Aronmore Residential Care Home

Aronmore Residential Care Home provides accommodation with personal care for older people, including those living with the experience of dementia and mental health needs. The service consists of a 27 bedded care home and four individual 'cottages' in the rear grounds of the main building. The service is registered for a maximum of 31 people and at the time of our inspection there were19 people living at the service, 17 in the main building and two in the cottages. Since the last inspection, the provider had not been taking new placements.

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

The provider did not always have effective systems in place to safeguard people from risk. Risks had not always been identified, assessed and recorded in care plans. Medicines were not always managed safely, and safe recruitment practices were not always followed to ensure only suitable staff were employed.

The provider had a process for recording incidents and accidents and lessons learned but these were not always recorded in the care plan so staff had relevant information to implement.

We observed staff were task focused and did not have time for much meaningful interaction with people. We made a recommendation for the provider to review how they deployed their staff to ensure the numbers of staff deployed were adequate to meet peoples’ needs and to ensure their safety.

There was also a lack of meaningful activities. We made a recommendation for the provider to consider recognised guidance for the provision of social and recreation activities for older people in care settings and provide meaningful activities for people living in the home.

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. For example, the use of a senor mat without consent or a best interest decision for its use.

There had been some improvement in the environment and the provider had decorated some communal rooms and bedrooms but there were still areas such as bathrooms and toilets that required further maintenance. We made a recommendation for the provider to seek and implement national guidance in relation to providing a dementia friendly environment.

The provider had quality assurance systems in place, and we found there had been some improvements in how the home was managed but there remained identified shortfalls, such as risk assessments and the safe management of medicines, that the quality assurance systems had not picked up.

Although we identified a number of concerns during the inspection, relatives and staff were positive about the service and felt improvements had been made. Relatives said people were safe and well looked after by kind and caring staff and they would recommend the service to others.

People were supported to maintain healthy lives and access healthcare services appropriately. Care plans recorded people’s preferences, so staff knew their likes and dislikes.

Staff were supported to develop their skills and provide appropriate care through inductions, supervisions, appraisals, training and team meetings. Staff knew how to respond to possible safeguarding concerns.

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 inadequate (published December 2021) 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 we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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, staff recruitment, consent to care and good governance at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Aronmore Residential Care Home provides accommodation with personal care for older people including those living with the experience of dementia and mental health needs. The service consists of a 27 bedded care home and four individual 'cottages' in the rear grounds of the main building. The service is registered for a maximum of 31 people and at the time of our inspection there were 28 people living at the service, 24 in the main building and four in the cottages.

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

The provider did not always have effective systems in place to safeguard people from the risk of abuse. Medicines were not always managed safely and staff had not completed medicines competency assessments. Safe recruitment procedures were not always followed, but the provider addressed this after we raised this issue during the inspection. Cleaning schedules were in place, but processes were not always implemented effectively to help ensure staff followed appropriate infection control practices to prevent cross infection.

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 supported this practice. Care plans were not always personalised so staff knew how to respond to people’s individual needs appropriately. Meaningful recreational activities for people to help prevent social isolation were limited.

The provider had quality assurance systems in place to monitor and manage the quality of service delivery. However, these were not effective as they had not identified the various areas we identified during our inspection as needing to improve and the provider had therefore not been able to improve the quality of the service.

Staff were supported to develop their skills through supervision and training to help them deliver appropriate care to people.

People were supported to access healthcare services. People and their relatives told us people were cared for by kind staff who knew the needs of the people they cared for.

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 good (published 24 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of care. This was followed up by the local authority who alerted CQC of further concerns around staffing, lack of social activities, and the oversight and governance of the service.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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 person centred care, privacy and dignity, consent to care, safe care and treatment, safeguarding people from the risk of abuse an improper treatment, safety and suitability of the premises and good governance at this inspection.

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

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 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.

Aronmore Residential Care Home provides accommodation with personal care for older people including those with dementia care needs. The service consists of a 27 bedded care home and there are four individual ‘cottages’ in the rear grounds of the service. The service is registered for a maximum of 31 people and at the time of our inspection there were 28 people living at the service, 24 in the main building and four in the cottages.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 registered manager had been registered with CQC since 3 August 2016. They are an experienced manager who had previously managed two other services owned by the provider.

At the September 2016 inspection we identified some shortfalls with medicines management, which the registered manager took action to address. At this inspection we found medicines management was good and processes for monitoring the medicines were in place and being followed. At the September 2016 inspection there was limited evidence of people’s input with their care records and people did not know about their care records. At this inspection action had been taken and this had been addressed.

Procedures were in place to safeguard people from the risk of abuse and staff knew the action to take if they had any concerns. Staff recruitment procedures were followed to ensure only suitable staff were employed at the service. There were enough staff available to meet people’s needs and the registered manager kept staffing under review so changes in people’s needs could be met.

Risks to individuals were assessed and plans put in place to minimise identified risks. Infection control procedures were being followed and he service was clean and fresh throughout. Systems and equipment were serviced at the required intervals and were maintained to keep them in good working order.

Staff training needs were identified and staff undertook recognised qualifications in health and social care. Staff received training in a variety of topics to provide them with the skills and knowledge to care for people effectively.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). People’s mental capacity had been assessed. For some people DoLS authorisations were in place to ensure that their freedom was not unduly restricted. Staff understood people’s needs and the importance of obtaining consent from people and of respecting peoples’ right to make choices for themselves.

People’s dietary needs and preferences were identified and met and there was a good range of meals available, including those to meet people’s religious and cultural needs. People’s nutritional needs and status were assessed and monitored. People’s healthcare needs were identified and monitored and they received input from healthcare professionals.

People and professionals were happy with the care and support being provided to people using the service. People, and where appropriate, their relatives, had been consulted about care needs and the care plans had been drawn up with their input. Care records were comprehensive and person centred and were reviewed regularly with input from people to keep the information up to date.

People were offered choices and staff treated them with dignity and respect. Staff had a good knowledge of people’s individual care and support needs and provided this in a kind and friendly manner.

There were a variety of activities each day and outings were arranged, all of which people could participate in if they so wished and people enjoyed the activity provision. There was a complaints procedure in place and people felt confident to express any concerns, however minor, so they could be addressed.

The registered manager provided good leadership and was approachable and responsive. People and staff were happy with the way they managed the service and felt that their opinions were sought and listened to.

The processes for monitoring the service were clear and ensured the provider was kept informed and could look for trends and take action to address any issues that might be identified.

Aronmore Residential Care Home provides accommodation with personal care for up to a maximum of 31 people. The service consists of a 27 bedded care home and there are four individual ‘cottages’ in the rear grounds of the service. At the time of our inspection there were 29 people living at the service, one of whom was in hospital.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 registered manager had been registered with CQC since 3 August 2016 and had recently taken over managing the service full time. They are an experienced manager who had previously managed two other services owned by the provider.

We found some shortfalls with medicine stock balances and recording so medicines were not always being safely managed. The registered manager addressed the finding at the time of inspection and said she would increase medicines monitoring so issues were promptly identified and dealt with.

There was limited evidence of people’s input with their care records and people did not know about their care records. The registered manager was aware and said this would be addressed.

People and relatives expressed their satisfaction with the care and support being provided.

Systems were in place to safeguard people from the risk of abuse and staff understood the action to take if they suspected abuse.

Risk assessments were in place for identified areas of risk to minimise them. Systems and equipment were serviced and maintained to maintain their safety.

Staff recruitment procedures were in place and being followed. There were enough staff on duty to meet people’s needs and recruitment was ongoing.

Staff received training to provide them with the skills and knowledge to care for people effectively.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS were in place to ensure that people’s freedom was not unduly restricted. Staff acted in people’s best interests to ensure their freedom was not unduly restricted.

People’s nutritional needs were assessed and monitored. People’s dietary needs and preferences were being identified and met.

People’s healthcare needs were identified and they were referred to the GP, community nurse and other healthcare professionals when required.

Staff understood the individual care and support people needed and provided this in a gentle and caring manner.

Staff respected people’s choices and treated people in a respectful and dignified way.

Care records were personalised and up to date and changes in people’s condition had been identified and included in the care plans.

People and relatives were confident to raise any complaints and systems were in place and being followed to record and investigate these.

The registered manager had recently taken over managing the service and demonstrated the knowledge and skills to do so effectively. The registered manager was approachable and listened to people and staff, taking action to address any issues promptly and to promote good practices.

Systems were in place to monitor the quality of the service and the registered manager was expanding these to ensure all aspects of the service were monitored. Work in this area was ongoing, with environmental improvements being planned for the service.

We spoke with two members of staff, two relatives and four people who were using the service during the inspection. People's needs were assessed and care plans developed to inform staff about how to meet them. People were able to access appropriate healthcare and identified risks were assessed to ensure staff took action to minimise these and keep people safe.

We saw positive interactions between staff and the people using the service and people told us they were happy with the care staff provided. One person said, 'they look after us very well' and a relative we spoke with said, 'they (staff) are excellent.'

People's dietary needs were met and we observed staff assisting people in a sensitive manner, explaining what was being served and engaging people in conversation while they ate.

The premises were well maintained and health and safety checks were taking place to ensure the environment was safe for staff and the people using the service.

There were enough staff on duty to meet people's needs and staffing levels were adjusted where required.

People were aware of the complaints procedure for the home and felt able to raise any concerns.

During this inspection we found that the provider had made improvements and was now meeting the relevant regulation.

Medicines were administered by staff with the training and knowledge to do so safely and people confirmed they received their medicines when they were due.

People said there was always someone to talk to if they were worried about anything. Staff understood safeguarding and whistle blowing procedures and were clear to report any concerns. Staff recruitment procedures were in place but were not always being followed, which could place people at risk.

Systems for monitoring and quality assurance were in place and were being followed. Surveys had been carried out in April 2012 and the responses were positive. Comments included 'Thank you for your care and kindness'Aronmore is a friendly and homely place and we speak very highly of it' and 'many thanks for your continuing good work'.

We spoke with four people using the service and four staff.