This inspection took place on 13 November 2018 and was unannounced.

Aaron House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Aaron House can accommodate up to 25 people who require accommodation and personal care. The home consists of one adapted building across two floors. At the time of our inspection there were 23 people living in the home.

There was a registered manager employed at Aaron House. A registered manager is a person who has registered with the CQC 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 living at Aaron House. There were enough staff available to keep people safe and to meet their needs in a timely way.

Systems were in place to identify and reduce risks to people. Staff had been trained in how to safeguard vulnerable adults and they had a good understanding of their responsibility to protect people from harm.

People's needs were assessed before they moved into the home. The support they needed from staff was clearly recorded in their care plans. People’s care plans recorded their preferences, likes and dislikes. This supported staff to provide person-centred care.

People received their medicines, as prescribed, from staff who had been trained in medicines management.

People told us staff were kind and caring. During this inspection we observed staff treat people with kindness, dignity and respect. Staff knew people living at Aaron House very well.

People were supported to take part in a range of activities, both within the home and in the local community. Staff supported people to take part in activities of their preference.

Staff received a range of training which supported them to do their jobs effectively. Staff were happy with the training they received. Staff were supported by the management team through supervisions and appraisals.

People were asked for consent before care was provided to them. Where people lacked capacity to make decisions for themselves, their care records showed decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

The service worked closely with community health professionals to support people with their health needs. People's care records evidenced they received medical attention when they needed it, to promote their health.

People were supported to eat a varied diet that met their nutritional requirements.

The provider had effective system in place to deal with any complaints.

Where people were receiving care at the end of their life, the service worked closely with community health professionals, to ensure people’s pain was effectively managed.

The registered manager completed regular audits of the service, to make sure action was taken and lessons learned when things went wrong. Effective systems were in place to support the continuous improvement of the service.

People living at Aaron House, their relatives and the staff were all positive about the registered manager and about how the home was run. We found a welcoming and positive culture within the home.

We carried out this inspection on 4 October 2017. The inspection was unannounced, meaning that the home’s staff and management did not know the inspection was going to take place.

Aaron House is registered to provide residential care for up to 25 older people, including those living with dementia. On the day of the inspection 22 people were using the service.

The home had a registered manager who registered with the Care Quality Commission (CQC) in August 2015. A registered manager is a person who has registered with CQC 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.

Our last inspection at Aaron House took place on 16 September 2016. The home was rated Requires Improvement overall. We identified a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Need for consent. The registered provider sent an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of this regulation.

At this inspection we found that the management of people’s money was not always safe. Records did not always correspond with outgoing transactions. Since the inspection the registered provider has audited all personal accounts held at the service to make sure records are accurate and no money unaccounted for.

We found systems were in place to make sure people received their medicines safely so their health needs were met. Medicine protocols were in place to guide staff when to administer medicines prescribed on an ‘as and when’ basis to meet their health needs.

Staff recruitment procedures were in place. The registered provider ensured pre-employment checks were carried out prior to new staff starting work. However, this required improvement so that the registered provider verified with potential staff the dates of their previous employment. This included identification and the exploration of any gaps in employment. Following the inspection the registered provider submitted an action plan stating that all new employees’ employment records will be checked, including verification and exploration of any gaps in employment.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. We found staff were receiving regular supervision and appraisal at the frequency stated in the registered providers own procedures.

Sufficient numbers of staff were provided to meet people’s needs. We saw staff responded in a timely way when people required assistance.

We looked at care records and found they contained detailed information and reflected the care and support being given. More detail was required in moving and handling support plans.

Two activity coordinators worked at the service and provided a programme of activities to suit people’s preferences. We observed activities taking place and feedback from people who used the service was positive. People spoken with were also very positive about their experience of living at Aaron House. They told us they were happy, felt safe and were respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were complied with.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The reg

We carried out this inspection on 16 September 2016. The inspection was unannounced, meaning that the home’s staff and management did not know the inspection was going to take place. The location was previously inspected in January 2014, where no breaches of regulation were identified.

Aaron House is registered to provide residential care to 25 older people, including those living with dementia. On the day of the inspection 24 people were receiving care services from the provider. The home had a registered manager who registered with CQC in August 2015. 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 gave us positive feedback about their experience of living at Aaron House. They told us they felt well-supported and found the home to have an enjoyable atmosphere. We observed that staff spoke to people with warmth and respect, and worked hard to ensure that people had a positive experience at the home.

Food in the home was good. People were offered a wide range of choice, and mealtimes were a pleasant experience. There were plentiful activities in the home, which people told us they enjoyed taking part in

We looked at the arrangements for obtaining and acting in accordance with people’s consent, but found that the provider did not act in accordance with the requirements of the Mental Capacity Act 2005

We found that medicines were safely managed, and that staff and the provider had a good knowledge of safeguarding. The provider had good arrangements in place for reviewing people’s care, and responding to changes in people’s health and social care needs.

We identified that risk assessments had not always been implemented where required, and found an incident where staff had failed to take appropriate steps when a person using the service sustained an injury.

The home had a registered manager, and additionally the nominated individual, who was one of the company’s directors, was involved in the day to day running of the home.

Audits took place to monitor the quality of the service provided, and actions were devised from audits in order to ensure continuous improvement.

We found a pleasant and relaxed atmosphere in the home. We received the following comments from people who used the service "The staff are marvellous and everybody is so friendly." and "The staff are fine and always ask me what I want for dinner."

We spoke with four members of staff who were able to describe how they maintained people’s privacy and dignity. The examples given included the right to get up and go to bed when people chose to, the right to choose what they wanted to eat and drink.

We spoke to one relative who was very satisfied with the care and her relative’s wellbeing. They told us that they had been involved in changes to the care plan involving how personal care was delivered to their relative

We found that all areas we inspected were clean, free from clutter and unpleasant odours. We observed that all toilets, bathrooms, showers, and kitchen areas hand hygiene instructions were clearly displayed along with appropriate soap and paper hand towel dispensers.

We looked at training records that evidenced that staff had been provided with training. Each member of staff had received induction training which included a period of working alongside other staff. We found that a matrix of training was recorded centrally.

We spoke to four people who told us that if they had a complaint about their care they would talk to their key worker or the manager. They told us all staff was approachable and they would have no hesitation in talking to them.

We spoke with five people who told us that they were always treated respectfully. Their comments included: "The staff are polite and knock on the door." "The staff are all nice and polite." We saw that staff spoke to people in a kind manner and with respect. People told us that their opinions were sought so that they were involved in decisions and that they had choice.

We observed staff providing reassurance, care and concern to people. People told us that they were satisfied with the care provided. Their comments included: “If we need help in the night we just press the button.” and “I can have a laugh and a chat with the staff.” We looked at a sample of relative’s questionnaires. Their comments included: “Like the homely atmosphere and cheerful welcome I get when I visit.” and “I have utmost praise for all the staff.”

We found that staff were very clear about what action they would take if they saw or suspected any abuse. People told us that they felt "very safe" living in the home and had no worries or concerns. They all said that if they had any concerns or worries they would speak to the manager.

We found that staff had received training and were supervised. We saw evidence that staff had the chance to develop and improve their skills. We spoke to one relative visiting the home who was very satisfied with the care being provided by staff.

We found evidence that the service regularly assessed and monitored the quality of their service.