Abbey Healthcare- Aarandale Manor

Aarandale Manor is a nursing home providing accommodation, nursing and personal care to 32 people at the time of the inspection. Some people were also living with dementia. The service can support up to 65 people. Aarandale Manor accommodates people in one adapted building over three floors.

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

Significant improvements had been made over the last year in the management of the home and the quality of care people received, despite management changes that had taken place.

Relatives commented that whilst management changes had taken place, the quality of care had not been affected and people were safe and received good care and support.

We observed people to be supported in a safe way, taking into consideration their needs, choices and wishes.

Risks identified with people’s health, medical and care needs had been assessed and documented with clear guidance on how to minimise the identified risk to keep people safe.

People received their medicines safely and as prescribed. Systems and processes in place supported this.

Recruitment policy and procedures supported the recruitment of staff who had been assessed as safe to work with vulnerable adults. We observed enough staff available to support people safely.

The home smelled fresh and was clean. There were increased infection control measures in response to the coronavirus outbreak. The provider reacted appropriately to keep people safe.

Staff received the required induction, training and support to carry out their role effectively. Care staff told us that they felt appropriately supported and that the management team were always available to provide direction and guidance.

The service supported people to eat and drink in ways which took into consideration their support needs, likes and dislikes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Most relatives felt engaged with the service and confirmed that they received regular updates and feedback about their relative. However, some relatives did comment that communication between them and the home could be improved.

Management audits and checks enabled managers to oversee the quality of care delivery and make the required improvements where necessary. During the inspection, minor issues were identified with the recording of supervisions, appraisals, capacity assessments, best interest decisions and DoLS. However, following the inspection, these issues were addressed.

We have made a recommendation about the provider and management sustaining the improvements and embedding all learning and development going forward.

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 requires improvement (published 4 April 2019) and there were breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulation 17 breach was a continued breach from the previous inspection (published February 2018) and the second time that the service had been consecutively rated requires improvement.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on the 3 and 4 September 2020 to check that the provider had followed their action plan, to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aarandale Manor on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People and their relatives in general were happy with the care and support that they received at Aarandale Manor. Some comments received were of a negative nature around insufficient numbers of staff and poor leadership.

The home did not have a permanent registered manager in place. A new manager had been recruited. In the interim the provider had implemented a management structure to support the home. Changes in management had impacted on the way the service was managed.

The provider and members of the senior management team overseeing the home were aware of the issues and concerns that the service faced around the quality of care and support that people received. Although an improvement plan was in place, the provider had been unable to implement the required improvements due to changes in management.

Risks associated with people’s health, care and social care needs had not been assessed to enable the safe delivery of care for each individual.

Processes in place for medicines management and administration were not always appropriately followed to ensure people received their medicines safely and as prescribed.

People’s care needs and preferences were not clearly understood by care staff. Care plans were disorganised and key pieces of information were not always clearly available to find.

Care plans were person centred and gave information about people’s lives, their likes, dislikes and preferences. However, due to the way in which care plans were structured, this information was not always easily accessible.

People and their relatives told us that they felt safe and secure living at Aarandale Manor. Care staff understood their responsibilities around safeguarding people and the steps they would take to report their concerns.

The service had made improvements to ensure that all staff were regularly supported through training, supervisions and annual appraisals.

We observed some very positive and caring interactions between people and care staff. However, we also observed some negative interactions. Practices seen did not always demonstrate a good awareness of appropriate dementia care.

People were observed enjoying their meals and were given a choice of what they would like to eat and drink. Snacks and drinks were readily available and offered to people throughout the day.

People were supported and encouraged to participate in a variety of activities organised within the home. The environment was supportive of people living with dementia. Appropriate signage had been used around the home to support people to orientate around the home and maintain their independence.

People and their relatives knew who to speak with if they had a complaint or concern to raise and were generally confident that their concerns would be appropriately addressed.

More information is in the detailed findings below.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and the governance of the service. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published February 2018). This service has been rated as Requires Improvement for the second time.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that whilst some improvements had been made around staff training and support, we continued to find further areas of concern that required improvement.

Follow up: We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Aarandale Manor is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Aarandale Manor accommodates up to 65 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of this inspection, only the ground floor unit was operational and there were 15 people using the service.

There was a registered manager in post at the time of this 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 and their relatives confirmed that they felt safe living at Aarandale Manor. All care staff understood the term safeguarding and were able to describe the different types of abuse and the steps they would take to report any concerns. However, where we saw records and body maps had been completed for one person who had obtained significant bruising and skin tears whilst in hospital, an incident form had not been completed and the registered manager had not reported these concerns to the local safeguarding authority, for further investigation.

Care plans detailed people’s risks associated with their health, care and support needs and provided guidance for staff on how to reduce or mitigate risk in order to keep people safe. However, some risk assessments did not contain sufficient information on the symptoms associated with certain health conditions such as diabetes.

Appropriate numbers of staff were observed supporting people as required. Appropriate recruitment procedures were in place to ensure staff were assessed as safe to work with vulnerable adults.

Training records confirmed that staff received the appropriate training necessary for their role. However, not all staff training records confirmed that all care staff had received an appropriate induction prior to starting work and where care staff were due to refresh their training this had not taken place. This meant that staff may not have had the appropriate training to support them in their role.

Most care staff confirmed that they felt supported in their role. However, records did not confirm that care staff had received appropriate formal supervision according to the provider’s policy.

People received their medicines as prescribed. Systems and processes were in place to ensure the safe management of medicines.

Most care plans contained appropriate documentation confirming people’s consent to care had been obtained. However, two care plans did not contain specific signed consent to care. Care staff were clearly able to explain their understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and how this impacted on the care and support that they delivered.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed people had developed positive and caring relationships with the care staff that supported them. People were treated with dignity and respect.

People ate well. People and relatives confirmed that they and their relative enjoyed the food that was presented to them and that they were always given a choice of what they wanted to eat. Drinks and snacks were available to people throughout the day.

Care plans were person centred and contained information about the person and how they wished to be supported. However, further information about people’s wishes for end of life care and their cultural and religious requirements was not recorded.

The provider had a number of systems and process in place to monitor and oversee the provision of care and support. However, there was a lack of detail evidencing the actions taken to ensure where issues were identified that these were addressed and that the service had taken note of any learning in order to make improvements.

The provider had displayed their complaints policy which detailed guidance on how people and relatives could lodge a complaint. People and their relatives knew who to speak with if they had any concerns or issues to raise.

The senior management team were accessible to people and relatives who spoke positively about them and how the home was managed. However, some care staff shared some concerns about the management and the lack of support received around training and some staff members’ specific roles.

At this inspection we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care staff were not receiving appropriate training. You can see what action we asked the provider to take at the back of the full version of this report.