Aronel Cottage Care Home Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

The registered manager reported serious concerns to the local safeguarding team. Posters in the home ensured people knew how and where to report any concerns they might have. The home was clean and uncluttered. There were sufficient qualified staff to keep people safe. Medicines were managed safely.

Although the registered manager recorded incidents and accidents in a paper based file, these were not always recorded in peoples’ care plans and so were not always investigated. Risks were managed by staff at the service; however people were not always included in this and some relatives and people told us the service was overly cautious and risk averse, which affected their day to day lives.

The service was previously in breach of the legal regulation in relation to people’s safe care and treatment. Improvements were found at this assessment and the service was no longer in breach of this regulation, although aspects of incident audits required further monitoring by the provider.

The service was previously in breach of the legal regulation in relation to the ways people’s medicines were managed. Improvements were found at this assessment and the service was no longer in breach of this regulation.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always investigate safety events. Lessons were not always learnt to continually identify and embed good practice.

We saw a paper based incident and accident book which was used to record any adverse incidents. Some incidents we looked at, including bruising or skin tears, were not also noted in people’s electronic records. This meant they could be missed when audits were completed on the electronic system only. Audits needed to ensure all written incidents and accidents were transferred to the electronic system. The registered manager told us these omissions were an oversight and care plans were usually updated with any injuries, however minor.

Staff had supervisions and these were recorded. We saw evidence that when issues were raised about staff conduct, staff were encouraged to reflect and learn from this.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The local authority told us they worked with the service, as necessary. Public Health England had assisted the service with actions plans around the use of personal protective equipment (PPE) and infection control. A staff member told us both general practitioners (GPs) and hospice nurses were involved with the home, and with managing people’s medicines. The registered manager was able to print care plan information from the electronic care system if people needed to take these with them to hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were posters about the importance of keeping people safe, safeguarding, and who people or staff could raise concerns to, in the hallway of the service. Staff had the correct level of safeguarding training and knowledge of how to keep people safe.

The registered manager told us they had tightened up procedures to ensure all safeguarding concerns were reported to CQC.

The provider did not always work well with people to understand and manage risks. Staff did not always enable people to do the things that mattered to them.

Risks were managed at the service, but sometimes the risks were managed for people and not with them. One person told us, “I’ve fallen on occasion and now I have to stay in bed or stay in a chair until they come and help.” Another person told us they felt the showers were too cold. They said “The shower room is enormous and it’s cold and wet. The water’s nearly cold.” A family member suggested the staff were taking care by regulating the temperature, to which the person responded “A bit too careful. Everyone says it’s too cold.”

People were not encouraged to walk alone, the registered manager told us people were always accompanied, including to the toilet. The registered manager told us this was to keep people safe, however people were not involved in decisions around risk management.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home was clean and uncluttered. Carpets were cleaned professionally and the registered manager had evidence of the cleaning dates. Where equipment was stored there were designated areas and those were kept tidy. Exterior doors to the property were locked with code locks so visitors could not access the service unnoticed. The gardens and courtyard areas were uncluttered with space to walk. Outside areas were well fenced so that people could not leave or enter without staff being aware.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited safely. Staff files were well organised and showed full employment histories alongside all relevant safety checks. There were enough staff to keep people safe, although people said there were times they felt there could be more staff for comfort. A person told us, “There’s plenty of staff so they notice if something’s wrong.” Although another person said it could be busy in the morning so they sometimes had to wait, I ring the bell to get up. I wait until 9.30 and then I wait until a person is available. Sometimes I wait half an hour.” Staff also told us there were busy times, but they said care was always safe. A staff member told us “It is a very safe home, the owner is very hands on and there are nurses.” We saw staff available for people at all times, and we did not see anyone wait for care when they needed help.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had access to PPE and in most cases used it appropriately. We spoke to the registered manager at the time about some staff wearing gloves at times it was unnecessary, and where hand washing would be more appropriate. The registered manager told us they would speak to staff about this.

Staff had annual infection control training which included a face to face practical. Staff were observed in hand washing techniques by the housekeeper and registered nurses, this was then recorded.

Staff helped people to stay clean, and dedicated cleaning staff ensured the home was kept tidy, hygienic, and fresh. We saw hoist slings washed and hanging in the garden to dry. The service had worked with Public Health England to improve infection control.

Relatives told us the home and their loved ones were always clean.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were managed and administered by trained nurses. Medicines were stored and disposed of safely. Medicine administration records (MAR) were accurate with no gaps in recording. MAR charts were provided by the local pharmacy.

The service now used an electronic care record system to record people’s care and clinical needs. The medicines were still recorded using paper charts, although a staff member told us that may change in future. We observed medicines were administered in line with good practice guidance. We saw staff administering medicines to people and talking to people kindly.