Aldringham Court is a care home with nursing. 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.

Aldringham Court accommodates up to 45 people. Some people using the service were living with dementia. At the time of this unannounced inspection of 27 June 2018 there were 40 people who used the service.

At our last inspection on 11 August 2016, we rated the service overall Good. The key questions Effective, Caring, Responsive and Well Led were rated good. The key question Safe was rated Requires Improvement as people were not consistently supported in a clean and hazard free environment.

At this inspection 27 June 2018 we found that improvements had been made and sustained and Safe is now rated as Good. We found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The design and layout of the building was hazard free and met the needs of people who lived there. All areas of the home were clean and in a good state of repair with equipment maintained. Systems were in place to minimise the risks to people, including from abuse, falls and with their medicines.

Staff understood their roles and responsibilities in keeping people safe. They were trained and supported to meet people’s needs. Staff were available when people needed assistance and had been recruited safely.

People were complimentary about the care they received and the approach of the manager and staff. They told us that they felt safe and well cared for. Staff had developed good relationships with people. Staff consistently protected people’s privacy and dignity and promoted their independence.

Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

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.

People enjoyed a positive meal time experience and were enabled to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

People received care that was personalised and responsive to their needs. They participated in meaningful activities and were supported to pursue their interests. The service listened to people’s experiences, concerns and complaints and took action where needed.

The manager was accessible, supportive and had good leadership skills. Staff were aware of the values of the provider and understood their roles and responsibilities. Morale was good within the workforce.

The service had a quality assurance system and shortfalls were identified and addressed. There was a culture of listening to people and positively learning from events so similar incidents were not repeated. As a result, the quality of the service continued to develop.

Aldringham Court provides accommodation, and personal and nursing care for up to 45 older people, some living with dementia. The service has four shared bedrooms, which were being used as single occupancy.

There were 36 people living in the service we inspected on 11 August 2016. This was an unannounced inspection.

There was a registered manager 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 and their relatives felt that the service was providing safe care. Staff were aware of their roles and responsibilities in protecting people from avoidable harm and abuse by reporting any concerns.

The provider kept an overview of any on-going maintenance, refurbishment and infection control to ensure that the building was safe and fit for purpose. However staff were not always independently identifying hazards and taking action to address / report them. We made a recommendation about this.

People were cared for by staff who were safely recruited, supported, supervised, appraised and trained. There were sufficient numbers of staff to provide safe care, and the service were proactively recruiting to vacant posts.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff. Staff had good relationships with people who used the service and their relatives. Relatives were invited to attend ‘workshops’ to support them in about the experiences of people living with dementia. Staff interactions with people were caring, respectful and supported people’s dignity.

People told us that the food was good, they were given choices and that they were supported to have enough to eat and drink. Dietary needs and nutrition were well managed and advice sought from appropriate health professionals as needed. People were supported to take their medicines as prescribed. Health care needs were met through the service’s qualified nurses, and external health care professionals, which the service had developed good working relationships with.

People’s, relative’s and staff’s views were sought about the service, and their feedback used to monitor the quality of the service, and be influential in driving improvements.

People and where applicable, their relatives, participated in the development of their care plans which stated their preferences. The service was developing their range of activities for people to choose from and participate in.

The service was aware of the changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). Therefore where needed, appropriate referrals were made to external professionals.

People felt their concerns and suggestions were listened to and acted on to drive improvements in the quality of the service they received. A complaints procedure was in place to ensure people’s comments, concerns and complaints were listened to and addressed in a timely manner and used to improve the service.

People, relatives, stakeholders and staff were complimentary about the new registered manager. Staff understood their roles and responsibilities and were working as a cohesive team. There were quality assurance processes in place to monitor the quality and safety of service people received.

Aldringham Court provides accommodation and personal and nursing care for up to 45 older people, some living with dementia.

There were 40 people living in the service when we inspected on 14 July 2015. This was an unannounced inspection.

There was a registered manager 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.

Staff understood the various types of abuse and knew who to report any concerns to. However, to safeguard people’s interests, improvements were required to ensure staff followed local safeguarding guidance in reporting any concerns so they could be dealt with in an effective manner.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely. However, improvements were required in the recording of people’s blood sugar, and to ensure people’s records provided an accurate account of what people had received

Staff were trained and supported to meet the needs of the people who used the service. There was enough staff, however there were occasions when people would have benefited from staff working more effectively together to ensure needs were met in a timely way. Improvements were needed to provide more social interactions to people especially those who due to their needs were more isolated or physically unable to move from their room or bed.

People, or their representatives, were involved in making decisions about their care and support. Staff needed further recorded guidance about people’s specific care needs and how their care needed to be met including up to date information about people’s changing needs.

The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed. However, improvements were needed to in the daily management of the service to ensure staff worked as a cohesive team, working in an effective manner. As a result the quality of the service will continue to improve.

We spoke with nine people who used the service. We also spoke with six relatives and received written feedback from four people’s relatives. We looked at what action the service had taken to address the shortfalls we had identified in our last inspection of 11 November 2013. We looked at four people’s care records. Other records viewed included information on staff training, staff supervision, medication and health and safety. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were provided with a clean, safe, well maintained environment which met their needs. One person's relative told us, “All the areas of the home I have visited have appeared clean and tidy, whilst maintaining a comfortable environment.”

We found improvements in the record keeping and support people were given with their medication. We found that people were provided with their medication in a safe manner.

We found improvements in the information held in people’s care plans. We saw detailed risk assessments and staff were given guidance to ensure people’s safety.

Although improvements had been made in the service’s record keeping, further improvements were required. This was to ensure that they accurately reflected the level of support that they had given. However, this had also been identified by the provider. They told us that arrangements had been put in place to provide staff with further training in recorded keeping.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental capacity Act (MCA) 2005 and Deprivation of Liberty Safeguarding (DoLs). While no DoLs applications had been made, discussions with senior staff demonstrated their understanding of when they would need to.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person's relative told us, “(Their next of kin) has expressed delight in being at this home and have not made a complaint to me at any time.”

We found improvements had been made and that suitable arrangements were in place to ensure staff were supported through supervision and appraisal. This included observation supervision, which provided staff with constructive feedback on their work practice.

People’s care records showed that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

Is the service caring?

People were supported by kind and attentive staff. One person who lived in the service told us that staff had, “Patience,” and that they were always treated in a kind and polite way.

One person's relative said, “The staff are all kind and very good to (name).” Another relative had written on a national care website and described the staff as, “Excellent.” Another relative had written on the same website described the staff as, “Warm and friendly.”

We looked at thank you cards staff had received from people’s relatives during 2014. One relative had written, “We want to thank you all from the bottom of our hearts for all the care, love, time and support you have given (name).”

Is the service responsive?

One person told us when they had raised a concern with management, “They believed what I said,” and had resolved the situation.

People’s preferences and choices were taken into account and listened to. We saw staff involved people in making decisions and acted on the information they received.

However, we also saw improvements were needed to ensure that people’s preferences for when they wanted to have a bath or shower were followed. When we pointed this out to the management, they took responsive action. They told us that the days people had requested to have their bath/shower would be highlighted on their daily personal care records, which would act as a ‘prompt.’ The completion of these would also be monitored.

People’s care records showed that where concerns about their health and wellbeing had been identified that staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from healthcare professionals which included a doctor and community dietician.

Is the service well-led?

The service had quality assurance systems in place and records seen by us showed that identified shortfalls were addressed promptly. We found the provider had listened to feedback they had received from people who used, or had contact with the service. As a result the quality of the service was continually improving.

This follow up inspection focused on the work that had been undertaken to address compliance following our inspections of 29 July 2013 and 20 August 2013. During this inspection we spoke with 10 people who used the service and eight staff.

One person told us, “I have been quite happy, I can’t complain about anything, everyone is very nice, nothing is too much trouble and the food is nice.” Another person told us, “I get on great with them (staff) have a good laugh and a joke…food not too bad here.” Another described the care they received as, “Pretty good.” Another said, “I think you could say that I am receiving good care here, nowhere is perfect.”

We found improvements had been made which ensured people were cared for in a clean, hygienic environment. One person told us, “I must say (staff) do keep it (the environment) clean.”

We found improvements in the service’s complaints system which ensured that people’s comments and complaints were responded to appropriately and within a timely manner.

Although we found improvements had been made in the service's medication systems, care planning and in the supervision of staff, we identified further work was still required in these areas, to ensure all the people who used the service were provided with safe care that met their individual needs.

We conducted this inspection to assess if people’s medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication. We conducted a sample audit of medicines and found there were gaps in the records and that there were some numerical discrepancies of medicines so we could not be assured people were being given their medicines as intended by prescribers. We noted some poor practice around the administration of medicines. We also noted that whilst there was some good information available about people’s medicines there was also a lack of written information to assist staff in safely administering some medicines

Information we had received from visitors to the service, raised concerns that the standard of cleanliness and hygiene in the service had, ‘slipped.’ Therefore, during our inspection we assessed the standard of cleanliness and infection control. We spoke with three people and one person’s relative. They told us that they had no complaints, and that staff kept their bedroom clean. One person who was happy with the standard of cleanliness told us, “Staff are always cleaning something, me included.”

We found the general standard of people’s bedrooms to be of a clean standard. However, we also found areas of poor staff practice where staff had not followed their own infection control procedures to minimise the risk of cross infection.

We spoke with 11 people who resided in the service and five people’s relatives and friends to gain their views of the service provided.

People felt generally the standard of care was good, but felt there were some areas that required improving. One person told us, “I am happy here.” Another person said, “It’s not too bad, staff are friendly enough… plenty of food and drink, someone always passing and asking if you want something.” Three people described the staff as, "Kind," and, "Hard working."

Two people felt the standard of service was, “Improving,” but felt improvements in monitoring staff practice and communication between staff could be made.

People told us that on-going changes of manager had left them confused as to who was in charge. Therefore they were unsure who to complain to when they had concerns.

We found that care staff were not encouraged to read people’s care plans, therefore they were reliant on verbal communication to keep them updated on people’s health and welfare. This meant that there were issues where staff had not always responded to people’s individual needs and preferences.

We found that staff were not always being appropriately supervised and supported. This meant where we had gained feedback on identified shortfalls in staff practice they had not been investigated, or acted on.

The service had robust recruitment procedures in place to ensure that they employed staff with the skills and knowledge to undertake their role.

When we arrived we met people sitting in the lounge. We observed a relaxed atmosphere and saw staff interact with people. One person who pointed to a member of staff told us, “Got my one or two I wouldn’t do without, one (member of staff) there is marvellous.”

We visited six people in their bedrooms and where able, sought their views on the standard of care they were provided with. People told us that they were given the support they needed with their personal care. One person said, “I get all the help I need.” Further discussion identified where people wanted changes made to the times staff helped them, that they felt comfortable to speak to members of the management team.

We saw that people looked well presented and had access to drinks and where required, were given assistance to eat their meals. We saw improvements in the way staff recorded the level of support they had given to people. Records showed when people had last eaten, been offered a drink, and reposition in bed to prevent their skin from becoming sore.

We asked people if they had seen an improvement in how long it took staff to answer their call bell. Comments we received included, “No, not so long,” “It’s got better” and “It’s a little bit better now.” Reassurances was given by the provider that they would continue to monitor the standard of service provision and listen to people who used the service, and their advocates. This will ensure that improvements made, are not allowed to slip back.

We spoke with 11 people using the service, three relatives and five staff.

People told us that they felt staff were kind and polite and provided them with the level of care and support they wanted. One person told us, “I think the carers are very good here.” Another person told us, “On the whole I find staff are very good.” However, the majority of people we spoke with told us at times there was an unacceptable wait for call bells to be answered. One person told us, “Only complaint is how long it takes staff to answer call bells.”

We observed that there was not enough staff on duty during our visit to ensure call bells were answered in a timely manner or provide individual or group activities. One person told us they played, “Bingo at least once a week.”

Relatives told us about the meeting they had attended which provided them with a forum to raise any issues. People told us that the food was very good. One person told us, “Meals come regularly, very good actually.”

We found that staff did not always complete records to confirm what care they had given. These records form an important part of monitoring to ensure vulnerable people receive the care they need.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People we spoke with told us that they were very happy with care they received at Aldringham Court. We were told by one person that they felt “very lucky to be here” and that they liked coming to spend time in the lounge. Another person told us that the staff were “excellent” and “I never thought I could be happy in a care home – but I am here”.