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

The service is registered to accommodate up to 73 people in one adapted building. At the time of the inspection there were 58 people using the service. The service consists of three units which provide a mixture of nursing care, and care for people living with dementia.

There was a registered manager in post within the service. 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 inspection was unannounced and took place over two days on the 21 and 22 March 2018. At the last inspection in February 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvement had been made, however we identified a continued breach of Regulation 17 and an additional breach of Regulation 18. You can see what action we told the provider to take at the back of the full version of the report in response to these issues.

Quality monitoring systems were being completed, however they had failed to embed quality into the day-to-day running of the service. We identified that a sluice room had been left unlocked and the tap in this room was dispensing very hot water. Pull cords had been tied up in some bathrooms which meant they were not accessible should people need these. We also found that care records did not always include consistent information about people’s needs.

We followed up on concerns raised by the local Clinical Commissioning Group (CCG) regarding the medication audit process used by the service. We found that this has been improved in response to issues they had raised.

Training was not being kept up-to-date within the service. Records provided by the registered manager showed that training was overdue in areas such as infection control, moving and handling. It is important that staff skills and knowledge are maintained to ensure they can carry out their role effectively.

Whilst people’s personal care needs were being attended to, we noted that they were not always being given the option of having a bath, where this was their preferred choice. Baths within the service all contained a layer of dust which showed they had not been used, and this was confirmed by records which showed people were predominantly offered a ‘wash’. We have made a recommendation to the registered provider in relation to the provision of person-centred care.

In a majority of cases the service was compliant with the requirements of the Mental Capacity Act 2005 (MCA); however we identified examples where mental capacity assessments had not been completed, and in one instance an application had not been made to deprive a person of their liberty as required. We looked into these examples and found that there had been no impact on the people being supported. We have made a recommendation to the registered provider in relation to the MCA.

We checked a sample of people’s medication and found that these were being administered appropriately. Medication records were being filled in as required by staff when these had been given, and the quantities of those medications that we looked at were correct and all accounted for.

We looked at a selection of staff recruitment records which showed that a robust process was in place. Staff had been subject to a check by the disclosure and barring service (DBS) and had also been required to provide two references, one of which was from their most recent employer. This helped ensure

Aaron Court is registered to provide accommodation for up to 73 people who require nursing or personal care. The service offers support to older people and people living with dementia. At the time of the inspection visit there were 65 people living at the service.

The inspection was unannounced and took place on the 7 & 8 February 2017. A previous inspection was carried out in February 2015 during which the service was found to be ‘requires improvement’. The follow up inspection completed in July 2015 found that action had been taken to address the issues that had been identified, and the service was rated as ‘good’.

There was a registered manager in post who had been registered with the CQC since December 2010. 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.

At this inspection we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Pressure relieving mattresses were not always on the correct setting which placed people at risk of harm. In addition, we observed that mattress settings did not always correspond to checks that had been carried out by staff and staff had failed to identify where the setting specified by records was not correct. This showed inaccurate recording of information and demonstrated that this system was not robust.

A bathroom tap dispensed water at 50 degrees Celsius, which is above the maximum limit of 44 degrees Celsius set by the Health and Safety Executive, where outlets are accessible to people. This place people at risk of scalding. This had been identified as an issue, as demonstrated by signage which warned that the water was hot. However appropriate action had not been taken to address this issue.

A majority staff treated people with dignity and respect, however we observed occasions where staff were task-led in their approach, or did not speak to people in a dignified way. This had not previously been identified as an issue, and therefore action had not been taken to address this. We have made a recommendation to the registered provider around the appointment of dignity champions to assist staff with recognising poor practice.

Audit systems had failed to identify and adequately address the issues found during the inspection visit. This showed that these systems needed to be more robust.

Some positive relationships had been developed between people and staff. We observed examples where they laughed and chatted together. Staff also acted to relieve people’s distress, for example by offering reassurance where people experienced episodes of anxiety. People’s family members also told us that they were made to feel welcome when they visited the service. People told us that a majority of staff were kind.

The environment was clean, safe and well maintained. However little consideration had been given to how the environment could be adapted to enhance the experiences of people living with dementia or a sensory impairment. For example, food menus were written in small writing and were not up-to-date, and there were no distinctive markers in corridors to help people find their way around. The registered provider had plans in place to carry out a refurbishment of the service.

People were protected from abuse. Staff had received training in safeguarding vulnerable people and were aware of the signs and indicators that may show abuse is taking place. Staff were aware of whistleblowing procedures and when they should use these.

Recruitment processes were robust and helped ensure that people’s safety was maintained. Checks were carried out prior to

We carried out an unannounced comprehensive inspection of this service on 16 February 2015. During this inspection a breach of legal requirements was found. This was because the medicine arrangements did not protect people from the risks associated with unsafe management of medicines.

After the comprehensive inspection, the provider wrote to us and told us what actions they were taking to ensure that they met the legal requirements in relation to the breach. We undertook a focused inspection on the 29 May 2015 to check that the improvements had been made and to confirm that they now met legal requirements.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Aaron Court Care Home’ on our website at www.cqc.org.uk.

Aaron Court Care Home is registered to provide personal and nursing care for up to 73 older people and people with dementia. The home has single room en-suite accommodation over two floors. Each floor has lounges, dining areas and bathing and toilet facilities. There is also a garden, which had a seating area with chairs and tables.

The home has a registered manager who has been in post for ten years. 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.

At our focused inspection on the 29 May 2015, we found that the registered provider had followed their plan and legal requirements had been met.

Many people living in the home were unaware of what medicines they took so were unable to discuss them with us.

Medicines were stored appropriately and were locked away securely to ensure that they were not misused.

There was an effective system of stock control in place and this helped both to reduce the risk of people running out of their medicines and also to minimise the amount of medication wasted.

Risk assessments and care plans were in place to support people who wished to look after some or all of their own medication.

This inspection took place on 16 February 2015 and was unannounced. We arrived at the home at 9.30am and left at 7.30pm.

Aaron Court Care Home is registered to provide personal and nursing care for up to 73 older people and people with dementia. On the day of the inspection 65 people were living in the home. The home has single room en-suite accommodation over two floors. Each floor has lounges, dining areas and bathing and toilet facilities. There is also a garden, which has seating and tables.

The home has a registered manager who has been in post for ten years. 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 had not met all of the regulations we inspected against at our last inspection on 5 August 2014, in that we found that the provider did not have appropriate arrangements in place for the recording of medicines and the management of creams and ointments. The provider subsequently submitted an action plan saying they would be compliant with this regulation by 19 September 2014.

At this inspection we found that the provider had made some improvements, but the arrangements still did not protect people from the risks associated with unsafe management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

The experiences of people who lived at the home were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. Some of the comments from relatives included, “We’re happy with the care” and “It’s the first time I’ve been to visit since my relative came in and I can see a big difference, [name] looks really well”.

People’s needs were assessed and care plans were developed to identify what care and support people required.

People spoke positively about the care and support they received. Comments included: “You can’t beat being here, the staff are really good and always there to help you”; “I can’t praise the staff enough, since I’ve been here I have been treated really well”; “I don’t know how but the staff seem to know if I need anything, you only need to ask and they are there for you” and “I like it here”.

There were regular reviews of people’s assessed needs and they were referred to appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

People received visitors throughout the day and we saw they were welcomed and included. People told us they could visit at any time and were always made to feel welcome. One relative said “The manager or one of the staff will ring me if there’s any change and when I come in they always talk to me”.

The staff ensured people’s privacy and dignity were respected. We saw that bedroom doors were always kept closed when people were being supported with personal care.

People remarked that the food was good. One person said “The food is usually nice” and another said “The food is very good and there’s a choice of half a dozen things for breakfast”.

People could choose how to spend their day and they took part in activities in the home and the community. The home employed an activity organiser and we saw that people were engaged in activities in small groups or individually during the day.

Staff received specific training to meet the needs of people using the service and received support from the management team to develop their skills. Staff had also received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were processes in place to monitor the quality of the service and identify and manage risks to the health, welfare and safety of people who used the service. However, these had not identified that staff were not following the provider’s policies on the safe management of medicines.

Our inspection team was made up of two inspectors, one with a social care background and one with a nursing background. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and the required authorisations had been obtained. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people's rights were upheld.

The registered manager set the staff rotas, making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

However, we found that improvements were needed in the recording of medicines and the management of creams and ointments.

Is the service effective?

There was an advocacy service available if people needed it, which meant that when required people could access additional support.

People’s health and care needs were assessed with them. People who used the service and their relatives said that they had been involved in writing their care plans and they reflected their current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us that they were happy with the service and well cared for. One person said "I chose to come here because they looked after one of my relatives very well". We also spoke with six relatives whose comments included: "The care is wonderful, spot on"; "The care is excellent and it's very homely"; "I'm 90% satisfied, my relative is well looked after and well nourished".

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service and their relatives completed an annual satisfaction survey. The vast majority of people were satisfied with the care provided.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly and a residents' committee had been set up to plan further activities.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities and had a good understanding of the ethos of the home. They said they felt well supported and had access to vocational training.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. However, the system had not been effective in picking up the shortfalls we identified in the management of medicines.

We looked at six care plans and other care records and they all had an assessment of the person’s health and social needs completed. The care plan documentation was up to date and reviewed on a monthly basis.

We looked at menus and food that was available to people who lived at Aaron Court. We found there was a good variety of meals available and people said the food was good and plentiful.

We spoke with four people who used the service, two relatives, the visiting hairdresser and six staff members. People who used the service said: “The staff are nice”, “I like the food” and “The staff are kind.”

Relatives commented: “The home is always clean, they keep it nice”, “The staff treat my relative very well”, “There always seems to be staff around” and “The standard of care is very good.” They didn’t have any concerns or complaints about the home.

Staff commented: “The manager is very good. She listens to the staff and acts for the welfare of the service users”, “We have regular staff meetings”, “I like supporting people and making them comfortable” and “The training is good here.” All the staff said they got good support from the management team and that the registered manager was good and care for the staff team as well.

We looked at the staff rotas and the staffing levels in general for the home. We discussed staffing issues with the manager and they confirmed that the current staffing levels met the needs of the people who lived at Aaron Court.

Many of the people who lived at Aaron Court were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

We spoke with nine people who were living at the service and two visitors during our visit. Their comments were mostly positive about the service and the care received. Comments included:

“I’m warm at night everything is fine”; “I’m well looked after, lunch was good” and visitors told us “Staff have told us we can look at our relatives care plans at any time but we haven’t bothered, everything is fine.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We noted that everyone was well dressed and well groomed. We saw many examples of good communication and patience by care staff, who interacted with people in a positive manner. Staff were friendly and respectful to the people they were supporting. We observed staff quietly talking to people at eye level. Staff took the opportunity to generally communicate and initiate conversations during every interaction they had with people they were supporting.

Recent training had been provided to all staff on ‘Dementia care.’ The manager advised on recent training from their local hospice regarding specialised support for ‘End of life care.’ Updated training and support helped staff to meet the diverse needs of the people living at Aaron Court.

We spoke with five people who live at Aaron Court and two relatives. They told us that a nurse visited them before admission to discuss what their needs were and how Aaron Court could meet their needs. They said that any changes in a person's needs were discussed with them and any changes to how they needed to be care for were agreed before being implemented.

People told us that they were happy with the service and well cared for. One resident said “I’m very happy here” and another said “It’s very nice”. A person who was in bed said “The care is very good, staff are always popping in to see me to make sure I’m alright”. A visitor said “The care is very good and my relative is always kept comfortable”.

People told us that staff were always careful to protect their privacy and dignity. They said they felt safe in the home, and would know who to speak to if they had any concerns.

People also said there was plenty to do if they wanted to get involved in all the activities. One person said “I really enjoy the karaoke nights” and another person, who was bedbound, said “I just happened to mention to a member of staff this morning that I was bored and she came and did a music quiz with me, which I really enjoyed.”

People said they were happy with and confident in the staff working in the home. Comments included: “The staff are very good”; “They’re a good crew”; “The staff are competent and very helpful”; “The night staff in particular are lovely, very polite and reassuring”.

The local authority told us they had no concerns about the care at Aaron Court.