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.

Aaron Court accommodates 91 people across four floors, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia and palliative care.

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 previous inspection in April 2016 we rated the service as ‘good’. At this inspection the service had not maintained the rating and had deteriorated to ‘Requires Improvement’.

At the time of our inspection visit 72 people were using the service.

The provider’s governance systems and processes used to assess the quality of care provided were fragmented. There was a lack of oversight and monitoring was ineffective.

People did not always receive their medicines as prescribed. Risks associated with people’s needs had been assessed but risks were not always managed. Care plans lacked information and clear guidance for staff to follow to provide person-centred care. Monitoring records were not always completed in full.

Staffing levels were not adequately managed to ensure there were enough staff to provide care and support to people when they needed it. The system to ensure staff were trained and supported in their role was not effective. Further action was needed to ensure staff training was kept up to date and staff competence and practices were monitored.

People and their relatives knew how to make a complaint but they were not confident their complaints would be fully addressed. The system to manage complaints was not effective. People did not feel confident that action would be taken. There were limited opportunities for people to express their views about the service and influence how the service was run.

People were provided with a choice and variety of food and drink. Further action was needed to ensure people’s cultural and specific dietary requirements were met. People at risk of malnutrition and dehydration were not always monitored. People were supported with their health care needs when required.

People were involved in decisions made about all aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Further action was needed to ensure staff training in Mental Capacity Act was up to date.

People were cared for by kind and caring staff. Most staff knew people well; understood their wishes and daily needs. People were supported and made decisions about their end of life care.

People were involved in the development of the care plans. However, people were not involved in a meaningful way to review their care so that they received person-centred care that was responsive. Improvements were needed to ensure staff treated people with dignity and respect.

The provider employed activity co-ordinators but people’s experiences about the activities, social stimulation and engagement varied. People’s diverse needs were mostly met.

Information was made available in accessible formats to help people understand the care and support agreed. The provider was developing picture menus to help people living with dementia choose what they want to eat.

We found breaches 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.

This inspection took place on 17 February 2016 and was unannounced.

Aaron Court is a care home that provides residential and nursing care for up to 91 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. Accommodation is over four floors accessible using the stairs or the lift. Bedrooms are all single ensuite and there is a choice of communal lounges and dining rooms on each floor. Each floor has a dedicated team of staff. At the time of our inspection there were 65 people in residence.

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

People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff were trained and understood their responsibility in protecting people from the risk of harm.

Risk assessments and care plans had been developed with the involvement of people and where appropriate their relatives and health care professionals. Staff had the clear information on how to reduce risks to ensure people were supported in a safe way.

Staff were recruited in accordance with the provider’s recruitment procedures and sufficient staff were available to meet people’s needs. People received quality care and staff receive on-going training and support.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles. This included staff seeking consent from people before supporting them. The registered manager sought advice and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

People and where appropriate their relatives and health care professionals were involved and made decisions about their care and support needs. People chose how they wish to spend their day and had opportunities to take part in activities that were of interests to them. People’s family and friend were encouraged to visit at any time.

People told us staff were caring and kind and that they had confidence in them to provide the support they needed. We saw staff positively engaging with people, and treated them with dignity and respect.

People were provided with a choice of meals that met their health and dietary needs. Referrals were made to relevant health care professionals where there were concerns about people’s health.

People’s views about the service and their relatives were regularly sought as part of monitoring the quality of service provided and to improve the service. The registered manager was developing new ways to engage and support staff to ensure they contributed to the staff meetings and the development of the service.

The provider’s quality assurance systems were used effectively to monitor the performance and the service provided. Regular audits and checks were carried out to ensure people’s safety, the premises and the equipment used was well maintained.

This inspection took place on 23 and 24 February 2015 and was unannounced.

Aaron Court is a care home that provides residential and nursing care for up to 91 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. At the time of our inspection there were 54 people in residence.

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

People told us they felt safe with the staff that looked after them. People’s needs had been assessed and they were involved in the development of their plans of care to meet their needs and manage the risks identified. Where appropriate expert advice was sought from health care professionals. People were satisfied with the care and support provided.

People were protected from harm and abuse. Staff were knowledgeable about meeting people’s needs and their responsibilities in reporting any concerns about a person’s safety including protecting people from harm and abuse. People said they received their medicines at the right time. Medicines were managed and stored safely.

Staff were recruited in accordance with the provider’s recruitment procedures this ensured staff were qualified and suitable to work at the home. People were supported by staff in a timely and sensitive manner, which meant people’s care needs were met. However, people told us staff were not always available to spend meaningful time with them such as having conversations about things that were of interest to them or pursuing hobbies, and we observed this to be the case at times.

Staff received an induction when they commenced work and on-going training and support. Staff were knowledgeable about people’s needs. Staff had access to people’s plans of care and regular communication between all the staff helped to ensure staff were kept up to date as to the needs of people. We observed the majority of staff supported people safely when using equipment to support people. Where we observed staff to be using unsafe practices we shared this with the registered manager. Following our visit the registered manager told us regular observation of practice and competency assessments would be carried out to further assure themselves people received appropriate care and support.

We observed that staff gained consent before care and support was provided. Staff understood their responsibilities in supporting people to maintain control and make decisions which affected their day to day lives. People were protected under the Mental Capacity Act and Deprivation of Liberty Safeguards and we found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions.

People were provided with a choice of meals that met people’s cultural and dietary needs, which they enjoyed. Drinks and snacks were readily available. We saw staff supported people who needed help to eat and drink in a sensitive manner.

People’s health needs had been assessed and met by the nurses and health care professionals. Staff sought appropriate medical advice and support from health care professionals when people’s health was of concern and had routine health checks. Records showed recommendations made by health care professionals were acted upon. This meant people were supported to maintain good health.

People lived in a comfortable, clean and a homely environment that promoted their safety, privacy and wellbeing. All the bedrooms were spacious and had ensuite shower and toilet facilities. All areas of the home could be accessed safely including the outdoor space.

People told us that they were treated with care and compassion. We observed staff to be kind and respected people’s dignity and privacy, which promoted their wellbeing. Staff had a good understanding of people’s care and cultural needs.

People’s social needs were met. We saw people received visitors and were able to spend time with them and had access to a range of opportunities to take part in hobbies and activities that were of interest to them, including meeting people’s religious and spiritual needs.

People were confident to raise any issues, concerns or to make complaint. People had access to an independent advocacy service if they needed support to make comments or a complaint. People said they felt staff listened to them and responded promptly if there were any changes to their health needs and wellbeing.

People were given information about how to make a complaint, which included the independent advocacy service. People and relatives we spoke with said they were confident to speak with the staff or the registered manager if they had a complaint or were unhappy with any aspect of care. Complaints received by the service had been investigated and steps taken to avoid a re-occurrence.

People using the service, their relatives, staff and health and social care professionals were encouraged to develop and share their experience of the service.

Staff were supported and trained for their job roles to ensure their knowledge and practice in the delivery of care was kept up to date. Staff knew they could raise concerns with the management team about the way the service was run and knew it would be acted on.

The registered manager understood their responsibilities and demonstrated a commitment to provide quality care.

The registered manager worked with the local authority commissioners that monitors the service for people they funded to ensure people received care that was appropriate and safe.

The provider’s quality assurance systems and processes monitored the performance of the service and the quality of care provided. There were systems in place for the maintenance of the building and equipment which ensured people lived in a safe environment. Audits and checks were used to ensure people’s safety and their needs were being met.