Background to this inspection
Updated
9 August 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 Inspectors.
Service and service type
Aaron House Care Limited is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Aaron House Care Limited is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. Since the last inspection, a new manager had been appointed. They had started their application to register with CQC and were in the process of resubmitting a revised application with the outstanding information required following initial application.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, as well as information from 2 safeguarding meetings organised by the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke to the owner/provider of the service who was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke to one of the directors, the manager of the home, the service’s team leader and 1 support worker. We spoke to 1 person who uses the service and 3 relatives of people who use the service.
We reviewed 2 people’s care documentation and a range of medicine records. A variety of records relating to the management of the service, including governance systems, policies and procedures were reviewed.
Updated
9 August 2023
About the service
Aaron House Care Limited is a care home registered to accommodate up to six adults with a learning disability or autistic spectrum disorder in one adapted building. At the time of our inspection six people were using the service.
People’s experience of using this service and what we found
The service did not have manager in place at the time of the inspection. In the absence of a registered manager, the service was managed by the team leader with some support from the provider. However, we found ineffective governance systems and monitoring roles and responsibilities were not clearly allocated and defined.
A comprehensive, effective quality monitoring or audit system was not in place to ensure the quality of care and risks were monitored and improved where needed. The provider had therefore not identified the concerns we found at this inspection.
People and their relatives told us they felt safe living at the service. However, we found shortfalls that placed people at risk of receiving unsafe care.
People's individual risks were not always identified, assessed and mitigated and staff were not given clear guidance or information on how to protect people from associated risks. Not all staff knew what to do in an emergency. People's medicines were not managed safely. A robust system was not in place to ensure the provider had oversight of all incidents or accidents.
Systems to ensure safe staff recruitment practices were not in place.
Infection prevention and control was unsatisfactory. This placed people, visitors and staff at risk of infections. People were not always protected from the risks of their environment. The provider had not always undertaken effective measures to ensure that people would be protected from risks associated with fire safety and legionella.
People were not always supported to have maximum choice and control of their lives and staff did not always 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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.
Based on our review of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right care, Right support, Right culture.
Right support: The provider was not always able to demonstrate how they planned the needs of people with a learning disability in line with best practice guidance. People’s care records did not reflect the support that had been planned and delivered.
Right care: Care was not always person-centered and did not always promote people’s dignity, privacy and human rights. .
Right culture: The lack of quality audits and absence of feedback systems did not support the development of an open and transparent service.
We sign posted the provider to the Right support, Right care, Right culture information on the guidance for providers page on our website.
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 14 June 2018).
Why we inspected
We received concerns in relation to several aspects of the management of the service and the quality of people’s care and support. As a result, we undertook a focused inspection to review the key questions of safe 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 inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
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.
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 Aaron House Care Limited on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to risk management, safe staff recruitment, good governance and safeguarding.
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.