We carried out an unannounced comprehensive inspection on 2 November 2016. Aaron Manor is registered to provide accommodation for 23 people who require personal care. The service is intended for older adults who require long term and short term (respite) care and those people living with dementia type illness. Before this inspection we had received some concerns regarding the cleanliness of the service and poor staff practices. These concerns were found to be unfounded during our visit.

There were 19 people using the service on the day of our inspection which included two people receiving respite care.

We inspected the service in October 2013 and found the service met all of the regulations inspected with the exception of the management of people’s medicines. We returned in March 2014 and the service had met the regulation.

The registered manager was in day to day charge at the service and was supported most days by the responsible person. 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.

Everyone gave us positive feedback about the responsible person and the registered manager and they were very visible at the service and undertook an active role. They promoted a strong caring and supportive approach to staff. They felt this was then the culture in which staff cared for people at the service.

People were supported to follow their interests and take part in social activities. The management team recognised the importance of social events for people. External entertainers were arranged and staff supported people with individual social support. Outings were arranged so people could go out into the local community. People spoke very positively about the activities arranged at the home and gave us many examples of activities they enjoyed. In particular the monthly ‘pub evening’, where families, friends and staff joined together for an evening of fun.

Staff demonstrated great skills in anticipating people’s needs. They were respectful, discreet and appropriate in how they managed those needs. They liaised with people’s families and went above and beyond in their actions to support them. For example, the staff helped a person be able to attend a family members wedding. They assisted with deciding appropriate meals options and a staff member accompanied the person to ensure they had their needs met appropriately.

There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff were compassionate, treated people as individuals and with dignity and respect. Staff knew the people they supported, about their personal histories and daily preferences. Staff showed concern for people’s wellbeing in a caring and meaningful way. Where possible, people were involved in making decisions and planning their own care on a day to day basis. People and relatives said staff were caring and compassionate and treated everyone with dignity and respect at all times. The service made sure staff knew how to manage, respect and follow people’s choices and wishes for their end of life care and as their needs changed. There was a clear message given to us from staff that they treated everyone at the service as their own family.

The management team and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People were supported by sufficient staff who had the required recruitment checks in place, were trained and had the skills and knowledge to meet their needs. Staff had received a full induction a

We carried out this inspection to follow up on a compliance action set at the last inspection.

During the inspection we looked at the management of medication within the home. We looked at care documentation, competency assessments and policies. We found that the provider had systems in place to ensure the safe storage, administration and disposal of medication.

We used a number of different methods to help us understand the experiences of people using the service. People we spoke with told us “you won’t find much to complain about here, it’s a good place to live" and “always something going on, I am very happy with everything here.” Visitors told us “staff are brilliant, it is like a home, not a rest home. They have been wonderful.”

During our inspection we found that people and their relatives/next of kin (NoK) had been involved in decisions about their care, and chose how they spent their time.

Care plans documented the needs of people living in the home. Risk assessments had been completed when required.

Cleanliness and infection control systems were in place, with a good standard of cleanliness observed throughout the home.

We looked at the systems and processes in place for the safe management of medicines and found that there were shortfalls in the safe handling and storage of medicines.

Peoples care needs were reviewed and updated regularly, this meant that staffing levels could be assessed to ensure that there were sufficient staff to meet the needs of people living in the home.

Due to people’s dementia type illness, some people were not able to tell us about their experiences. We used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people using the service. We also used a 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.

People we were able to speak with who lived in the home told us they were happy with the care provided. One person who was staying at Aaron Manor for a period of respite told us “I am very content here, I do the things I enjoy doing, it’s nice here”. Another person who lived at the home told us “The foods lovely, just like you would make at home, I give the home 10 out of 10, when you start talking about how nice it is you realise how lucky you are to have found a home from home”.

Overall the residents and visitors spoken with were very happy with the home. With residents saying that the staff were ‘wonderful,’ ‘they always have time for us,’ ‘they treat us as individuals’ and that ‘they are very lucky to have such a wonderful caring place to be’. Visitors stated that they were very happy with the care provided and felt that the staff welcomed them and made them feel involved with the residents care where appropriate. One stating that it was ‘like an extended family.’