Aaron Court Care Home

Aaron Court is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

A concern raised related to staff not self-isolating after returning from a holiday abroad. We found safe procedures had been followed following staff holidays in line with current government guidance.

We found all areas of the home to be clean and free of malodours. Staff had received up to date infection control training to ensure safe working practices.

People commented: “It’s very good here, I am happy. The home is clean, and staff are wearing PPE. Very good care” and “The staff are very good with using PPE and the home is clean. Had my coronavirus test this morning. I am that bit more critical about infection control measures.”

The provider’s infection prevention and control policy was up to date and audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule was in place to ensure the whole home was effectively cleaned on a regular basis.

Rating at last inspection

The last rating for this service was good (published date March 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns in relation to infection control and the wearing of personal protective equipment and the service not following government guidance. This inspection only looked at those risks. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service and take appropriate action which may include carrying out a further inspection.

Aaron Court Care Home is registered to provide personal care for up to 24 older people some of whom may be living with dementia. The property is a large family type home that has been extended and adapted to provide additional bedrooms and living space. Some of the bedrooms were registered as shared bedrooms but only occupied by one person, thereby reducing the maximum capacity to 21. At the time of the inspection there were 21 people in residence.

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

Staff ensured people were looked after safely. They received safeguarding adults training and knew how to report any safeguarding concerns to the local authority or CQC. The management of risks to people’s health and welfare were assessed and appropriate plans put in place to mitigate those risks. The number of staff on duty each shift were appropriate and ensured each person’s care and support needs were met. Staffing numbers were kept under continual review and adjusted as and when necessary.

The service followed safe recruitment procedures to ensure they only employed suitable staff. Pre-employment checks included written references and a Disclosure and Barring Service check. People received their medicines as prescribed. Medicines were well managed and administered by those staff who had been trained and were competent.

People received person-centred care. Their needs were assessed and a care plan written setting out how they wanted to be looked after. People signed their care plans in agreement. Staff received the training they needed to enable them to do their job well. For new staff there was an induction training programme and for all others there was a mandatory refresher training programme. Staff were well supported to do their job and received a regular supervision session with a senior member of staff.

People were assisted by the staff team to access any healthcare services. People received the food and drink they needed to maintain a healthy, balanced diet. Any preferences they had regarding food and drink were accommodated.

People were encouraged to retain as much choice and control of their daily lives and staff supported them in their best interests. The service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

People were looked after by staff who were kind and caring. People and relatives were complimentary about all aspects of care at Aaron Court. People’s individual care and support needs were met and they were encouraged to make their own decisions about their daily life and the way they were looked after. The staff team had kind, friendly and good working relationships with people and their relatives.

The service was responsive to each person’s specific needs and they were able to participate in a range of meaningful social activities. Trips out were arranged weekly and external entertainers visited regularly.

The registered manager and deputy manager provided good leadership and management of the staff team. The service ensured people received the health and social care services they needed. They encouraged people and their families to provide feedback about the service - their views and opinions were listened to and acted upon.

The provider of this service and another service with a separate entity had shared working directors, common to both services. They worked collaboratively with both registered managers to obtain the best possible outcomes for both services. At the time of this inspection the registered manager was not meeting with other relevant health or social care professionals or registered managers with other registered care services.

We have recommended that the provider seek opportunities for the registered manager to liaise and work with other relevant care services, to keep abreast of current best practice.

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 August 2017).

Why we inspected

This was a planned inspection based upon 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 is registered to provide accommodation for 24 people who require personal care. At the time of the inspection there were 20 people living at the home.

There is 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 2008 and associated Regulations about how the service is run.

The registered manager had kept us informed about progress towards achieving the provider’s action plan, and we found some improvements in the areas requiring improvement since the last inspection. However, we also identified some areas for further improvement. At the last inspection in January 2016 we found people’s rights were not always protected under the Mental Capacity Act 2005 (MCA). Staff did not have an understanding of the MCA or how the principles applied to their practice. People’s capacity to make particular decisions had not always been assessed and documented, or a best interest process followed. In addition, people had not been referred for assessment under the Deprivation of Liberty Safeguards (DoLS). This meant, at that time, they were potentially being deprived of their liberty to receive care and treatment without being assessed to determine if this was in their best interests and legally authorised under the MCA.

At this inspection in May 2017 we found applications had been made for people to be cared for under DoLS where appropriate. Staff understanding of the MCA had improved significantly following training, and records showed that people’s capacity had been assessed and decisions made in their best interest where appropriate. However, we found further learning was required regarding the protection of people’s legal rights when they did not have capacity to consent to the use of a pressure pad to alert staff of their movements, for example if they were at risk of falls. Although the use of a pressure alert pad is a measure to keep people safe it is seen as a restriction of people’s free movement and requires a best interest decision making process. We have made a recommendation that the service seeks support and further training to enable them to consolidate and build on their knowledge of the MCA and ensure people’s legal rights are fully protected.

At the last inspection we identified that risk assessments, care plans and reviews were not up to date, which meant staff did not have access to accurate written information about potential risks or the actions they must take to reduce those risks. At this inspection we found improvements had been made and there were systems in place to ensure risk assessments, care plans and reviews were comprehensive, current, and supported staff to provide safe care. Care plans were reviewed every week by the person and their keyworker, and formally once a month. However, relatives had not always been involved in the formal reviews of their family member’s care plan, although the service kept them informed about the welfare of their family member. We discussed this with the registered manager, who, by the second day of the inspection had written to all relatives inviting them “to be more involved in the care planning process” if they wished.

When we inspected in January 2016 we found people did not have individual fire risk assessments or a personal emergency evacuation plan (PEEP) to show what support they would need in the event of a fire or other emergency. At this inspection we found emergency plans were now in place and reviewed monthly which meant they remained accurate if people’s needs changed.

There was a committed staff team at the home which was well supported by managers and the providers. An induction and training programme was in place to support them to do their jobs effectively. Ongoing professional development was encouraged for all staff members. One member of staff told us, “There’s enough training. I’m always quite happy to do it. It’s good to have ‘refreshers’”. We identified that further steps could be taken by the registered manager and provider to ensure the service keeps up to date with best practice and developments in adult social care. We have made a recommendation that they seek further support and training in this respect from a reputable source.

The service had a quality assurance system to ensure they continued to meet people’s needs safely and effectively, although further improvement was required to ensure people’s legal rights were protected when restrictive practices were in place. People’s views were actively sought and suggestions acted on.

People were supported by a caring staff team who knew them well. Staff spoke with great affection when they told us about the people they supported. One member of staff said, “I love to sit and talk to them, sing the old songs, do the knitting with them…I think we’ve got a special home”.

People told us they felt safe and there were sufficient numbers of staff deployed to meet their needs. One person commented, “I feel safe – funnily almost too safe. From time to time I have to leave to go to medical appointments but I’m always so pleased to get back here”. There was additional monitoring in place for people who found it difficult to use the call bell system, for example because they were living with dementia. People were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process. Systems were in place to ensure people received their medicines safely.

People were supported to maintain good health and had access to healthcare services. People were referred appropriately and guidance followed. One health professional commented, “If the nurses highlight a concern or a problem, they tend to ‘get on with it’. They listen to our concerns and take on board what we say”.

People had sufficient to eat and drink and received a balanced diet, and care plans guided staff to provide the support they needed. They spoke positively about the food. Comments included, “We have two choices of meals. If we don’t like either, they’ll find us something else”, “I have a choice about where I can eat my meals” and, “Lunch was lovely today”.

Staff promoted people’s independence and treated them with dignity and respect. People were supported to make choices about their day to day lives, for example how they wanted their care to be provided and how they wanted to spend their time.

Aaron Court is registered to provide accommodation for 24 people who require personal care. At the time of the inspection there were 19 people living at the home.

The last inspection of the home was carried out on 2 October 2013. No concerns were identified with the care being provided to people at that inspection.

There is 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 2008 and associated Regulations about how the service is run. Everybody was very complimentary about the registered manager. Staff told us, “I couldn’t have a better boss.”

At the time of the inspection, the service was recovering from a period of staff sickness and movement. To promote continuity of care during this time, existing staff had provided cover on overtime. The priority for the service had been providing the care, rather than completing the paperwork. This meant there was a risk that people may not receive safe care, because risk assessments, care plans and reviews were not up to date. Risks were minimised because existing staff knew people well. However, staff were being recruited and new people were moving into the home, so clear information and guidance was essential to enable staff to understand and meet their needs.

Staff had received training in fire safety, fire checks and drills were carried out in accordance with fire regulations and the fire system had been recently updated. People did not have individual fire risk assessments or a personal emergency evacuation plan (PEEP) to show what support they would need; however following the inspection the service hired a ‘Fire Protection’ company to implement the required change.

There was no documentation in place to support a best interest decision making process where people lacked the capacity to make an informed decision. This meant people’s human rights were not being fully protected under the Mental Capacity Act 2005 (MCA). Some people at the service were subject to continuous supervision and control, not free to leave, and lacked capacity to consent to these arrangements. They therefore required an assessment under the Deprivation of Liberty Safeguards, to determine whether this was in their best interests, but a DoLS application had not yet been made. These issues were being followed up by the registered manager. Training had been arranged to help staff to understand the legislation and use it in their practice to ensure people’s rights are protected.

Although new staff were still being recruited, there were enough staff deployed to meet the needs of people at the service and to care for them safely. They worked closely with health and social care professionals, and feedback from the professionals was positive. For example, the chef was proactive in seeking specialist advice, and worked alongside health professionals to ensure people’s nutritional needs were met as they changed.

People told us they felt safe. They were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process. Systems were in place to ensure people received their medicines safely.

Staff promoted people’s independence and treated them with dignity and respect. One person told us, “There is nothing that I would improve, there is everything I want. I love it here, the staff are so nice and kind and friendly. They are all lovely”. People were supported to make choices about their day to day lives, such as what to wear and how they wanted to spend their time.

People’s relatives said they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

There was a dedicated and dynamic activities organiser working with people to develop a fulfilling programme which met everybody’s needs. A relative told us, “They have so many functions and events, their effort is unbelievable. No-one is left to rot”.

There was a committed staff team at the home which was well supported by managers and directors. A comprehensive staff training programme enabled them to do their jobs effectively, and ongoing professional development was encouraged for all staff members. They told us,”[X] is such a good manager. There is no sense of hierarchy; there is a really close team of girls. I am proud to work here”.

The service had an effective quality assurance system to ensure they continued to meet people’s needs effectively. People’s views were actively sought and suggestions acted on.

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 this report.

People told us they were happy living at Aaron Court and praised the staff team. For example, one person said 'I wouldn't wish to be anywhere else'. People's privacy and dignity was respected by a stable and experienced staff. People's health and well-being was assessed, and care was provided in a way that suited people's individual needs.

Staff offered people choice, and treated people with kindness and respect. Care and support was offered to people in a friendly, cheerful and professional manner. The home was well maintained and meet the needs of the people living there. Staffing levels met people's current needs. Training was promoted to ensure staff skills were based on best and safe practice.

People chose to move into Aaron Court. Some had their families help them to find the right place to move to. Everyone we spoke with told us that they liked living at Aaron Court. One person said "It's as near to your own home as you can get." They told us that they enjoyed trips out. "Sometimes she (the activities co-ordinator) takes me to see my friend."

We inspected the way the home manages the administration of medication and found that this was done safely and competently by properly trained staff. We looked at staffing and saw that the home took proper precautions to ensure that they only employed people who were suitable for the role.

We looked at the home's policies and procedures and found that they were up to date and fit for purpose. We spoke to people about any complaints they may have and were told "I have no complaints whatsoever..."

We found Aaron Court offered a range of activities that interested and stimulated those who chose to participate. We saw that Aaron Court provided a safe and supported environment for those who preferred to mainly stay in their rooms.