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  • Care home

Archived: Aaron Lodge Care Home

Overall: Requires improvement read more about inspection ratings

13 Marmaduke Street, Liverpool, Merseyside, L7 1PA (0151) 261 0005

Provided and run by:
Aaroncare Limited

All Inspections

14 February 2017

During a routine inspection

This unannounced inspection of Aaron Lodge Care Home took place on 14 and 20 February 2017.

The home was last inspected in May 2016 and judged as 'inadequate' overall and placed into 'Special Measures.' We identified ten breaches of the regulations.

These were in relation to safe care and treatment [two breaches of this regulation], dignity and respect, staffing levels, staff training, consent, person centred care, governance, nutrition and hydration and safeguarding.

This unannounced inspection took place to check if the provider had made enough improvements to meet their legal requirements.

Aaron Lodge is a dementia care home registered to provide care for up to 48 people living with dementia across two floors. There was a passenger lift within the care home.

At the time of the inspection 21 people were living at the home and the care provider had announced closure of the care home. The Local Authority was working with the care provider to ensure all people living at Aaron Lodge Care Home were being transferred to another suitable care home. We undertook this unannounced inspection to check that the people who lived there were safe.

A manager was present at the time of inspection that was brought into the care home to manage the transition of care for people to another care home. There was no registered manager in post within the care home at the time of our 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 were not always being kept safe from harm and the provider remained in breach of the regulation related to safe care and treatment. Medicine records seen were not always accurate and there had been two incidents reported of the person being subjected to harm.

The care provider remained in breach of the regulation related to safe care and treatment.

Care plans we viewed had been updated with person centred information and some contained a photograph. The information within the care plans provided staff with enough information they needed to know to be able to care for the person however it was difficult to find information within them.

The provider was no longer in breach of regulation related to person centred care.

At the last inspection we raised concerns regarding the staffing levels in the home. The provider was in breach of regulations relating to this. We found there were not enough staff to provide the care people needed at the time they needed their care. We checked if there was enough staff to meet the needs of the people living at the care home on this inspection. The methods used were the SOFI [Short Observational Framework for Inspection] and other observations. We found there were enough staff to meet the needs of the people living in the care home at the time of this inspection. People were observed to be responded to by staff when they needed assistance and staff were observed engaging with people more frequently than on our last inspection. Staff were attempting to undertake activities with people but due to time constraints the care being delivered was mostly still task led.

The care provider was no longer in breach of the regulation related to staffing levels.

Previously we raised concerns about the service not always following the principles of the Mental Capacity Act (MCA) 2005. We found that consent was not being sought in line with the Mental Capacity Act 2005 and decisions were being made on behalf of people without following a best interest’s process. At this inspection we found the principles of the Mental Capacity Act 2005 had been adhered to. The care provider demonstrated they had followed the best interests’ process in line with the principles of the MCA 2005 legislation.

The provider was no longer in breach of this regulation related to Consent.

During our last inspection we raised concerns around people's dignity and safety. On this inspection we observed staff upheld people’s dignity at all times and were respectful of people’s wishes.

The provider was no longer in breach of the regulation related to dignity and respect.

At our last inspection we found that people were not always protected from abuse and the provider was in breach of regulations relating to this. We found that the procedure for reporting and acting on safeguarding's had improved since our last inspection in May 2016.

The provider was no longer in breach of this regulation related to safeguarding.

During our last inspection, we identified that not all staff had received up to date training as required by the provider. At this inspection we saw that staff had not received emergency first aid training and one staff member out of the four files we checked had not received up to date manual handling training. We were informed by the care provider the emergency first aid training had been placed on hold due to the announcement of the closure of the care home. The care provider also told us their in-house manual handling trainer’s training needed updating prior to them completing any additional training with staff.

The care provider remained in breach of the regulation related to staff training.

During our last inspection we identified that people were not receiving enough to eat and drink. We checked if improvements had been made on this inspection. We found that people were provided with jugs of liquids in their bedrooms and there were jugs of liquids in the lounges on both floors for people to have a drink if they wished. For people who were unable to monitor their own fluid intake staff were observed asking people during the day if they would like a drink. Fluid balance charts were no longer being completed retrospectively and the system of recording had also improved. People’s weights and food intake were being monitored in line with the recommendations being made by the medical staff and health care professionals.

The care provider was no longer in breach of the regulation related to nutrition and hydration.

During our last inspection we found systems were not robust such as the system for recording fluids/drinks, communication systems and systems of recording and reporting abuse. We checked these systems at this inspection and found the systems had improved. There was a new doctor’s visit sheet in care plans, a new more detailed handover sheet and a more robust recording and reporting of safeguarding concerns and incidents.

We no longer found the provider in breach of the regulation related to governance. However, further work was still required and we made a recommendation with regards to this as they did not always action concerns appropriately or pick up on some of the concerns we found.

You can see what action we told the provider to take at the back of this inspection report.

31 May 2016

During a routine inspection

We undertook an unannounced comprehensive inspection on 31 May, 1, 2 and 10 June 2016. The service was previously inspected on 19 and 23 November 2015. The service was rated inadequate and placed in special measures. They were found to be in breach of Regulations relating to person centred care, dignity and respect, medicines, Hydration and nutrition, governance and staffing. We received an action plan from the provider detailing what improvements they were going to make in the care home. We received information of concern from members of the public prior to our inspection and from Statutory Notifications received from the care home.

At our most recent inspection we found the service remained in breach of the same regulations as were evident on our last inspection in November 2015, apart from medicines where improvements had been made. The service was also found to be in breach of regulations in relation to the need for consent and safeguarding service users at our most recent inspection.

Aaron Lodge is a dementia care residential home which is located close to Liverpool city centre. The home is registered to accommodate 48 people. At the time our inspection, there were 48 people living at the home.

There was a registered manager in post at the time of our 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.’

The service was not always safe and people were at risk of harm to their health and well-being due to poor systems of communication, under reporting of incidents and not having sufficient numbers of staff. Actions stated as being required in people’s care plans were not always followed which put them at further risk of harm.

There were deprivation of liberty authorisation applications seen in the records but we found that the best interest’s process was not always being followed.

Staffing levels were a concern as we found people’s care needs were not being met. The service was using a dependency matrix which was designed for determining nursing staff provision and not suited to the care needs of people with dementia in a residential care home setting.

The registered manager had completed some audits such as infection control and incidents. Other audits had been delegated to carers to complete. Despite these audits being completed which demonstrated a commitment and drive to improve, we were concerned about the effectiveness of the monitoring of systems in place which were failing such as the systems of communication, system of reporting incidents to the registered manager and systems of documenting pertinent information related to the health and well-being of people to keep them safe.

We observed people at various times of the day and found the mornings and lunch times were more pressured than other times of the day for staff to meet people’s care needs. This had not been factored into the staffing levels within the care home and the impact of this for people was that they were not being supported to go to the toilet in a timely manner. People were not receiving drinks throughout the day and they were not being supported to eat and drink when they were provided with sustenance on a table in front of them.

A recommendation was made from the last inspection in November 2015 regarding improvements needed to the design and decoration within the care home to meet the needs of people with dementia. We found dementia friendly knitted hand muffs had been made but were not yet used and the bathroom doors had signage which was a different colour to stand out for people but no other improvements had been made. The registered manager told us that they had not sought the advice of someone with the skills in dementia adaptation/design other than their own in-house painter and decorator who decorates all care homes owned by New Century Care.

Safeguarding procedures were in place but they were not always being followed by staff. We found incidents were documented in the daily records which had not been reported to the Local Authority.

Staff recruitment included a DBS check (Disclosure Barring Service) to ensure staff were checked for previous convictions prior to working within the care home and staff received an induction.

Not all staff were up to date with training including safeguarding, hydration/nutrition and pressure care. However, a supervision structure was in place and the registered manager had completed supervision sessions specifically related to infection control and hydration.

We observed a medication round during our inspection and found that the breach in respect of the safe administration and recording of medications, identified at the last inspection, had been met.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

19&23 November 2015

During a routine inspection

Aaron Lodge Care Home provides accommodation and personal care for up to 48 people who are living with dementia. The home is owned by Aaroncare Limited.

There were 47 people living in the home at the time of our inspection.

This was an unannounced inspection which took place over two days on 19 & 23 November 2015.

There was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the service was not always safe. There were not enough staff on duty at all times to help ensure people were cared for in a safe manner.

The manager was able to evidence a series of quality assurance processes and audits carried out internally and externally to the home. We found the quality assurance system not currently developed to ensure the most effective monitoring.

The concerns we identified are being followed up and we will report on any action when it is complete.

There was a risk medicines were not administered safely. Medication administration records were not always clear. Monthly medication audits had not identified these issues.

We made observations at meal times. We saw that people did not always receive support from staff. Meal times were disruptive and were not a positive experience for people.

We asked people if staff were polite, respectful and protected their privacy and dignity. We received mixed responses. Our observations of care evidenced that, at times, staff compromised the respect and dignity shown to people.

We found people and their relatives were not always involved in planning their care to help ensure it was more personalised and reflected their personal choices, preferences, likes and dislikes. We looked at the care record files for people who lived at the home. We found that care plans and records lacked detail and were not personalised to individual care needs.

You can see what action we told the provider to take at the back of the full version of this report.

We toured the environment of the home. The designed and adaptation of the premises could be developed and improved for people living with dementia.

We made a recommendation regarding this.

There were effective monitoring/checking systems in place to ensure the home’s environment was maintained safely. We found there had been appropriate liaison with the local authority environmental health regarding a recent risk.

Staff understood what abuse meant and knew the correct procedure to follow if they thought someone was being abused.

Staff had been checked when they were recruited to ensure they were suitable to work with vulnerable adults.

We looked at whether the home was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. We found examples of good practice in supporting people with decisions in their ‘best interest’. The registered manager understood the need to extend the use of mental capacity assessments for key decisions for people. The manager said this would be developed with further staff training.

There was some information available in the home for people. This included information on advocacy services and the complaints process.

We found people were provided with social activities and were encouraged to participate in the daily life of the home. We thought this aspect of care could be developed to provide more positive experiences for people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

11 and 14 November 2014

During a routine inspection

Aaron Lodge Care Home is a residential care home that provides accommodation, care and support for up to 48 adults who have dementia care needs. Accommodation is provided over two floors and the home is fully accessible to people who are physically disabled. The service is situated in the Edge Hill area of Liverpool.

During the inspection we met most of the people who lived at the home and we spoke with eight people individually or in a small group. We also spoke with a number of visiting relatives, four members of the care staff team, the cook and the registered manager.

We found that people living at the home were protected from avoidable harm and potential abuse because the provider had taken steps to minimise the risk of abuse. Clear procedures for preventing abuse and for responding to allegations of abuse were in place. Staff were confident about recognising and reporting suspected abuse and the manager was well aware of their responsibilities to report abuse to relevant agencies.

Each of the people who lived at the home had a sufficiently detailed plan of care that provided clear guidance on how to meet their needs. Risks to people’s safety and welfare had been assessed as part of their care plan and plans were in place to manage any identified risks. People’s care plans include information about their preferences and choices and about how they wanted their care and support to be provided.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff referred to outside professionals promptly for advice and support. We spoke with a visiting healthcare professional and they gave us very positive feedback about the home. They told us staff were proactive in how they supported people with their health needs and that they always followed their advice and guidance about how to support people with their health conditions. They also told us that communication between themselves and staff at the home was good and effective.

Medication was in good supply and was stored safely and securely. However, records we looked at indicated that some people had not always been administered their medicines as prescribed. The manager took immediate action to introduce a more thorough check on how medicines were managed. This included a daily stock check for any medicines not dispended from a monitored dosage system.

The manager had knowledge of the Mental Capacity Act 2005 and their roles and responsibilities linked to this and they were able to tell us how they ensured decisions were made in people’s best interests. However, some of the processes in place to support this were not robust and required development.

During the course of our visit we saw that staff were caring towards people and they treated people with warmth and respect. People we spoke with gave us good feedback about the staff team and relatives told us they felt staff were caring towards their family member.

There were sufficient numbers of staff on duty to meet people’s needs. Staff were only employed to work at the home when the provider had obtained satisfactory pre-employment checks.

Staff told us they were well supported in their roles and responsibilities. Staff had been provided with relevant training and they attended regular supervision meetings and team meetings. Staff were aware of their roles and responsibilities and the lines of accountability within the home and across the company.

The premises were safe and well maintained and procedures were in place to protect people from hazards and to respond to emergencies. The home was fully accessible and aids and adaptations were in place in to meet people’s needs and promote their independence.

The home was clean and people were protected from the risk of cross infection because staff had been trained appropriately and followed good practice guidelines for the control of infection.

There was a registered manager at the service at the time of our 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.

Systems were in place to regularly check on the quality of the service and ensure improvements were made. These included regular audits on areas of practice and seeking people’s views about the quality of the service.

11 December 2013

During a routine inspection

People we spoke to, which included family members, told us they were regularly invited to attend care reviews which allowed them to have an input into their care and treatment the person using services received. Where people did not have the capacity to attend, the provider arranged `best interest` meetings which ensured their care and welfare was maintained. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and there were arrangements in place to deal with any unforeseen emergencies. Medicines were kept safely and were safely administered and disposed of appropriately which ensured the safety and welfare of all people at Aaron Lodge.

The home was fully staffed at the time of our visit and we spoke to several people who visited and one commented "it really is a lovely place to come to - the staff are all wonderful". Staff members had the skills and experience which ensured all people at Aaron Lodge received good quality care and support. The provider had procedures in place that dealt with comments and complaints which included providing people who use services and their families/carers with information related to the process.

3 September 2012

During a routine inspection

During our visit we spoke individually with seven of the people living at Aaron Lodge Care Home and with four of their visitors. We also spoke with six members of staff who held different roles within the home. In addition we toured the premises, looked at a sample of records and observed the support being provided to the people living there.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences.

The people living at Aaron Lodge Care Home told us that they liked the staff team and that they felt safe living there. Visitors told us that they believed the people living there were getting the support they needed with their health and personal care.