Aaron Court Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes. The provider was in breach of legal regulation in relation to lawful consent and application of the Mental Capacity Act (MCA).

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Although assessments were usually completed, staff did not always understand or follow them. We found repeated problems with how assessed needs were met in practice, especially around food and drink support, mouth care and the use of equipment to help people eat and drink safely. Although some care plans included detailed medical information, this was often inconsistent or not turned into practical guidance. Risks such as falls, choking and skin damage were not supported by clear instructions for staff. Long-term conditions such as diabetes, Parkinson’s disease, epilepsy, blood-thinning medicines and dementia were listed without guidance on symptoms to monitor or when to escalate concerns. Some relatives told us about staff not recognising or responding to changes in people’s health. One relative said, “They didn’t even support [Name] to eat when they were unwell.” Some staff said plans relied too much on copied templates rather than individual detail. Other staff reported improvements after management changes. They said care plans were “better than what they were” and more personalised now. Leaders described systems to track key risks such as weight loss and falls and said they reviewed advice from health professionals. We found these systems were in place but not always used consistently.

The provider did not consistently plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice and standards. We found concerns with food and drink support, particularly for people who required modified diets to support safe swallowing. Food textures were not always consistent with assessed needs, and this indicated a lack of clear oversight and consistency in practice. For example, we observed one person on two occasions being served food that did not match the texture specified in their care plan. Portion sizes were variable. While we observed some improvement during the assessment following our feedback, including appropriate portion sizes and people being offered additional servings, this was not consistently reflected across the assessment period. Falls prevention was not managed in a structured way. People who had repeated falls did not have clear, step-by-step plans to reduce the risk of further incidents. Care plans often lacked evidence of review or changes based on previous incidents. We observed staff did not always recognise or respond promptly when people’s health deteriorated. Some staff said they had received training on conditions such as diabetes and epilepsy. However, several said training was not practical or timely enough. Comments included, “Training isn’t robust enough” and “There should be more practical training as well.” Professional partners told us they had seen some improvements, including better use of health monitoring tools and closer clinical oversight.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Some staff raised concerns about poor communication and a lack of teamwork. One staff member said, “Communication is the big problem.” Others described reliance on agency workers, particularly at night, and said this affected continuity and supervision. Some staff told us they often needed to provide additional support to agency workers, who had limited induction, restricted access to systems, and were sometimes unclear about their responsibilities. They told us this placed extra pressure on permanent staff and raised concerns about fairness, safety and effective teamwork. We observed a verbal shift handover had not yet taken place at the time of our observation. A written handover had been completed. However, handover processes were not consistently structured or accessible to all staff, including agency workers, and did not always support effective communication of risk and care needs. We observed variability in handover practice. During one shift handover, staff shared information clearly, spoke respectfully about people and demonstrated concern for their wellbeing. Leaders described systems to improve teamwork, including electronic records, daily meetings, structured handovers and nurse supervision. They described working with outside professionals through regular meetings and shared reviews. Some professional partners told us they had noticed improvements in the way the provider collaborates with them. Other partners raised concerns about delays in communication and responsiveness.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. We saw people sitting for long periods with little activity or interaction. One person remained seated from lunchtime until the evening still wearing a clothes protector. Some people were told to sit rather than being encouraged and supported to move safely. Footwear and seating were not always suitable to support posture and balance. We saw little engagement, such as televisions turned down and minimal conversation. One person said there was, “No one really to talk to.” Some staff encouraged more activity and positive engagement. One staff member said, “It’s worth 15 minutes of time rather than being distressed all day.” One professional partner told us they had observed people on the nursing unit spending more time in communal areas. Relatives shared mixed views, with some seeing better engagement since the last assessment and others still reporting long periods of inactivity.

The provider did not consistently monitor people’s care and treatment to drive continuous improvement. They did not ensure outcomes were consistently positive or aligned with clinical expectations or people’s preferences. We observed communal areas were not always actively supervised. While people did not require continuous observation, we saw occasions where people were left without staff presence and where responses to people showing signs of discomfort, distress or deterioration were not always timely. Food and drink records were not monitored reliably. Records showed one person had missed several meals over a reviewed period without clear documentation or evidence of follow-up. This meant it was not always clear how risks to nutrition were being monitored and managed. We observed people left with meals or waiting in dining areas without support, despite care plans stating they required assistance. Skin health was not always monitored consistently. While some care interventions, such as repositioning, were in place and recorded, we found gaps in oversight, including limited evidence of regular review or escalation where concerns had arisen. Care plan reviews did not always clearly demonstrate whether people’s care was improving. Many records contained general statements such as "up to date and relevant," even where people had experienced changes in their health, including falls, weight loss or hospital admissions. Leaders told us they had introduced mealtime checks, closer oversight of nutrition, and improved monitoring of weight and falls. However, these improvements were not yet consistently embedded across the service.

The provider did not consistently make sure people were asked for their consent or their rights were protected when decisions were made about their care. Records did not always make it clear whether people could make their own decisions, and sometimes different documents gave different answers about the same person. Some people were restricted without the correct legal authorisations in place, or with paperwork that was out of date or incomplete. Staff could not always explain the legal basis for the care or restrictions they were using. One professional partner told us they found an expired Deprivation of Liberty Safeguards (DoLS) authorisation “still on the system”, and the current one had not been uploaded or contained no conditions. Records did not reliably show staff checked whether people could make decisions for themselves, involved families or professionals when needed, or reviewed whether restrictions were still necessary. We saw consent was not always built into day-to-day care. Some staff had a basic understanding of the Mental Capacity Act (MCA) and DoLS and said they aimed to support people to make their own choices wherever possible. Others were unsure or gave incorrect answers about when legal safeguards applied. Leaders told us they were improving systems by tracking capacity assessments, reviewing legal documents and adding alerts to flag updates. This put people at risk of having fewer choices, being less involved in decisions about their own lives, and receiving care that was unsafe or unlawful.