Aronel Cottage Care Home Limited

Aronel Cottage is a residential care home providing personal and nursing care to up to 38 people. The service provides support to people who have care and health needs including impaired mobility, frailty of age, diabetes and people living with Parkinson’s disease. At the time of our inspection there were 38 people using the service. Accommodation was in one adapted building over two floors which were accessed by a lift.

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

Aspects of leadership and governance of the service were not effective in identifying some service shortfalls. There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete.

People and their relatives told us current visiting arrangements were restrictive. We received feedback that the provider did not always follow government guidelines for visiting in care homes. We made a recommendation about visits to the care home and sign posted the provider to current government guidelines for visiting in care homes.

People were not always protected from avoidable harm because the provider did not have effective procedures in place to make sure people were safe. Incidents were not always responded to or reported to the appropriate authority. Action was not always taken to mitigate the risk of harm to people.

Processes were not in place to ensure support plans and risk assessments contain detailed and person-centred information to accurately reflect the needs of people. Risks to people's health and wellbeing were not consistently managed. We have made a recommendation about staff knowledge and understanding of dysphagia and modified diets.

Staffing levels were enough to meet people’s individual needs. Positive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. Feedback from people and their relatives told us they were happy with the service. Comments included ‘Nothing is too much trouble’ and ‘There appears to be enough staff, I don’t hear call bells constantly ringing and the staff seem to be calm and competent’

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.

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 good (Published 6 June 2018).

Why we inspected

We received concerns about the failure to notify CQC of incidents that affect the health, safety and welfare of people who use the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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

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 protecting people from abuse and harm, safe care and treatment and overall governance and management of the service, at this inspection.

We have made recommendations about visiting in care homes and improving staff skills in dysphagia.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aronel Cottage Care Home Limited is a nursing home. People in nursing homes receive accommodation for nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Aronel Cottage Care Home Limited is registered to accommodate up to 38 people in one adapted building. On the day of our inspection there were 35 people using the service with a range of support needs including older people and older people living with dementia.

At the last inspection on 24 March 2016, the service was rated as good in the areas of Effective, Caring, Responsive and Well-led. The service was rated as requires improvement in the area of Safe but the overall rating for the service was Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us that they felt safe. Staff remained to have a good understanding of their roles and responsibilities for identifying and reporting allegations of abuse and knew how to access policies and procedures regarding protecting people from abuse. Risks to people were assessed and monitored during their stay and communicated with other healthcare professionals involved in their care.

Staffing levels were assessed and amended based on the needs of the people using the service and there were arrangements in place for covering if staff were unable to come to work at short notice. The building was well maintained and there were systems in place for ensuring that regular checks of the environment and equipment were carried out. Medicines were managed safely and people were supported to take their medicines.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People remained to make choices about their support and were able to maintain their independence and provided with information and guidance to access other services which were relevant to them for on going support.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink.

Staff were trained in subjects relevant to the needs of the people who used the service and received regular supervision which enabled them to develop in their roles. Staff said they felt supported.

Staff spoke to people respectfully and treated them with dignity and respect. People felt that their privacy was respected and staff kept information confidential. People were involved in planning their support.

People’s individuality was respected and people’s preferences were taken into account when planning their care such as religion. There was an accessible complaints process in place which people knew how to use if they needed to however people told us that they hadn’t needed to make a complaint.

People said that the registered manager was approachable and listened to them. Staff felt that the registered manager was open and they were able to raise any concerns and put forward suggestions for improvement. The vision and values of the organisation were visible within the service and staff were proud to work at the service. The provider worked with other healthcare professionals to ensure that people received care that met their needs

Quality assurance audits completed by the registered manager were embedded to ensure a good level of quality was maintained. We saw audit activity for areas such as infection control, care planning and training.

Further information is in the detailed findings below

There was a registered manager in post. 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.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people, however safe recruitment practices were not always followed. Medicines were managed safely.

People told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Staff received regular training and there were opportunities for them to study for additional qualifications. All staff training was up-to-date with refresher courses booked for people. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity. .

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways – verbally, through physical gestures or body language. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s preferences and likes and dislikes were documented so that staff knew how people wished to be supported. There were a variety of activities and outings on offer which people could choose to do. Complaints were dealt with in line with the provider’s policy.

The culture of the service was homely and family-orientated. Regular audits measured the quality of the care and service provided. However care records were not always kept securely.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

One inspector carried out this inspection.

The accommodation was spread over two floors and there was a large bright lounge. We found it was clean and well maintained.

We spoke with five people who used the service and four people who were visiting relatives or friends at the time of our visit.

When we arrived we found most people having breakfast in the large lounge and the atmosphere appeared calm and relaxed. During our visit we observed that activities took place in the lounge with a person singing and playing guitar to small groups of people. People told us they enjoyed the activities provided by the home. We observed that a chiropodist employed by the service arrived during the morning of our visit.

We considered our inspection findings to answer the questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

We saw that people's needs were assessed and care and treatment was planned in a way that was intended to ensure people's safety and welfare. Care records contained information on people's needs and information for staff on how to meet them. We saw that potential risks to people were appropriately assessed and planned for. The service screened for risks associated with mobility, skin integrity and falls. There were instructions for staff on how to reduce risks to people in these areas.

We found staff were knowledgeable about people's needs and were respectful of people's privacy and dignity.

We observed that staff used appropriate equipment when moving and handling people that needed assistance.

People told us they were confident in the support offered. One person told us, 'They look after me very well'.

People were protected against the risks of abuse as the provider ensured staff received training on safeguarding. Staff we spoke with knew the different types of abuse that might occur, the signs that might indicate abuse and they were aware of their responsibility to report abuse.

We found the provider had taken appropriate steps to ensure that staff were qualified and competent to carry out their role and meet the needs of people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted the manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

People's health and care needs were assessed. We saw that specialist needs such as dietary and pressure care had been identified in care plans. Daily records showed that care was delivered in line with these. Staff we spoke to demonstrated a good understanding of people's care and support needs.

People told us that they were happy with the care that had been delivered and that their needs had been met. One relative told us, 'I love the way they are looked after'. Another person told us, 'They come quickly if you press the buzzer'.

Is the service caring?

People were supported by attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We observed staff spoke in a friendly and polite manner to the people they were supporting. One person told us, 'They are very caring, very attentive'. Another person told us, 'The little things make a difference. They give Easter eggs and a Christmas present for those without relatives, it's really nice'.

Is the service responsive?

We found that regular residents meeting took place and satisfaction surveys were carried out after people moved into the service. People told us they had been provided with information on how to complain when moving to the service.

People told us that the management team were very approachable and were confident that they would resolve any issues they had. One person told us, 'The doors always open, just go up there and see them'.

Is the service well-led?

The staff we spoke with were clear about their roles and responsibilities. They told us that they felt supported by the management team and were confident in being able to deliver the care and support needed. One person told us, 'It is very organised here. Everybody knows what they are doing'.

Staff we spoke with and records we looked at showed staff had regular training and supervision. We found that the provider had procedures in place to ensure that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

We saw that the service had quality assurance systems in place to monitor the quality of service that people received.

We spoke with five people who lived at the home. They were full of praise. One said, 'It's splendid, they're all so kind'. Another told us, 'It's very pleasant I must say'. People told us that the staff were caring and very good. They were especially pleased with the meals and entertainment on offer.

We spoke with two relatives. They were both very happy with the care provided. One said, 'The staff are very helpful'. The other told us, 'There isn't one person here I can fault'. They told us that the rooms were lovely and that the home was always clean and tidy. During our visit we also spoke with two visitors. One told us, 'They take a huge amount of care to get things right for the residents. It's the best home I know'.

We spoke with five members of staff. They told us that it was a good place to work. One said, 'I feel it is a good home here, everything is organised'. Another told us, 'It's one of the best places I've worked. I'm really happy'.

We found that the home was clean and bright and that people looked well cared for. During our visit there was a quiz taking place and people participated with enthusiasm. Staff were welcoming and we saw that they supported people with kindness and respect.