About the service:

- The service is in a residential area of Loughborough.

- The service provides accommodation and personal care for people with a brain injury or with a dementia type illness or similar conditions. The care home can accommodate 22 people in one building. At the time of our inspection there were 11 people using the service.

People's experience of using this service:

• The service was not comprehensively safe. Staffing levels did not always keep people and staff safe. There were insufficient numbers of staff deployed to meet people's care and support in a safe or timely way and to comprehensively protect the safety of staff.

• There were audits in place to see whether the service provided high quality, safe care. However they had not comprehensively ensured quality care, as not all issues of concern or areas requiring improvement had been identified.

• People were not always protected against abuse, neglect and discrimination. Although staff were aware of ensuring people's individual safety risks and acting to prevent harm coming to them, three incidents had not been reported to us so we were not able to evaluate whether an earlier inspection was needed.

• Complaints made had not always supplied a comprehensive response to concerns made.

• There was a homely atmosphere and the home was kept warm.

• Questionnaires had been supplied to people’s representatives for their views of the service. These were generally positive about people’s satisfaction with the service.

• People were treated with a friendly and caring manner by staff.

• Staff members knew people well and people appeared to enjoy the attention from staff.

• People were assisted to have choice and control of their lives.

• Peoples representatives had a say in how the service was operated and managed.

• People's care was personalised to meet their individual needs.

• A registered manager was in place to ensure governance of the service.

• The service met the characteristics for a rating of "good" in caring and effective but not in safe, responsive and well led where the rating was Requires Improvement.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "Good". Our last report was published on 19 July 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will follow up the breach in regulation and require the provider to outline necessary improvements in an action plan and continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

We inspected the service on 19 July 2016. It was an unannounced inspection.

Aarons specialist unit provides accommodation, nursing and personal care for a maximum of 30 people with a brain injury or similar conditions. There were 23 people using the service on the day of our inspection.

There was a registered manager. 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 were protected from harm. People told us they felt safe and that there were enough staff available to meet their needs. There was a recruitment policy in place which the registered manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were administered safely.

People’s independence was promoted and staff treated people with dignity and respect. Some people were supported to follow their interests and engage in activities. We observed times of inactivity for some people. Records did not make clear if activities were consistently being offered to people.

People were supported to make decisions about the care they received. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was clear of their role in ensuring decisions were made in people’s best interest.

The registered manager had assessed the care needs of people using the service. Staff had a clear understanding of their role and how to support people who used the service as individuals.

People enjoyed the meals provided and where they had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager and were confident that they would address issues if required. Relatives found the registered manager to be approachable.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with seven people who used the service for their views. We also used observation to understand people’s experience, as some people had communication needs and were unable to tell us their views and experiences.

We spoke with a senior manager, the deputy manager for the service, members of the multidisciplinary team that consisted of an occupational therapist, physiotherapist, speech and language therapist and a psychologist. We also spoke with a senior nurse and two support workers.

We looked at some of the records held in the service, including the care files for eight people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People spoke about their individual needs and how staff supported them to keep them safe and well. This included support with personal care, social interests and weekly activities with the physiotherapist and occupational therapist.

Staff showed a good understood of each person’s needs and how they wished to be supported. We saw people had care plans and risk assessments that instructed staff of what they were required to do to keep people safe.

People could be assured that they received their medicines appropriately and as prescribed. The provider had safe systems and procedures for the administration, ordering and storage of medicines.

We found there were sufficient staffing levels available during all times of the day and night to keep people safe. We looked at the staff rota that showed how staff were deployed appropriately dependent on their experience, skills and qualifications.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw examples that DoLS applications had been made, and found the provider had adhered to the legislation that protected people’s human rights.

Is the service effective?

Whilst we found the service effective, the lack of structured and meaningful activities could have a negative impact on people’s mood and behaviour.

We found people had their care plans and risk assessments reviewed on a regular basis. The multidisciplinary approach to the delivery of care and treatment, meant people had their needs monitored by a team of health professionals who worked together.

Is the service caring?

We observed staff involved and treated people with compassion, kindness, dignity and respect. We observed staff to be sensitive, caring and attentive to people’s needs.

We observed staff intervene to support one person who was becoming upset and agitated. This was done in a calm and respectful manner, and without bringing undue attention for others in the lounge. One person who used the service was asking the same question repeatedly. A staff member replied each time in an appropriate and respectful way. This was done without discrimination.

During the morning of our visit we observed staff supported people with a hand massage. Another person was supported to attend the gym and lunchtime was found to be relaxed and calm. Staff were observed to anticipate people’s needs, and we found staff to be knowledgeable about the needs of people including their routines and preferences.

Is the service responsive?

We saw the provider had a complaints policy and procedure that informed people how to make a complaint and what their rights were.

We found some examples that showed the service was responsive to people’s assessed needs. For example, people were supported with their routines and activities that were important to them. However, it was difficult to ascertain if people were supported to achieve their therapeutic goals and outcomes or aspirations as records did not clearly document this.

Is the service well-led?

People who used the service were able to share their views about the service. The provider supported people to have ‘house meetings’ to discuss and share their views about the service provided.

The provider carried out internal audits that monitored service delivery. Staff meetings were regular and staff were enabled to share their views and experiences that contributed towards the running of the service.

There was not a registered manager in place but staff told us that they felt there had been improvements since our last inspection. They described the leadership as good and that they felt supported.

People who live at Aarons Specialist Unit told us that they were satisfied with the care and support they received. People said they were involved to make sure their care and supports needs were provided in a manner that suited them. One person said “I feel I’ve got my life back and can see there is a future for me.” A visiting relative told us they were satisfied with the care and support their relative received and said “This place is so much better than where she was last time” and “we’ve always found she is clean and she’s much happier here.”

People told us they were treated with respect and their independence was promoted. People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly by staff and health care professionals. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People were protected because there was effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work. Staff received training which enabled them to meet people’s care needs safely.

Information about how to make a complaint was available to people using the service. People told us they were confident to raise concerns with the manager. One person said “I’ve got no complaints but I’m sure I could tell the staff if there was a problem.”

Because many people living at Aarons had communication difficulties, we were unable to ask direct questions about all of the essential standards we reviewed. People spoken with were satisfied with the service provided.

People told us they were involved in the assessment and care planning process to make sure their needs would be met. They said staff sought permission before they were helped. People had varied opinions about the support they received from staff. Comments received were, “The staff are very good, always asks how you are and seem really caring” and “Staff aren’t always available when you want to go out.”

People received medicines on time and knew what they took. The system for receiving, dispensing and recording medicines were not safe. The medication audits were ineffective because although they identified actions needed to be taken it was not always clear if this had been done.

People using the service were supported by trained staff. Staff did not receive adequate or timely support for their job role and development, and there were not enough suitably qualified and experienced staff were available to meet people’s needs safely.

The provider did not effectively assess and monitor the quality of service. People’s views were not sought and audits were not carried out regularly to ensure the health, welfare and safety of people using the service was protected.

During our inspection visit the registered manager informed us they had resigned. The provider had appointed an interim manager and the service was not taking new admissions until improvements were made.