were no longer in breach of regulation, further time was required to evidence consistency and longevity of good practices.

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 inadequate (last report published 16 May 2022). 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.

The service has been in Special Measures since 16 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 March 2022. Breaches of legal requirements were found in relation to safe care and treatment, need for consent, staff training, meeting nutritional and hydration needs and good governance. We also made recommendations in relation to reviewing people's care plans for care and support and staff developing more effective communication skills.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aarondale Care Home is a care home providing personal care for up to 48 older people, including those living with dementia. The service is purpose built and accommodation is over three floors. At the time of the inspection there were 44 people living at the service.

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

The safety of the service was inadequate. Practices at the service placed people at risk of harm. People did not always receive their medicines safely. Risks to people had not been appropriately identified, assessed and mitigated.

Systems in place to monitor, assess and improve the safety and quality of the service being provided were not robust. Some of areas of the service appeared worn and tired and required repainting. We saw fire exits which were partially blocked, meaning people were at risk of safely evacuating the building in the event of an emergency. Equipment which was in place to ensure people were moved and transferred in a safe way, was not always being used by staff.

The oversight of the service was inadequate. There were failures in the provider's quality and assurance systems. Records relating to care and the management of the service were either incomplete or inaccurate and not kept up to date. Although some concerns found during the inspection had been identified by the providers monitoring systems, actions had not been put in place to address them.

The service was not effective. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Not all staff had received the necessary training to help them carry out their role in a safe and competent manner. People were not adequately supported with their nutrition and hydration needs. People were not always being supported in a way which led to good outcomes for their care and support.

We have made a recommendation about reviewing people's care plans for care and support.

The service was not always caring. People's dignity was compromised by the lack of consideration given to the general environment and the quality of food.

The service was not always responsive. Care records were inconsistent and did not contain the most up to date information about people's health care needs and requirements. Staff did not always communicate with people in a way they understood.

We have made a recommendation about staff developing more effective communication skills.

We observed some positive interactions between staff and people living at the service.

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

Rating at last inspection

This service was registered with us on 1 October 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 13 August 2019.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was prompted in part due to concerns received about infection control and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, need for consent, staff training, meeting nutritional and hydration needs and good governance at this inspection.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvement.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'national lockdown - stay at home policy'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. Most authorised visitors were checked at the door of the home to make sure they were safe to enter. Some of these processes needed to be extended to cover visiting health and social care professionals. The registered manager implemented this change during the inspection.

There was weekly testing of staff and every 28 days for people living in the home. Hand sanitiser and personal protective equipment (PPE) were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands, regular use of hand sanitisers and appropriate social distancing.

Where appropriate, ‘socially-distanced' visits had been taking place before the inspection. There was a visiting pod that had been created at the front of the home of the home so that visitors did not have to enter the home itself. The facility incorporated appropriate protections for visitors and their loved ones. It was a high quality construction that could be used in all weather conditions. Visitors could contact an administrator to arrange visits. The registered manager said visiting facilities would be extended further to incorporate a gazebo on a lawn in the garden. It was hoped this would be available in the summer months.

Infection control policy and people's risk assessments had been considered and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home.

The provider insisted people were tested before admission and consistent with local guidance, people had not been admitted to the home for the most part of the pandemic. However, at the time of inspection, this position had been reviewed. In line with changes in restrictions and new guidance relevant to the geographical area, the service had started admitting people to assist with the wider health and social care position. We spoke with one person who had recently been admitted and was shielding during the inspection. They confirmed the level of support and care was good and that they were looking forward to fully integrating into the home. We were satisfied the service, staff, people and visitors were following the rules

People's mental wellbeing had been promoted by innovative use of social media and electronic tablets so people could contact their relatives and friends. Where required, staff supported people with this technology.

The home was clean and hygienic. Staff also had comprehensive knowledge of infection prevention, access to good practice guidance and had attended Covid 19 specialist training hosted by the provider. We noted this followed best practice and the latest guidance. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

If required, staff could receive Covid 19 related supervision and had access to appropriate support to manage their wellbeing. The registered manager had a good understanding and knowledge of the staff team.

The provider and registered manager encouraged residents and staff appropriately around taking up the vaccines to Covid 19. This programme had been rolled out shortly before the inspection.

Further information is in the detailed findings below.