Aaron View Care Home is registered to provide accommodation and care for up to 30 older people. Bedrooms are located on both the ground floor and first floor level with stair and lift access. On the day of our inspection there were 21 people living at Aaron View.

This comprehensive, inspection was unannounced, which meant the provider did not know we were coming. It took place on 12 July 2018.

At the last inspection in March 2016 the service was rated overall as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Aaron View Care Home’ on our website at www.cqc.org.uk.

At this inspection we found the service had improved to Good.

There was a registered manager at the time of our 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.

Management of medicines had improved and records showed people received their medicines as prescribed. Improvements had been made to control and prevent the spread of infection. The standards of cleanliness and maintenance in the home had improved since the last inspection. One downstairs bathroom had been converted into a wet room, providing new bathing facilities to better meet people’s needs Further steps had been taken to make areas of the home more dementia friendly. The registered provider continued to make sure people were protected from the risk of abuse. Staff we spoke with knew the importance of reporting any incidents. Assessments identified risks to people and management plans were in place to reduce the risks. We received positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe. There was sufficient staff to meet people’s needs.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful. People’s plans of care and other written records reflected people’s current needs and their choices and preference.

The home employed an activity co-ordinator who was responsible for arranging activities and social events. The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern, although everyone told us they were happy with the service provided.

Relatives were very happy with how the service was run. There were systems in place to monitor and improve the quality of the service provided. Action plans were implemented for any improvements required and these were followed by staff. The registered manager was keen to continue to improve the service. They placed emphasis on listening to and involving people and on continued learning.

The inspection was unannounced, which meant the provider did not know we were coming. It took place on 4 April 2017. The home was previously inspected in March 2016 and was rated requires improvement with breaches of regulations in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive care that was person centred and met their needs, staff

The home is registered to provide accommodation and care for up to 30 people. Bedrooms are located on both the ground floor and first floor level with stair and lift access. On the day of our inspection there were 22 people living at Aaron View.

There was a registered manager at the time of our 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.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with knew the importance of reporting any incidents. Assessments identified risks to people and management plans to reduce the risks were in place. We received extremely positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe and relatives also said the home provided safe care.

Systems were in place to make sure people received their medications safely, however these were not always followed.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found predominately the requirements of the act were being met.

There was an infection control policy and a procedure in place, however we found this was not followed and many areas were not kept clean or well maintained.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives we spoke with confirmed when they visited there were sufficient staff on duty.

Some steps had been taken to make areas dementia friendly. However, there was room to further improve the environment for the people living with dementia who lived in the home.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day. People told us they enjoyed the food provided at the home.

We observed staff interacting with people who used the service and found they were kind, caring and respectful.

We looked at care plans and other written records and found that in most cases, they reflected people’s current needs. However, these were not always reviewed to ensure they reflected people’s current needs.

The home employed an activity co-ordinator who was responsible for arranging activities and social events. We saw activities taking place and people enjoying these.

The provider had a complaints procedure in place. People felt they could speak with staff if they had a concern. However, people told us they were happy with the service provided.

Relatives were very happy with how the service was run. There were systems in place to monitor and improve the quality of the service provided. Action plans were implemented for any improvements required and these were followed by staff. The quality monitoring had identified that some environmental improvements were required, however, the provider had not approved these and we had no date for work to commence. Since our inspection we have been informed they are approved and awaiting confirmation of start dates.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we t

We carried out this inspection on 4 and 8 March 2016. The inspection was unannounced, which meant the people living at Aaron View and the staff working there didn’t know we were visiting.

The home is registered to provide accommodation and care for up to 30 people. Bedrooms are located on both the ground floor and first floor level with stair and lift access. On the days of our inspection there were 22 people living at Aaron View.

Our last inspection at Aaron View took place on 16 June 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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. There had not been a registered manager at the service since January 2016 and the provider was in the process of recruiting a replacement. The deputy manager, who was temporarily covering the manager’s post was present during both days of our inspection.

People told us they liked living at Aaron View.

We saw that people’s medicines were stored safely and securely, and procedures were followed to ensure that people were given the correct medicines at the right time. One person told us, “They [staff] are very good here. They make sure I get my tablets right.”

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action.

Care records were not up to date or readily accessible to staff. There was no evidence to suggest that people or their relatives were involved in any reviews of their care needs. The manager and the provider did tell us they were reviewing and updating all care records.

We saw there were not enough staff available to care for people adequately and to meet all of their needs. People confirmed they would like to have more baths or showers than they were currently able to. Staff were rushed when serving dinner.

There was a part time activities coordinator employed at Aaron View, however some of their time was taken up caring for people. There was no programme of activities available. Both the people living at Aaron View and the staff working there told us they would like more activities to be available to people.

There was no complaints policy on display, however the manager had recently introduced a system to record any complaints and what action, if any was taken to resolve the concerns raised.

People who lived at Aaron View and the staff that worked there told us the manager was approachable and supportive.

There were no systems in place to monitor and improve the quality of the service provided. There had not been a residents or relatives meeting in the last 12 months. This would have given people and their relatives the opportunity, in a formal way, to provide their opinion of the quality of the service provided. Regular checks and audits in some areas, such as medication were not undertaken to make sure the policies and procedures in place were properly followed.

All of the service’s policies and procedures were out of date. None had been reviewed since September 2010 and therefore may no longer reflect current legislation practice guidelines.

During our inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to staffing, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

On Monday 16 June 2014 an adult social care inspector carried out this inspection. We spoke with eight people, four visiting relatives, five staff and the interim manager. We have referred to the interim manager as the manager throughout this report. We used SOFI and observed people in the communal areas. We checked records relating to people and staff.

We considered all of the evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary which describes what people using the service and the staff told us, what we observed and what we found from the records we looked at on the day. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We noted before people were admitted to Aaron View senior staff from the home had carried out pre-admission needs assessment of the people. This was to ensure the home was able to provide the correct level of care and support to people and maintain their safety.

People and their relatives confirmed the care was planned and delivered in a way that was intended to be safe. To support this, people’s needs had risk assessments. These helped staff identify any harm to people. When planning care the risk assessments helped staff to take necessary actions to minimise the risk and ensure people were safe.

The provider had arrangements in place for handling medicines safely. Staff made sure they checked people’s identity before giving them medication and stayed with people until they had taken the medicine before moving on to the next person. These actions promoted safe administration of medicines and prevented other people from unintentionally helping themselves to taking medicines they were not prescribed.

There were effective recruitment and selection processes to ensure suitable staff were employed to ensure people’s safety. Staff told us that checks were undertaken and that they had to wait for a satisfactory response to these before they began work.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had been needed, the manager told us that they had policies and procedures in place. The manager also told us that, whilst staff had already received training, further training and update sessions were being arranged to ensure that they would know when an application should be made, and how to submit one.

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with relatives who said people received good care and support. They said staff referred people to the GP in a timely manner. They also told us that community nurses visited the home and supported the staff so that the treatment people received were effective.

Is the service caring?

People were supported by staff who were kind and attentive. One person said, “Very good, they always let me know what they are there to do.” We saw care workers giving people encouragement when supporting them. During meal times, people who needed support received this in a discreet way. This demonstrated that staff were caring and mindful of people’s dignity and independence. One relative told us, “I am thinking of putting my name down for here. I think staff are smashing.”

Is the service responsive?

People and relatives confirmed that individual’s care needs were assessed before people moved into the home. Records confirmed people’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

We observed that there was a lack of meaningful activities for people which had a negative impact on the people’s wellbeing. We were told by relatives and staff that people did not receive any meaningful activities. The manager told us they were looking to address this at their earliest opportunity.

The manager said they would refer staff who were a risk to people in health and social care settings to the appropriate bodies to protect other vulnerable people.

Is the service well-led?

There were arrangements in place to deal with foreseeable emergencies. Staff were aware of the procedures to follow when there was an emergency. Personal Emergency Evacuation Plans were used when evacuating people in an emergency. The manager said they were making sure they were updated and was going to appoint a member of staff to ensure these remained up to date.

The provider, or their representative visited the home on average every two months. This visit was to check the quality of the service. They prepared a visit record which identified work needed to be carried out and the manager had been given an action plan so that necessary improvements were made.

People we spoke with, the visiting relatives and staff were not aware of the annual satisfaction surveys by the provider seeking out their views. We have highlighted this and the need for publishing their findings to promote an open and transparent culture.

Although there were regular staff meetings held by the manager, there had not been any residents and relatives meetings in the last six months. The manager was looking into convening a meeting.

There was evidence that learning from events such as incidents, accidents and complaints had taken place and appropriate changes were implemented.

During our visit we spoke with three people using the service, one relative and seven members of staff. We looked at three sets of care planning documentation and three staff files.

All of the people using the service and their relatives that we spoke with were positive about the home. One comment from a person using the service included “I’m happy. It’s comfortable here and the staff are nice. The food is good too. My niece is happy that I am here."

People using the service and their relatives told us that care and treatment was planned and delivered in a way that ensured safety and welfare. A comment from a relative included “They look after dad well. They understand his needs and he has been more settled there than I ever imagined he would.”

All the people and relatives we spoke with said they had no concerns about abuse in the home. One relative told us “They are keeping him safe. He would say if there was anything horrible going on. I know how to raise any concerns as well.”

Staff told us that “We feel very supported here by the manager and by each other as a team.” We found that there was appropriate training, staff support and supervision and opportunities for staff to develop their skills.

We found that there were systems in place to ensure the quality of the service including regular and effective audit, analysis of incidents and accidents, analysis of feedback from people involved in the service including complaints.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we have used a formal way to observe people during this inspection to help us understand how their needs were supported. We call this the Short Observational Framework for Inspection (SOFI).

Throughout the SOFI we saw all staff treated people with respect and courtesy. The atmosphere in the home was relaxed and during our observation we saw positive and friendly interaction between staff and people who use the service. We saw that people who use the service were given choices and supported to make decisions and staff took their time to understand people where they had communication difficulties.

We were able to speak with three people who use the service, a visiting relative and a visiting healthcare professional. The people we spoke with told us they were happy living at the home and we received comments such

“The staff are good here”, “No, we don’t get bored”, “There’s plenty to do here” and “Yes the food is good”.

A relative we spoke with told us they often came to visit their relative who was currently residing at the home. They told us that their relative was happy at the home and that the staff were knowledgeable and approachable. They felt they were involved in the care of their relative and staff kept them informed of any changes. They had no complaints or concerns about the care provided and spoke very positively about the service and staff.

We spoke with a practice nurse who had visited the home on a weekly basis for the last five years. The practice nurse told us that they had no concerns about the home and felt that people were well cared for and seemed happy living there. They told us that the home had a good atmosphere, the staff and managers were approachable and caring.