Aaron Court

Aaron Court is a residential care home providing accommodation for people who require personal and nursing care for up to 91 people. The service provides support to older people, some of whom are living with dementia, people with a physical disability and younger adults. At the time of our inspection there were 84 people using the service.

Aaron Court was purpose built and has an accessible garden. The accommodation is provided over four floors. Each floor provides communal facilities for relaxation and dining, bedrooms, bathing and toilet facilities.

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

People’s safety was underpinned by the provider’s policies and processes. Lessons were learnt and improvements made through the analysis and reporting of accidents, incidents along with safeguarding concerns and investigations.

Potential risks related to people’s care were assessed. Medicine systems were managed safely, which included a proactive approach that ensured medicines to support people with end of life care for pain management and symptom relief were in place.

People were supported by sufficient staff who had undergone a robust recruitment process and had undertaken training in topics to promote their safety. People lived in an environment which was well maintained and clean, with safe infection and prevention measures.

Care plans provided clear and comprehensive guidance for staff to ensure people’s health care needs were understood and their needs met. People’s health and welfare was monitored by staff. Staff liaised effectively with health care professionals to achieve good outcomes for people.

People’s dietary needs were met assisted by staff’s commitment to create a positive dining experience for people and by people having access to snacks and drinks throughout the day. The environment was well-maintained and included facilities for people to relax and take part in activities.

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.

People and family members were in the main complimentary about the service they received. Staff told us they were supported by the management team and spoke of the opportunities available to them through ongoing training and development opportunities, including career progression. The provider had systems in place to monitor and improve the quality of the service provided, which included good communication and recognising and celebrating achievement across the organisation.

External professionals provided positive feedback about the quality of care people received, and of the commitment and knowledge of the management team and staff.

There was a proactive approach to continuous development to improve people’s quality of life. The registered manager and staff worked collaboratively, by committing themselves to pilot projects focusing on new ideas and technology.

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 5 October 2022). At the last inspection we found improvements were needed to improve people’s safety by improving care plan records and guidance on the use of medicines. In addition, we found improvements were needed to ensure the principles of the mental capacity act were implemented, and systems to support governance to monitor quality and safety were required.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At our last inspection we recommended the provider improved guidance for the administration of covert medicines.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aaron Court is a care home providing personal and nursing care to up to 91 people in one adapted building. The building is across four floors, each of which has separate adapted facilities. The service supported people with mental and physical health needs. At the time of our inspection, 80 people were using the service.

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

Staff did not always have sufficient care plan guidance in place to meet people’s needs. However, staff knew how to meet people’s basic needs as they had worked with them for a while. Medicines were not always managed safely. There were enough staff, and staff were safely recruited. The service used agency staff as they had found it difficult to recruit permanent staff. However, these agency staff were booked on longer term contracts and deployed effectively around the home. Staff did not always record incidents that occurred. However, incidents that were recorded resulted in clear lessons being learnt and improvement made.

People were not always supported to have maximum choice and control of their lives as the mental capacity act was not always followed. The policies and systems in the service did not support good quality mental capacity practice. We have made a recommendation that the provider improves mental capacity record keeping, so staff have suitable guidance available on the administration of covert medicines . Staff were mostly well trained, but further training was needed for all staff to understand complex health conditions. National standards were not always met. There was good quality working with external health and social care professionals. The service was adapted to meet people’s needs.

Improvements had been made to the service since the last inspection. However, the management team had not yet resolved all concerns. People, staff, relatives and visiting professionals spoke highly of 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 and update

The last rating for this service was inadequate (Published 18 March 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 the provider had made some improvements but remained in breach of some regulations.

This service has been in Special Measures since 18 March 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 inspection of this service on 7 and 8 February 2022. We found breaches of regulation in relation to safe care and treatment, staffing, governance and recruitment. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The inspection was planned to inspect the key questions Safe and Well Led. However, as we identified concerns with the application of the Mental Capacity Act, we made the decision on the day of the inspection to widen the scope of our inspection. We therefore also reviewed the key question of Effective.

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 Inadequate to requires improvement, based on the findings of this inspection.

While the provider has improved, we have found evidence that the provider needs to make further improvements. Please see the safe, effective 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aaron Court 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 safe care and treatment, consent and good governance.

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

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.

Aaron Court is a care home providing personal and nursing care to up to 91 people in one adapted building, across four floors, each of which has separate adapted facilities. Some people were also living with dementia. On day one of our inspection 85 people were using the service and on day two, 84 people were using the service.

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

Risks associated with people’s individual care and treatment needs had either not been assessed, or risk plans were insufficiently detailed or not followed. A new electronic system had been introduced in December 2021. Not all staff had received training, and information had not all migrated from the previous electronic system. Following the inspection, the provider forwarded details of training key staff had received. Staff were using a combination of records; the new electronic and previous electronic system and paper records. This increased the risk of people not receiving the care and treatment they required.

People’s prescribed medicines were not consistently managed safely. This included the administration, ordering, storage and recording of medicines.

The service was not consistently clean and hygienic. Infection prevention and control practice was not consistently followed, increasing the risk of infection and cross contamination. Personal protective equipment, including hand sanitiser, had not been replenished when required. Kitchenettes were found to be dirty.

Health and safety checks on the environment were not sufficiently robust and put people at risk of fire or injury. Combustible items were found in a stairwell. Action was not taken to remove a trip hazard in a timely manner resulting in near misses.

Staff deployment did not consider staff skill mix, experience and competency. The largest and most complex unit had the greatest amount of agency staff. Observations of staff engagement with people was not consistently good.

Staff recruitment procedures were not sufficiently robust. Shortfalls were identified in risk management, employment and reference checks. Interview procedures had not been consistently completed.

Incident management procedures were not consistently followed. Complaint investigations completed were not readily available, to understand how outcomes and decisions had been made. Concerns received were not logged to track for themes and patterns to help develop the service.

The provider’s systems and processes to assess, monitor and mitigate risks were not sufficiently robust. Staff communication, oversight, accountability and leadership required improvements to ensure people received the care and treatment they required.

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

Rating at last inspection

The last comprehensive rating inspection for this service was Good (published 25 September 2019).

Why we inspected

We received concerns in relation to staff deployment and people receiving poor care and treatment. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

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, staffing, governance and recruitment procedures.

Following our inspection, we issued a Letter of Intent to the provider in relation to urgent and extreme risks we identified during the inspection. We reviewed their response and were sufficiently assured the provider had taken immediate actions to mitigate those risks.

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 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.

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.

We found the following examples of good practice.

• Safe arrangements were in place for professional visitors to the service. This included temperature checks, lateral flow testing, risk and health questionnaires, hand sanitisation and wearing a mask.

• Isolation, cohorting and zoning was used to manage the spread of infection. This meant that when necessary, people self-isolated in their rooms which were all en-suite. Staff were allocated to work on one floor to reduce movement across different floors.

• Enhanced cleaning and disinfection took place to reduce the risk of infection spread. There were sufficient numbers of housekeeping staff who completed checklists to record and monitor cleaning tasks.

• There were sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. Staff had received training in infection prevention and control, PPE including donning and doffing and hand hygiene.

• PPE was kept in and near people’s rooms for staff to easily access when they were supporting people with personal care. PPE was disposed of safely in clinical waste bins which helped reduce the risk of cross contamination.

• A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if any positive results were received.

• Infection prevention and control audits took place which ensured the registered manager had oversight of all aspects of infection control. Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.

• The laundry area was spacious, well ventilated, clean and organised. There were two sperate doors, one to enter with soiled linen, and one to exit. There were clean and dirty areas for linen to be stored. This helped to reduce the risk of infection spread.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Aaron Court on our website at www.cqc.org.uk.

Aaron Court is a care home providing personal and nursing care to 91 people across four floors, each of which has separate adapted facilities. At the time of the inspection visit 57 people were using the service.

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

The provider had made the required improvements to the quality of care and people’s safety. People told us they received their medicines as prescribed. Improvements were evident in relation to the management, storage and administration of medicines. Care plans provided clear guidance for staff to support people with their medicines. Where protocols for medicines to be administered as required were missing this was addressed by the registered manager.

People felt safe because risks associated to their health, safety and welfare were assessed, managed and monitored. Care plans provided clear guidance for staff to follow to meet people’s needs and staff used equipment to promote people’s safety.

People told us they felt safe. Systems and processes were in place to promote people’s safety. Staff recruitment procedures were followed, and all necessary pre-employment checks were carried out. Staff were trained in safeguarding procedures and knew how to raise concerns. Safeguarding procedures were followed when people’s safety was of concern by reporting concerns to the relevant agencies. Infection control was maintained to a good standard and people were protected from the risk of the spread of infection.

People told us their needs were met by staff. Some people and staff felt staffing numbers could be better, but no one had expressed concerns to the registered manager about this. The registered manager confirmed the use of agency staff had reduced following appointment of permanent care staff, nurses and ancillary staff.

Improvements were found to staff training. All staff received an induction and ongoing training for their role. Staff training was monitored to ensure their skills and knowledge was kept up to date and their competency was checked regularly. Nurses accessed clinical training and support to meet people’s nursing care needs. Staff were supervised and supported in their roles.

People were provided with enough to eat and drink. People’s dietary needs were mostly met to ensure risks were managed and to maintain good health. Menus were being reviewed to ensure people’s food preferences and cultural diets were reflected and alternatives were suitable. Observations of the dining experience was positive with examples of staff being attentive, kind and encouraging people who needed support to eat and drink.

People were supported to access a wide range of healthcare support. Staff worked with health professionals to meet people’s ongoing health needs and supported to attend routine health checks. Procedures were followed to ensure people had the opportunity to express their wishes in relation to end of life care.

People's needs were assessed thoroughly and in good detail. People’s desired outcomes and wishes were documented in their care plans which included how any health conditions impacted on their daily life and the level of support required.

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. People’s capacity, any authorisations to deprive people’s liberty and best interest decisions were kept under review and monitored.

People lived in an environment that was welcoming and homely. The provider had already started to make improvements to the environment. Some new furniture and furnishings were in place to create areas of interest. Further improvements included sensory stimulation which could be accessed easily especially for people living with dementia.

People received care from kind and caring staff and had developed good relationships with them. People’s privacy and dignity was maintained. Individual rooms with full en-suite facilities also promoted people’s privacy and independence.

People received care that was responsive to their needs. Improvements were made to ensure care provided was person-centred. People were involved in the planning and reviewing of their care. Care plans contained a good level of detail about individual preferences, wishes and diverse needs were captured so staff knew how people wished to be supported.

People knew how to complain and raise concerns and were listened to. People had opportunities to express their views about the service. For example, a board entitled ‘You said & We did’ showed the actions taken in response to feedback from people. Results from the surveys were shared with people and relatives which showed action was being taken in response to feedback.

The service had two registered managers and they understood their legal responsibilities. The provider’s quality assurance and governance systems were being used effectively to monitor the quality of the service and to drive improvements. Systems were in place to support staff in their roles. People, their relatives, health professionals and staff felt the registered manager on duty was approachable and acted on concerns. Lessons were learnt when things went wrong.

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

Rating at last inspection

The last rating for this service was requires improvement (published 24 January 2019). 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aaron Court accommodates 91 people across four floors, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia and palliative care.

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.’

At our previous inspection in April 2016 we rated the service as ‘good’. At this inspection the service had not maintained the rating and had deteriorated to ‘Requires Improvement’.

At the time of our inspection visit 72 people were using the service.

The provider’s governance systems and processes used to assess the quality of care provided were fragmented. There was a lack of oversight and monitoring was ineffective.

People did not always receive their medicines as prescribed. Risks associated with people’s needs had been assessed but risks were not always managed. Care plans lacked information and clear guidance for staff to follow to provide person-centred care. Monitoring records were not always completed in full.

Staffing levels were not adequately managed to ensure there were enough staff to provide care and support to people when they needed it. The system to ensure staff were trained and supported in their role was not effective. Further action was needed to ensure staff training was kept up to date and staff competence and practices were monitored.

People and their relatives knew how to make a complaint but they were not confident their complaints would be fully addressed. The system to manage complaints was not effective. People did not feel confident that action would be taken. There were limited opportunities for people to express their views about the service and influence how the service was run.

People were provided with a choice and variety of food and drink. Further action was needed to ensure people’s cultural and specific dietary requirements were met. People at risk of malnutrition and dehydration were not always monitored. People were supported with their health care needs when required.

People were involved in decisions made about all aspects of their care. 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. Further action was needed to ensure staff training in Mental Capacity Act was up to date.

People were cared for by kind and caring staff. Most staff knew people well; understood their wishes and daily needs. People were supported and made decisions about their end of life care.

People were involved in the development of the care plans. However, people were not involved in a meaningful way to review their care so that they received person-centred care that was responsive. Improvements were needed to ensure staff treated people with dignity and respect.

The provider employed activity co-ordinators but people’s experiences about the activities, social stimulation and engagement varied. People’s diverse needs were mostly met.

Information was made available in accessible formats to help people understand the care and support agreed. The provider was developing picture menus to help people living with dementia choose what they want to eat.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Aaron Court is a care home that provides residential and nursing care for up to 91 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. Accommodation is over four floors accessible using the stairs or the lift. Bedrooms are all single ensuite and there is a choice of communal lounges and dining rooms on each floor. Each floor has a dedicated team of staff. At the time of our inspection there were 65 people in residence.

A registered manager was 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.

People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff were trained and understood their responsibility in protecting people from the risk of harm.

Risk assessments and care plans had been developed with the involvement of people and where appropriate their relatives and health care professionals. Staff had the clear information on how to reduce risks to ensure people were supported in a safe way.

Staff were recruited in accordance with the provider’s recruitment procedures and sufficient staff were available to meet people’s needs. People received quality care and staff receive on-going training and support.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles. This included staff seeking consent from people before supporting them. The registered manager sought advice and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

People and where appropriate their relatives and health care professionals were involved and made decisions about their care and support needs. People chose how they wish to spend their day and had opportunities to take part in activities that were of interests to them. People’s family and friend were encouraged to visit at any time.

People told us staff were caring and kind and that they had confidence in them to provide the support they needed. We saw staff positively engaging with people, and treated them with dignity and respect.

People were provided with a choice of meals that met their health and dietary needs. Referrals were made to relevant health care professionals where there were concerns about people’s health.

People’s views about the service and their relatives were regularly sought as part of monitoring the quality of service provided and to improve the service. The registered manager was developing new ways to engage and support staff to ensure they contributed to the staff meetings and the development of the service.

The provider’s quality assurance systems were used effectively to monitor the performance and the service provided. Regular audits and checks were carried out to ensure people’s safety, the premises and the equipment used was well maintained.