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Aden Court Care Home Requires improvement

Reports


Inspection carried out on 3 October 2017

During a routine inspection

The inspection of Aden Court took place on 3 and 4 October 2017 and was unannounced. The home had previously been inspected during September 2016 and was found to require improvement in all five of our key questions at that time. The previous inspection found multiple breaches of regulations in relation to dignity and respect, safe care and treatment, good governance and staffing. During this inspection, we checked and found improvements had been made in all these areas.

Aden Court is registered to provide residential and nursing care for up to 40 people. The home has a reception area, a large dining room, a choice of lounge areas and an activities room. All bedrooms are ensuite. At the time of our inspection there were 37 people living at the home, with 14 people receiving nursing care and 23 people receiving residential care.

There was a registered manager in post and this was a different registered manager since the last inspection. 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 told us they felt safe living at Aden Court. Appropriate safeguarding policies and procedures were in place, which staff understood, to protect people from abuse.

Risks to people had been assessed and a range of measures were in place to reduced identified risks.

Staff were recruited safely, with appropriate pre-employment checks taking place. Sufficient numbers of staff were deployed to keep people safe, however, some people felt improved quality of care could be provided if additional staff were deployed.

Regular safety checks took place such as those in relation to fire, gas and electrical systems. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained to use evacuation equipment effectively.

Actions had been taken to improve the management of medicines since the previous inspection. Medicines were managed and stored appropriately, although we did identify some missing information in relation to, ‘as required’ medicines on a small number of medication administration records.

People were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible; the policies and systems in the home supported this.

Staff had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

Care and support staff told us they felt supported. Staff received regular supervision, although this was sometimes to address specific issues, as opposed to a supportive two-way discussion.

Our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. There was a pleasant atmosphere in the home. People’s cultural and religious needs were considered.

End of life care plans had been developed where appropriate and, where people did not wish to discuss this aspect of care, this was recorded and respected.

Care records were person centred and reviewed regularly. A ‘resident of the day’ system was being introduced, which was not yet fully embedded, to help ensure people were regularly involved in reviewing their care and support. People told us they could make their own choices in relation to their daily lives.

Staff told us they felt supported by the registered manager and people and their relatives spoke positively about the registered manager. Regular audits and quality assurance checks took place. It was evident the home was continuing to improve since the last inspection and the registered manager acknowledged this was ongoing.

Inspection carried out on 8 September 2016

During a routine inspection

We inspected Aden Court Care Home on 08, 09 and 12 September 2016. The first day of the inspection was unannounced, which meant the home did not know we were coming. People who live and work at the home refer to it as ‘Aden Court.’

The home was last inspected on 05 August 2013. We found it was compliant in all the aspects of care we inspected at that time.

Aden Court is a privately owned home providing nursing and residential care for up to 40 older people. It is situated in the Moldgreen area of Huddersfield. At the time of our inspection the home was fully occupied, with 17 people receiving nursing care and 23 people receiving residential care.

The ground floor of the home has a reception area, a large dining room, a choice of lounge areas and an activities room. All bedrooms are ensuite; some are located on the ground floor with the rest on other floors. There is a lift for access.

The home had 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.

Most medicines were managed properly and we saw their administration was person-centred. However, we found there were a lack of protocols for ‘as required’ medicines, the administration of topical creams was not recorded and the temperature of the clinic room where medicines were stored had frequently been above 25°C in recent months.

Risk to people was not always assessed and managed appropriately. Issues arose as care plans had not been updated when people’s circumstances or health had changed. One person had become trapped in their bedrails; the home’s response in terms of minimising the risk of this happening again was not documented.

People told us they could not always use the toilet when they needed to due to a shortage of care staff. Relatives and care staff also thought the home was understaffed and the rota showed this had been the case in recent weeks. The registered manager was in the process of recruiting more care workers to address this issue.

We noted people’s access to baths and showers was structured and not person-centred. Care staff did not always close people’s bedroom doors when providing personal care because they said they could not hear call buzzers.

We found issues with record-keeping and incident follow up at the home which had not been identified by audit and monitoring.

We found breaches of regulation during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The recruitment for new care staff at the home was robust and staff had received training in safeguarding and could demonstrate a good knowledge of the subject. However, no documentation was available to show a regular volunteer had been checked to ensure they were suitable to work with vulnerable people.

Staff received the training they needed to meet people’s needs. Supervision records showed sessions focused on addressing issues and problems rather than providing the staff member with support. Annual appraisals were thorough and records were detailed.

Care workers’ knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) was appropriate for their roles. Applications for DoLS authorisations had been submitted to the local authority for people who needed them; however, no assessments of people’s capacity to make other decisions had been made.

People said they enjoyed the food at Aden Court. We saw they were provided with a choice each mealtime and had access to drinks and snacks in between meals. We found issues with the level of detail in records care staff kept for people at risk of weight loss.

Care files showed some people and their relatives had been involved in planning their care. Other care plans had been signed by relatives only, and the involvement of the person was not clear. The home was about to implement a ‘resident of the day’ system whereby each person had a set day of the month where they and their relatives would be invited to assist care staff to review and update their care plans.

Care staff could recognise when people needed advocacy services and knew how to make referrals when they needed to. At the time of the inspection the provider was investigating a serious complaint about end of life care at the home. We spoke with people, their relatives, the staff at the home and checked people’s future wishes care plans. Whilst end of life care training for staff was lacking, appropriate care plans were in place and feedback from relatives whose family members had received end of life care at the home was positive.

People’s care files contained risk assessments and care plans for a range of care aspects. Of the four files we inspected in detail, three contained care plans which had been reviewed and evaluated regularly. One other care plan had not been reviewed for over three months because the named nurse responsible had been absent from work and another nurse had not been allocated to cover. Daily records did not always evidence people had been supported according to their care plans.

We saw the home was clean. Regular safety checks had been completed on the building, facilities and equipment used to support people. Contingency plans were in place for fires, floods or other emergencies and people had personalised plans which emergency workers could use to help them evacuate, if required.

People had access to a range of healthcare professionals to help them maintain their holistic health. Healthcare professionals we spoke with who helped support people living at the home gave us positive feedback about the home’s staff and the care they provided.

People told us they were treated with dignity and respect by the staff. Staff knew people well as individuals and could describe their likes, dislikes and preferences.

People enjoyed the range of activities on offer at Aden Court; this included those nursed in bed. Relatives were encouraged to take an active role within the home and told us they were always made to feel welcome. We found the atmosphere at the home was warm and friendly as a result.

None of the people or relatives we spoke with told us they had ever made a formal complaint. Those who had either raised concerns or given feedback said it was acted upon quickly. All those we spoke with said they would feel comfortable raising any issues with the registered manager or other staff at the home. People and their relatives were asked to feedback about the service so improvements could be made.

Inspection carried out on 5 August 2013

During a routine inspection

At the time of our inspection there were 38 people living in the home. We talked with five people who used the service, five visitors and six staff, including the manager and area manager.

People's diversity, values and human rights were respected. We observed staff speaking to people in a kind and respectful manner as they responded to their needs and wishes.

Before people received any care or treatment they were asked for either, their verbal or written consent and the staff acted in accordance with their wishes.

All staff observed interacted with residents in a positive way. Visitors told us they felt welcome in the communal lounge where they sat with relatives.

We saw that staff were caring, sensitive to people’s needs and responded to those needs in a timely manner.

Comments from individual people who used the service included:

“The staff are lovely, the manager is very nice to us. It’s like being part of a family.” Another person said, “It does get lonely sometimes but they always come and encourage me to take part in things.”

Inspection carried out on 11 September 2012

During a routine inspection

On the day of our inspection we spoke with six people who used the service and a visitor. People told us, and we saw that staff knocked on bedroom doors before entering. People told us they had opportunities to make choices and had a say in how their care was delivered. For example, one person told us they could choose when they got up in a morning and went to bed at night. A second person told us they were supported to get dressed, whilst another person said they were given a choice of what they would like for their meal. These are examples of how staff respects peoples privacy and maintain their independence.

People told us they were happy living at the home and they were looked after by the staff.

We spoke with one visitor who told us all the staff were kind and caring. They told us the staff had been brilliant with their relative, the atmosphere was lovely and they had no concerns with the care.

People told us they had not had to complain but they knew who they would speak with if they were not happy.

A visitor told us, “The home is run well. If I had a problem I would go to the manager.” They said, “The food is good, the laundry is done well, and there are plenty of activities to keep people occupied.”

On the day of our inspection we observed there were enough qualified, skilled and experienced staff to meet people's needs.

Inspection carried out on 9 November 2011

During an inspection to make sure that the improvements required had been made

We spoke to people who live at the home about the care and support they receive. Without exception they made positive comments about the manager and staff. Some of the comments included;

“The staff here area very kind and considerate”

The staff are lovely they make my life very comfortable”

“Staff are always available and I don’t have to wait for long if I need assistance”

“Nothing is too much trouble here”

Inspection carried out on 7 June 2011

During a routine inspection

People said that the care they receive was agreed prior to admission and that the staff were sensitive to their needs and knew the care that they needed.

Comments from people include:

“Staff are very good.”

In response to the food one person said, “If you don’t like something just tell the staff and they won’t give you it again.”

“Couldn’t ask for better staff. They are lovely and are always there to help.”

Relatives commented that staff were approachable, and kept them up-to-date with issues affecting their relative.

People that we spoke with told us that they felt safe in the home and they knew who to speak to if they had any concerns. They also said they would have confidence that any issues would be properly dealt with.

One person said that they had a good relationship with the manager and it they had a concern, “She would sort it out.”

Another person said, “If I have a concern, yes I know who to talk to. I just let them know.”

A visiting relative said that they had no concerns and if they had they would speak with the manager.

People said that they liked living in the home and that it was always clean.

Relatives said that the home was comfortable but appreciated that it was in need of redecoration.

People said that there were always enough staff on duty to care for their needs.

Reports under our old system of regulation (including those from before CQC was created)