Aynsley Care Centre

Aynsley Care Centre is registered to provide accommodation and personal care for up to 28 people. There were 15 people were living there at the time of the inspection, some of whom were living with dementia.

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

The systems in place to monitor the quality and safety of the service were not always effective. They did not highlight all the issues identified during the inspection and it was not always clear if actions had been taken to address identified issues. The manager was not always aware of actions identified on audits, so could not ensure the appropriate steps were taken to improve the quality and safety of the home.

Although improvements had been made regarding the management of medicines, further changes were still required. We made a recommendation regarding the use of homely remedies. There were no homely remedies available to people, which meant there was a risk medicines would not be available to people when they needed them.

Medicines were administered safely by staff who had undertaken training and had their competency assessed. Medication records were completed robustly and showed that medicines were given as prescribed.

People told us they felt safe living in the home. Procedures were in place to ensure safeguarding concerns were reported appropriately. Risks to people and the building had been assessed. Care files showed that measures had been taken to minimise risks to people. Staff knew the people they supported well. Information regarding people’s health conditions was available and advice from other health professionals was reflected within people’s care files. The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

There were enough staff available to meet people’s needs in a timely way. Most safe recruitment procedures had been followed to help ensure staff were suitable to work in social care.

The home appeared clean and well maintained. PPE was available to staff and they had undertaken training to help prevent the spread of infections. Staff were encouraged to undertake regular COVID-19 testing, but there was no system in place to ensure staff tested in line with current government guidance.

Accidents and incidents were reviewed and acted upon to ensure the service acted in a transparent way. People’s relatives were kept informed of any changes regarding their family member and were encouraged to visit the home safely.

Systems were in place to gather feedback regarding the service. Feedback from people and their relatives regarding the care provided and the management of the service was positive. Staff told us they enjoyed their jobs and were well supported by the management team. The manager liaised with other health and social care professionals to help ensure people's needs were met.

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 January 2022) and the provider was found to be in breach of regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2002 (Regulated Activities) Regulations 2008.

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 that some improvements had been made and the provider was no longer in breach of regulation 12 but was still in breach of regulation 17.

This service has been in Special Measures since 17 January 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 3 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and the governance of the service.

This inspection was carried out to follow up on action we told the provider to take at the last inspection, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those 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 inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aynsley Care Centre 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 monitor the service and will take further action if needed.

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.

Aynsley Care Centre is registered to provide accommodation and personal care for up to 28 people. There were 19 people were living there at the time of the inspection, some of whom were living with dementia.

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

The systems in place to monitor the quality and safety of the service were not effective. They were not in place for all aspects of the service and did not identify the risks to people that we highlighted during the inspection. When audits identified that actions were required, it was not always clear if they had been addressed.

Risks to people were not always effectively assessed or managed, such as those regarding smoking, emergency evacuation and COVID-19. Care files did not all contain sufficient information to ensure staff knew people’s needs, including their medical needs and not all staff had completed training to ensure they had the knowledge required to support people safely.

The environment was not always well maintained. There were several repairs needed around the home and records were not available to evidence that all required internal and external safety checks had been completed recently.

Medicines were not all managed safely and although staff had completed training, records showed that not all staff had had their competency assessed to ensure they could administer medicines safely. Temperatures of the storage areas were not monitored regularly, stock balance checks were inaccurate, and records showed that medicines were not always administered as prescribed. The provider was in the process of improving the medication systems prior to this inspection.

Appropriate infection prevention and control measures were not in place to prevent the spread of infection. Processes in place to ensure safe visiting procedures were not effective and visitors in the home were not wearing PPE. There was no evidence to reflect that staff were undertaking COVID-19 testing in line with government guidance and people living in the home did not have their temperature monitored in line with the guidance. There was no evidence that all staff and professional visitors entering Aynsley Care Centre had received two doses of the COVID-19 vaccination, or were exempt, as required.

There was no system in place to establish how many staff were required to meet people's needs. Not all staff felt there were sufficient numbers of staff, although people living in the home did not raise any concerns regarding this. The provider agreed to review their systems. All staff had had a disclosure barring service (DBS) check prior to commencing in post, however, risk assessments were not available for potential risks identified in the recruitment process.

Feedback regarding care provided was very positive and people told us they felt safe living in the home. Relatives agreed that it was a safe place to be, although they had not been asked about their views of the service. Staff had undertaken safeguarding training and knew how to raise any concerns they had. Accidents and incidents were recorded, however a concern was raised as to whether safe procedures were always adhered to following falls.

The manager and business managers were responsive during the inspection and took timely actions to address concerns raised. The provider submitted an action plan following the inspection to inform us of further actions they would take to ensure improvements were made.

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 28 September 2018).

Why we inspected

This was a planned inspection based on the previous rating and our current inspection methodology.

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 the management of medicines, infection prevention and control, the management of risk and the governance of the service. 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.

Aynsley nursing Home 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 registered to provide accommodation with personal care or nursing care for up to 28 people and 19 people were living there when we visited, some of whom were living with dementia. The accommodation is provided in single and double rooms. However, no one was sharing a room at the time of the inspection. Access to the upper floors is by way of stairs or passenger lift.

At the last inspection on 19 July 2017 we rated the service requires improvement overall and in each of the five questions we ask. This was because improvements made since the previous inspection needed to be sustained.

The service had a registered manager. 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.

Improvements to the service provided identified at the last inspection had been maintained. However, we identified some gaps in the completion of some records that needed to improve.

People and relatives told us they felt the service was safe. People were protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe management of medicines. People were supported to get their medicine safely when they needed them. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff felt fully supported by management to undertake their roles and were given training updates, supervision and development opportunities.

People were encouraged to express their views at meetings and results of customer satisfaction surveys were positive. People and relatives felt listened to and any concerns or issues they raised had been addressed.

Staff supported people to participate in activities of their choice and trips to the local shops and tourist attractions had been organised.

People were supported to eat and drink sufficient amounts and they were given time to eat at their own pace. People’s nutritional needs were met and people had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with commented positively on the caring and respectful attitude of a consistent staff team which we observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The ratings from the previous inspection were on display in accordance with requirements.

We last inspected the home on 7, 8 and 15 February 2017 and found breaches of regulations 9, 10, 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because: The premises were not adequately maintained or refurbished and there was unsafe equipment in use. There had been very little training for staff and there was insufficient evidence that all new staff had been recruited safely. People’s capacity to consent to care and treatment had not been assessed and care plans did not adequately describe the individual characteristics of people living at the home. People’s dignity was not always upheld. There was a poor standard of record keeping and no evidence that the provider had oversight of the service being provided at the home.

During this inspection we found that improvements had been made in all of these areas but further improvements were required. However, in response to the improvements that had been made we took the service out of special measures.

As a condition of the provider’s registration with the Care Quality Commission, the home is required to have a registered manager. 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 home has not had a registered manager for a long time. CQC has taken enforcement action in relation to this issue and the provider has paid a fixed penalty notice. The current manager has now submitted an application to CQC which is being processed.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 21 people were living there when we visited for this inspection.

During previous inspections we saw that people were potentially at risk from inappropriately fitted bedrails and from hot radiators. We also saw that maintenance records were incomplete. During this inspection we saw that all radiators had been fitted with protective covers and people who required the use of bedrails were provided with beds that were safe and suitable to meet their needs. We also saw records to show that equipment and services had been tested and maintained.

During our last inspection we were concerned that adequate arrangements were not in place to protect people from the risk of fire and we referred these concerns to the Fire Service. At this inspection we were able to see that the provider had taken appropriate action to address this.

During previous inspections we found that the premises were not adequately maintained and the home looked ‘tired’ and was in a poor state of repair and decoration in some areas. During this inspection we saw that a programme of redecoration and refurbishment was underway to provide a more pleasant environment for people to live in.

During previous inspections we found that staff records were poorly maintained and records relating to the recruitment and employment of new staff were incomplete. During this inspection we saw that this had been addressed and records relating to two new staff contained adequate information to show that they were safe to work with vulnerable older people.

During previous inspections we found that staff had not received the training and support they needed to work safely and effectively. During this inspection we saw that a programme of staff training and supervision had been put in place and was underway.

At our last inspection we found that the manager had not followed the requirements of the Mental Capacity Act 2005 because people’s capacity to make decisions about their care and treatment had not been assessed. At this inspection we saw that a mental capacity assessment tool had been introduced and some Deprivation of Liberty Safeguard applications had been made to the local authority to ensure that people’s rights were protected.

At our last inspection we found that people’s privacy and dignity were not always protected when support was provided for them. At this inspection we found that some improvements had been made, for example only one bedroom was being shared and this had a privacy curtain. However further improvement was needed.

At our last inspection we found that people’s care plans were not person-centred and did not describe their individual needs and preferences. During this inspection we saw that new care planning documentation had been introduced and this presented information in a person-centred style.

During our last inspection we found that the provider’s quality assurance process was ineffective. Although the home did not have a registered manager, there was no evidence that the provider had oversight of the service being provided. At this inspection we saw that the provider had been involved in implementing improvements to the service and in monitoring the quality of the service provided.

During our visit we saw that there were enough staff to support people and meet their needs and people we spoke with described the staff as kind and caring.

As a condition of the provider’s registration with the Care Quality Commission, the home is required to have a registered manager. 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 home had not had a manager who was registered with the CQC since August 2014. Following our last inspection we made the provider aware that this was a breach of the Health and Social Care Act 2008. We also wrote to the provider about this in July 2016.

This is a criminal offence with respect to Schedule 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Section 86 of the Health and Social Care Act 2008.

During this inspection we also found breaches of regulations 9,10, 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the premises were not adequately maintained or refurbished and there was unsafe equipment in use. There had been very little training for staff and there was insufficient evidence that all new staff had been recruited safely. People’s capacity to consent to care and treatment had not been assessed and care plans did not adequately describe the individual characteristics of people living at the home. People’s dignity was not always upheld. There was a poor standard of record keeping and no evidence that the provider had oversight of the service being provided at the home.

Areas we had identified as needing improvement at our last inspection had not been addressed by the provider and there was no development plan to show how the service would move forward.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 25 people were living there when we visited for this inspection.

During our visits we saw that there were enough staff to support people and meet their needs. People we spoke with described the staff as kind and caring and we observed warm and respectful interactions between staff and people who lived at the home. However, two people had contacted CQC to tell us that their relative had not always received the care they required at Aynsley Nursing Home.

Records relating to the recruitment and employment of new staff were incomplete so did not provide evidence that staff recruitment had always followed safe procedures to ensure that new staff were of suitable character to work with vulnerable older people.

Staff had received training about safeguarding vulnerable people from abuse in September 2016, however little other training had taken place since 2015 and there was no training plan. Some staff had attended individual and group supervisions over the last year but there were no records to identify staff who may not have had supervision.

Some people were potentially at risk from inappropriately fitted bedrails and from hot radiators. Maintenance records were incomplete. This meant that we could not be sure that all equipment and services had been tested and serviced.

The service had not followed the requirements of the Mental Capacity Act 2005 because people’s capacity to make decisions about their care and treatment had not been assessed.

People’s needs were assessed before they moved into the home and referrals were made to medical professionals as needed. Care plans recorded people’s care and support needs but were not person-centred.

The manager completed a series of monthly quality audits but these were not verified in any way and had not identified the shortfalls that we found.

The home looked ‘tired’ and in a poor state of repair and decoration in some areas, but was clean and there were no unpleasant smells.

Medicines were stored safely and people received their medication as prescribed by their doctor.

Most people we spoke with were happy with their meals.

Complaints records were maintained and showed how complaints had been addressed. Regular meetings were held for people who lived at the home and their families, and for staff. These gave people opportunities to express their views.

They told us:

'I am very happy here, they look after me very well',

'It's wonderful, they look after me very well',

And relatives told us:

'It's excellent, they are really committed to what they do',

'Mum is well looked after, she calls it her home'.

We found care was assessed, planned and delivered according to the person's individual needs. Staff were knowledgeable in safeguarding and there was access to the local safeguarding authorities guidance, policies and procedures.

We found there were suitable numbers of staff employed at the home and they were appropriately trained. However we found that some training was out of date and that service specific training, such as dementia, had not been undertaken for some staff.

The provider had systems in place to monitor the quality of service provided.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "This home is homely and second to none.'

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.