Archived: Aarondale House

Aarondale House is a residential care home that provides accommodation and personal care to people aged 65 and over. At the time of this inspection 15 people were living at the service.

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

The service has failed to receive a good rating for the last five consecutive inspection. Systems in place had failed to improve the quality and safety of the service. The provider had failed to learn from previous inspection findings, advice given from visiting professionals and feedback from people living at the service.

There was insufficient staff to meet people's needs and to ensure a safe clean environment. This meant people had to wait for personal continence care and support with their meals and staff were not available to respond to risks to people. There were no planned activities and a lack of stimulation for people.

Infection control procedures were not effective to reduce the risk of spread of infection during the COVID-19 pandemic. Medicines were not managed safely. Appropriate health and safety checks had not been carried out and risk management was not effective, placing people at risk of harm.

Safe recruitment practices were not followed. Staff did not receive adequate induction, training, or supervision to ensure they had the appropriate skills and knowledge to support people.

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. We have made a recommendation about the application of the Mental Capacity Act 2005.

People were supported to see health professionals and relatives felt they were kept up to date with appointments.

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 requires improvement (published 10 May 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections. This inspection has been rated inadequate.

Why we inspected

We completed our direct monitoring activity in which we identified concerns in relation to staffing, risk management, good governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at 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 Aarondale House on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, assessing risk, infection control, health and safety staffing, recruitment and governance.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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 improvements.

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.

People’s experience of using this service: Although people were protected from abuse we found the provider had failed to ensure safeguarding incidents had been reported to the appropriate authorities.

There had been a failure to ensure all legally required notifications had been submitted to the Care Quality Commission (CQC). People were exposed to unnecessary risk because the provider failed to operate effective governance systems that would identify shortfalls.

Safe recruitment processes were not always followed. We have made a recommendation about this. Staff received appropriate induction, training, and support.

People and their relatives told us they were happy with the service provided.

Staff understood the importance of providing person-centred care and had developed positive relationships with people. We observed staff to be friendly and polite. Staff took time to get to know people and had a clear understanding of, and how to support, people's individual needs.

Risk assessments had been completed and contained information to help guide staff about the support people needed to manage risks. These were reviewed regularly.

People told us they received their medicines as prescribed. Medicine records were clear and complete. Regular auditing of medicines meant any medication errors were prevented or immediate actions were taken in response.

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. Records confirmed people's involvement and where they were unable to consent the provider followed appropriate legislation to make sure any decisions made were in the persons best interest.

The dining experience for people was positive and people received sufficient food and drink.

Some people's records were more detailed and person centred than others. All people’s plans of care were being evaluated and transferred to a new electronic system at the time of the inspection.

People and their relatives told us they were confident if they had any complaints the registered manager would address them appropriately.

People knew the registered manager and provider and told us they had confidence in them. Staff said the registered manager was supportive and approachable.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around good governance. Details of the action we have asked the provider to take can be found at the end of this report.

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

Rating at last inspection: Requires Improvement (published 6 March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We found the provider failed to notify us of incidents which had occurred at the service which the provider is legally required to inform us of. More information is in detailed findings below. We are dealing with this outside of the inspection process and will publish a supplementary report once we know the action we will be taking.

Follow up: This is the fourth consecutive time the service has been rated Requires Improvement. We will meet with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least Good. We will re-inspect Aarondale House within our published timescales to see what improvements have been made.

Aarondale House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is located in the seaside town of Hornsea, in the East Riding of Yorkshire. It has single and shared accommodation for a maximum of 20 older people, some of whom may be living with dementia. On the day of the inspection there were 15 people using the service.

The service had 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 and associated Regulations about how the service is run. The registered manager was unavailable during this inspection and we were supported by the provider and deputy manager.

At the last inspection on 23 and 24 August 2017 the service was rated 'Requires Improvement' overall. We issued two requirement notices for breaches in Regulation 9, person centred care and Regulation 12, safe care and treatment. We also issued a warning notice for the breach in Regulation 17, governance. You can read the report from our last inspection on our website at www.cqc.org.uk. The provider completed an action plan to show what they would do to meet the requirements of the regulations. They had prioritised some areas that needed immediate attention including: medicines, updating care plans and risk assessments, quality assurance systems, cleanliness and infection control practices and the provision of activities.

The provider had made a voluntary agreement with the local authority to temporarily suspend all new admissions. This was to remain in place until the provider could show improvements had been made. Prior to this inspection this agreement was partially uplifted and the service was now able to accept up to one admission each week.

During this inspection we saw evidence to confirm that the service had improved and achieved compliance with Regulation 9, Regulation 12, and the warning notice for Regulation 17.

The provider, deputy manager and staff had worked hard to introduce new systems and procedures and we saw that medicines systems had been reviewed and changed; infection control practices had been improved; some care plans and associated risk assessments had been updated; quality monitoring of the service had been developed and activities for people had been strengthened. The provider told us this work was on-going and during this inspection we found this was the case.

Whilst improvements had been made to the assessment and reviewing process when considering the risks to people’s safety, these needed to become more embedded in daily practices. Some assessments had not been completed and others were inaccurate and not reviewed. We have made a recommendation about this. Despite this, staff we spoke with knew how to provide the care and support that people needed.

Regular audits were carried out to identify any shortfalls and this had led to improvements in areas such as medicines management, infection control practices and activities. People, their relatives and staff told us that the service had improved and was well led and that the provider and deputy manager were supportive and approachable. The provider had begun to seek feedback from people and their relatives. We saw people being encouraged to share their views about the service each day.

We found improvements had been made and people now had the opportunity to take part in a range of activities in-house. People’s opportunities to have trips out of the service were being developed. We saw some improvement had been made to the environment to support people living with dementia.

People told us they were happy with the care they received. Staff were observed to be kind and attentive and demonstrated a caring approach to people.

People’s medicines were managed safely. Policies and procedures had been implemented and were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. There were sufficient numbers of staff to meet people's needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People's capacity to consent to care was considered and the service worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Throughout our inspection, we saw that people who used the service were able to express their views and make decisions about their care and support. We observed staff seeking consent to help people with their needs.

People's health care needs were assessed, monitored and recorded. Referrals for assessment were made when needed and people received regular health checks.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. The provider told us, and we reviewed records, that demonstrated they had acted promptly when concerns were raised.

Aarondale House is a care home which provides single and shared accommodation for up to 20 people. At the time of our inspection there were 19 people living there. The service supports older people, some of whom may be living with dementia and is located in Hornsea, in the East Riding of Yorkshire.

There was a registered manager who was present during our 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. The registered manager will be referred to as 'manager' throughout the report.

At the last inspection on 30 June and 1 July 2016 we found the provider was in breach of three regulations of the Health and Social Care Act 2008. These related to the need for consent, staff training and supervision and good governance. We rated the service as requires improvement. The manager sent us an action plan in August 2016 which stated what action the service would take to address the issues. At this inspection we found that the provider had made sufficient improvements to meet the requirements of Regulations 11 and 18.

During this inspection we found not all of the changes made to the processes and audits had been completed robustly and did not identify further issues highlighted during this inspection. For example, we found that people's medicines were not always managed safely; we found the balance of three people's medicines were incorrect and did not tally with the stock that was recorded. In one bathroom cupboard we found used hairbrushes, razors and opened soap. Staff were not always aware of people's care needs and people's records did not always clearly reflect these, risk of harm to people was not always assessed, managed and reduced and the manager had not informed the CQC of all significant events.

Although there were some audits in place these had not picked up the shortfalls and inconstancies of information in people's care plans, risk assessments, infection control and medicine practices, and the non-notification of incidents, therefore they were ineffective at driving improvements. These areas need to be strengthened to ensure people received a safe and consistent service.

We saw that overall people's access to activities had not improved since the last inspection and activities were low key both inside and out in the local community. The people we spoke with consistently told us they would like to go out more. We saw a singer performed at the service on the first day of this inspection.

This meant we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the (Registration) Regulations 2009, in relation to good governance and notification of other incidents. We also found an additional two breaches in relation to safe care and treatment and person centred care

People told us that they felt safe living at Aarondale House. Staff told us that they had received safeguarding training and showed an understanding of how to report safeguarding concerns.

The provider followed safe recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way.

Safety equipment, electrical appliances and gas safety were all checked regularly.

The manager and the staff had knowledge of the Mental Capacity Act (2005) and their responsibilities linked to this. People's consent was recorded in areas of their care.

People spoke highly of the staff who cared for them and felt able to raise any concerns with staff.

We observed some positive, caring interactions and relationships between people living at Aarondale House and staff. Visiting relatives were welcomed at the service and we saw that they had a positive rapport with staff.

People we spoke with told us they were happy with the meals available to them.

People who used the service received additional care and treatment from health professionals based in the community.

There was a complaints procedure on display and people and their relatives felt able to complain.

You can see what action we told the provider to take at the back of the full version of the report.

Aarondale House is a care home that is located in the resort of Hornsea about half a mile from the seafront. It has single and shared accommodation for a maximum of 20 people with needs relating to old age and dementia.

The registered provider is required to have a registered manager in post and on the day of the inspection, there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

The homes manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS). However, we found that Mental Capacity Act (2005) guidelines were not always followed. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that although staff had received an induction and completed training in a variety of topics, they had not completed training that would enable them to safely carry out physical restraint. Staff told us they felt well supported; however, the supervision records we saw showed that staff were not receiving regular supervision. This was a breach Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that robust quality assurance systems were not currently in place and therefore issues of concern in relation to care plans, staff supervisions, activities and staff training had gone undetected. We observed that some record keeping within the service required improvement. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager had not informed the CQC of all significant events. This meant we could not check that appropriate action had been taken to help prevent reoccurrence and address the concerns. This was a breach of Regulation 18 of the (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

People were offered some activities to be involved in. However, there was no formal programme of activities in place and the people who used the service we spoke with told us they would like the opportunity to be involved in more activities. We made a recommendation about this in the report.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported. However, we found some elements of the care plans required further development.

People's comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided. We saw that any comments, suggestions or complaints were appropriately actioned; however, they were not always effectively recorded.

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately in the service.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk. The home was clean, tidy and free from odour and effective cleaning schedules were in place.

People's nutritional needs were met. Most people told us they enjoyed the food and that they had enough to eat and drink. We saw people were offered a choice of food and drink and were provided with refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from healthcare professionals. We found that staff were knowledgeable about the people they cared for and saw they interacted positively with people living in the home. People were able to make choices and decisions regarding their care.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records.

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

Is the service safe?

N/A

Is the service effective?

N/A

Is the service caring?

N/A

Is the service responsive?

N/A

Is the service well-led?

We found that the provider had taken appropriate action to improve the quality assurance system for the service. Records seen by us showed that the provider was listening to feedback from relatives, people who used the service and staff. Audits were being completed that identified any shortfalls within the service and these were addressed promptly. As a result the quality of the service was continuingly improving.

The service had an open door policy so staff were able to discuss any concerns with the manager and there were staff meetings so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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?

People were treated with respect and dignity and we observed caring and compassionate care by the staff. People told us they felt safe. People had their own care file and these contained an assessment of needs for example; pre-admission profile, life history, one page profile and daily routine. This contained information about the way each person should be supported and cared for. Additional information included risk assessments to ensure people remained safe from harm.

There were activities for people to be involved in to give them stimulation and a choice about their welfare.

We saw that the service had appropriate controls in place for the safe administering of medicine. People commented, 'I get my medication at breakfast and teatime, they are always on time, I never miss my medication' and 'I have my medication three times a day, I always get it when I need it.'

There were clear policies and procedures in place and safe and appropriate moving and handling practices were followed within the service.

The service and rooms were recently refurbished and was pleasant, clean and hygienic.

Is the service effective?

A pre-assessment support plan was always completed with people when starting with the service. Specialist dietary and mobility needs had been identified in care files where required. Care files were checked on a monthly basis by the manager and people signed their care file to say they had read and agreed with it.

A visiting district nurse told us, 'I have been to the service several times and staff always seem caring and they can't do enough for people.'

During lunchtime we saw everyone that was having their lunch were effectively supported if they needed. Ambient background music was played during the mealtime which gave a relaxed and pleasant atmosphere.

Staff responded quickly to support people of the offer of a second helping, people appeared happy during their meal and some of them sang along to music.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were supportive and attentive to people's needs, and were professional and courteous. People commented, 'I couldn't be in a better place and I feel safe' and 'Can't wish for better staff and they are very obliging. They treat me with dignity and respect.'

People were asked verbally by the manager about their views about the service. People commented, 'The manager and the staff always ask me about the food and we tell them if we are not happy about anything, but I have never needed to complain', 'The manager often comes in and asks us about how things are and the owner does too.'

Special dietary requirements were recorded in some peoples' care files and when we checked with staff, they know about this and ensured people were given the correct food during their mealtime.

Is the service responsive?

People completed a range of activities in and outside the service regularly. Different event and activities were available for people to use like? For example, hairdressing visits, chiropody appointments and pub quiz nights. Staff commented, 'We had a choir attend yesterday and it was very enjoyable' and 'We had wartime singers in last week and the residents liked that very much.'

People commented, 'There was a religious service yesterday in the main lounge and I attend when these are arranged' and 'I do 'Suduko' and crosswords as I choose to do these, it keeps my mind active.'

People knew how to make a complaint if they were unhappy. One person said that they had made a complaint and were satisfied that it was being dealt with. We looked at how these complaints had been dealt with, and found that the response had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service had a lack of evidence to ensure the quality assurance system was effective. Although, people were overall happy with the care and support they received, the service did not monitor the quality of its service provision.

The staff we spoke with knew about their involvement with team meetings and supervisors observing their care, but they did not make a regular commitment to meeting and they did not make records of checks that were done.

The system does not systematically ensure that the manager is able to provide monitoring feedback to the provider, so monitoring the provision of care is not being properly taken into account.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make.

We visited on 22 October 2013 to ensure the provider was fully compliant with regulation 15. We found that other bedrooms had been redecorated, carpets and curtains had been replaced and so the provider was compliant. People that used the service had an improved environment in which they lived.

We had visited the service in April 2013 and found that regulations 9 'care and welfare', 15 'safety and suitability of premises' and 20 'records' had not been met and so compliance actions had been made. The service had sent us an action plan in May 2013 stating timescales for when the service would be compliant.

We found that care plans had been improved to reflect peoples' current needs, had been reviewed and were up-to-date. People told us they were satisfactorily looked after, but would still have liked to go out more often. They said, 'We have no worries', 'We are treated fine' and 'We can't just get up and go out, but would love to'.

We found that the premises were in the middle of a programme of redecoration and light refurbishment, which still had a way to go to completion. The time scale for completion had been given as the end of July 2013. This had not been met completely and so a short extension had been granted until the end of October 2013.

We found that records had been improved, particularly with regard to care plans, risk assessments and daily diary notes.

We found that peoples' consent to care was obtained before they received care. We found that generally people were satisfied with the physical care and support they received, but they wanted to do more activities, wanted to be treated more fairly by the staff and wanted to experience an improved culture within the home. They said, 'I am satisfactorily cared for', 'Nothing happens to occupy me' and 'People who are unable to make their own decisions are treated more favourably.'

We saw that while the home had undergone some positive improvements to the communal areas of the environment, private areas had not yet been upgraded or redecorated, some rooms had unpleasant odours, oxygen signage was missing and people could not easily access the call bell in the lounge.

We found that staff had appropriate training and supervision and that there was a complaint system available to people that used the service. We found that some of the records maintained in the home were not always up to date, reflective of peoples' needs or fully completed.