Aaron Court Care Home

Ratings

• Overall

  Inadequate

• Safe

  Inadequate

• Effective

  Inadequate

• Caring

  Requires improvement

• Responsive

  Inadequate

• Well-led

  Inadequate

Our view of the service

Date of Assessment: 10  November  to 18  December  2025. The service is  a care  home  with nursing  providing  support to older people including people  living with dementia and physical disabilities.

The provider was previously in breach of the legal regulations in relation to person-centred care, dignity and respect, lawful consent and application of the Mental Capacity Act (MCA), safe care and treatment and governance. We carried out this assessment to check if the necessary improvements had been made.

Improvements were not found and the provider remains in breach of these regulations. We observed unsafe care practices, poor application of the Mental Capacity Act (MCA) 2005, and the statutory requirements for best interests’ decision-making, ineffective risk management, and governance systems that did not reliably identify, mitigate or learn from risk.

The provider was previously in breach of the legal regulation relating to staffing. Some improvements were noted during this assessment; however, further improvements were still required to ensure staffing arrangements were consistently safe and effective.

This provider remains in special measures. The purpose of special measures is to ensure services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

We found repeated failures in safety systems, leadership, oversight and day-to-day care. There were risks linked to medicines, infection control, the environment, nutrition, skin care, consent and supervision.

People were exposed to avoidable harm because concerns were not consistently acted upon to improve safety. Care plans and records could not be relied on to support safe care. Documentation was often inaccurate, contradictory, overly generic or not practical to use. Risk assessments, care plans and reviews were not aligned, and important events such as falls, and health deterioration were not consistently reviewed to identify where improvements to quality and safety could be made. We were not assured people were consistently receiving safe, effective, dignified and person-centred care.

The provider had experienced ongoing leadership instability. Frequent changes in management affected staff morale, continuity and accountability, alongside long-term improvements to quality and safety. Learning from CQC’s previous assessment had not been properly embedded and safeguarding people, medicines management and learning systems were not consistently effective in practice.

Although many staff showed compassion, skill and commitment, we found gaps in their supervision, slow responses to people in distress, unsafe information sharing between staff, and the use of agency staff without proper induction or oversight

There was improvement in staff conduct and professionalism and staff recruitment processes were safe. Some progress had been made in areas such as activities provision.

People's experience of this service

Some people told us they did not consistently experience continuity in their care and were not involved in formal decisions about their care. They described limited interaction from staff and described feelings of loneliness.

Several relatives told us about concerns they had in relation to their loved one’s safety such as poor hygiene, loss of dignity, slow responses when help was needed, unexplained injuries and poor nutrition. They spoke about repeated unexplained falls, bruising and injuries, and a lack of clear information about what had happened or what action had been taken. One relative said they felt, “Nothing changes” despite raising concerns. Another said they were, “On the fence” about safety because of repeated falls without explanation. Several relatives described feeling frightened or distressed when visiting, with one saying they, “Always leave feeling worried.”

Some relatives described people being left in wet pads, not being washed properly, and having dirty hair, teeth and nails.

A lack of communication from the provider was a recurring concern amongst relatives we spoke with.

Some relatives described unsafe or poorly planned changes. One relative said their loved one could not shower for a long time because the right equipment was not available.

However, several people said they felt in control of their day-to-day care and could express preferences about their routines. Comments included, “Yes, I am my own boss, but anything I want they do for me,” and “If I want a lie in, I can tell them.” Some people described being supported to maintain personal routines.

Most people said staff were kind. One person responded "Yes I do," when asked whether they felt they were treated with kindness and dignity. Some relatives expressed confidence in the care provided. Comments included, “They deserve medals for what they do,” “I can’t fault the staff,” and “[Name] was happy as Larry and clean and safe.”

Several people said they enjoyed activities and social interaction, particularly bingo, which one person described as, “Such a laugh, everyone joins in.”

While some people expressed general satisfaction with their care, our assessment found care did not meet the expected standards.