Aston Court Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This comprehensive inspection was unannounced and took place on 18 September 2017.

Aston Court Nursing and Residential Home accommodates up to 52 people in one adapted building over two floors. At the time of our inspection, 42 people (who had physical health needs and/or were living with dementia) were using the service. Our last inspection took place in March 2016, and the service was rated as Good. At this inspection, we found the service remained Good.

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.

At our last inspection, we asked the provider make improvements to ensure the service was effective. We had found that when people were not able to make certain decision for themselves, this had not been reflected in their care plans or reviewed. At this inspection, we found the required improvements had been made. 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 continued to receive care that was safe. Staff understood their responsibilities to protect people from possible harm. Risks to individuals were assessed, monitored and reviewed, and staff followed safe working practices. There were enough staff to meet people’s needs and the provider ensured staff were suitable to work with people. People received their medicines as prescribed, and were protected from any risks associated with them.

Staff had the knowledge they needed to carry out their roles and received training to develop their skills. People were enabled to maintain a balanced diet and were able to access health care services when needed. They were supported by staff who knew them well and treated them with dignity and respect. Staff were patient and kind and promoted people’s independence. People were able to maintain relationships that were important to them, and there were no restrictions in place for visitors.

The care people received was individual to them and responsive to their needs. They were able to participate in activities they enjoyed and follow their interests. The care records in place reflected the support that people needed, and gave staff information to support them in providing personalised care. People knew how to raise any concerns and the provider had responded to any issues in a timely manner.

There was a positive, open culture at the service, and people were happy with the support they received. Staff were supported and enjoyed their jobs. The registered manager had effective systems in place to drive continuous improvement, and they sought feedback from people who used the service and their families.

This inspection took place on the 14 March 2016 and was unannounced. At our previous inspection on the 13 March 2015 the service was meeting the regulations that we checked but we did ask the provider to make some improvements. This was because improvements were needed to ensure the recruitment procedures were thorough and there were enough staff to meet people’s needs in a timely way. Improvements were also needed to the management of medicines, the social activities provided to people and the staff’s understanding of their roles and responsibilities. At this inspection we saw that improvements had been made in these areas.

We returned to inspect this service in January 2016 following information received regarding the moving and handling practices when using bath hoists. We found that the service was meeting the regulation that we checked but we did ask the provider to make some improvements to ensure staff had clear direction and training on how to use this equipment safely. At this inspection we saw that improvements had been made.

Aston Court provides accommodation and nursing care for up to 55 people. On the day of our inspection 43 people were using the service; this included 12 people from the local hospital that required rehabilitation prior to being discharged home.

A registered manager was in post at the time of this 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.

People’s capacity was not always reflected in their records or reviewed in a timely way, but the manager had identified that this was an area for improvement and was taking action to address this.

People felt safe and staff understood their role in protecting people from the risk of harm. Checks were carried out prior to staff starting work to ensure their suitability to work with people and staffing levels were monitored to enable people’s needs to be met. Medicines were managed safely and people received their medicines at the right time, as prescribed. Staff had clear direction and training on how to use this equipment safely.

People were supported by staff who had the knowledge and skills to provide safe care and support People received food and drink that met their nutritional needs and preferences. Health concerns were monitored and people received specialist health care intervention when this was needed.

People’s preferences were considered and incorporated in their support plan. There were regular reviews of people’s care to ensure it accurately reflected their needs. People were able to take part in social activities. People liked the staff and their dignity and privacy was respected by the staff team. The staff team were approachable and made visitors feel welcome.

People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns which were raised.

There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt confident that they could raise any concerns with the registered manager. People felt the service was well managed and systems were in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We carried out an unannounced comprehensive inspection of this service in March 2015. The service was judged as requires improvement overall and in the safe key question. After that inspection we received information in relation to the safety of people at the service. As a result we undertook a focused inspection on 7 January 2016 to look into those concerns. This report only covers our findings in relation to the safety of people.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Aston Court Nursing and Residential Home on our website at www.cqc.org.uk

Aston Court provides accommodation and nursing care for up to 55 people. There were 48 people who used the service at the time of our inspection.

The service had 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 had equipment they needed to assist people. However they had not been trained in the safe use of some pieces of equipment in use at the service. Documents for safe working practices, policies and procedures did not always specify or identify how some equipment was to be safely used.

This inspection took place on the 13 March and was unannounced. At our previous inspection in September 2014 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding consent to care and treatment, care and welfare, management of medicines and staffing. A warning notice was issued to the provider regarding the management of medicines at our inspection in September 2014. The provider sent us a report in October 2014 explaining the actions they would take to improve.

We returned to inspect this service in October 2014 and found the provider had met the conditions of the warning notice. At this inspection, we found improvements had been made since our visit in September 2014, although further improvements were needed to ensure people’s needs were met in a timely way.

Aston Court provides accommodation and nursing care for up to 55 people. There were 48 people who used the service at the time of our inspection.

The home is required to have 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. There was no registered manager in post at the time of our inspection. The manager who registered with us in January 2015 had left in March 2015 and an interim manager was overseeing the management of the home. A new manager was due to commence in post in May 2015.

Improvements had been made to the staffing levels but further improvements were needed as people’s needs were not always met in a timely way.

The recruitment practices were not always thorough to ensure the risks to people’s safety were minimised.

Although safe medicine management procedures were in place these were not always followed. Records did not always demonstrate that people received their medicines as prescribed.

People we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise the identified risks. Plans were in place to respond to emergencies to ensure people were supported appropriately.

Staff had all the equipment they needed to assist people. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff received training which supported them to meet people’s needs effectively.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions.

Risks to people’s nutrition were minimised because people were supported to maintain their nutritional health. People enjoyed the meals provided.

People were supported to maintain their health and in general were supported to access the services of other health professionals when they needed specialist support. However there were occasions when referrals to health professionals had been overlooked.

People liked the staff and their dignity and privacy was respected by the staff team. Visitors were made to feel welcome by the staff.

People and their relatives were involved in planning and agreeing how they were supported, but recreational pursuits were not engaging people, as people’s interests were not incorporated in to the planning of these.

There were quality assurance checks in place to monitor and improve the service. People who lived at the home and their relatives were supported and encouraged to share their opinions about the quality of the service.

The management team told us that the service had made significant improvements since our previous inspection on 17 September 2014. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures.

At this inspection, we found that the warning notice had been met. Appropriate arrangements were now in place to ensure that medicines were managed safely.

This visit to Aston Court was an unannounced inspection in response to concerns we had received. These concerns were that the meals served were of poor quality and that low staffing levels meant that people were not supported effectively and in accordance with their wishes.At this inspection we also followed up on the compliance action we left in June regarding the management of medicines at Aston Court.

At the time of our visit 37 people were using the service. We spoke with 15 people that were using the service and five people’s relatives. Below is a summary of our findings based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask.

Is the service safe?

We checked to see if improvements had been regarding the management of medicines since our inspection on 12 June 2014. Although there was some improvement in medicine administration recording we also found further areas of concern with medicine safety.

The majority of people using the service that we spoke with and people’s visitors told us that there were not enough staff on duty to ensure their needs and preferences were met in a timely way. One person told us; “I have to stay in bed until the staff come to get me up as they have to hoist me in and out of bed. Sometimes it can be as late as 2pm before I get up that means I have to have my meal in my bed.” One person’s visitor told us; “The care is good but there are not enough staff to help my relative. My relative has to wait to be taken to the toilet; this can be a long wait sometimes which is not good. They treat my relative very well so it’s not the care I have concerns with.”

The staff rotas seen demonstrated that sufficient staffing levels were not always maintained to ensure people’s preferences and needs were met in an effective and timely way.

Is the service effective?

When people lose the capacity to make some decisions through illness or disability other people can be authorised to make decisions on their behalf as long as they are in the person's best interests. Records such as a mental capacity and best interest assessments should then be in place to ensure the person’s rights are protected. We found that mental capacity assessments and best interest assessments were not always in place when people lacked capacity.

We saw that call bells were not always in reach for people to use if they needed to call for staff support and although care plans were in place they were not always followed in practice. This meant that people could not be assured that their needs and preferences would be met.

Prior to this visit people’s relatives had raised concerns with us and the local authority regarding the quality of meals served at Aston Court. We found that there had been some improvements to the quality of meals served and new menus were in place and accessible to people using the service. Some people told us that the quality of the meat served was not always good and we discussed this with the area manager who said that this had not been reported back to the supplier to address but confirmed this would be done.

The staff training record and discussions with staff demonstrated that staff were provided with training on an ongoing basis. This meant that staff were provided with essential training to enable them to support people effectively.

Is the service caring?

People using the service and their relatives were in general complimentary about the staff team. People told us; “The staff are very kind and compassionate to me.” And “When staff give me personal care they are gentle with me.” One person told us that some staff were more respectful towards them than others but told us; “If I wasn’t happy I would complain to the staff.”

Is the service responsive?

A range of activities were available to people using the service which ranged from group activities to individual one to one sessions for people.

Due to the staffing levels we observed that staff could not always ensure that people’s requests to participate in activities were met. One person on the day of our visit missed the majority of an exercise class because there was not enough staff available to support them to attend.

Is the service well-led?

Since our last inspection the acting manager who had been in post since April 2014 had left employment and the deputy manager had also left employment. Prior to this the previous registered manager had been in post for less than 12 months and then moved to another Bupa home. This meant that there had been some inconsistency in the management of the home. People’s relatives told us that although meetings had been held with them they had been concerned as they hadn’t been informed about the reasons for this by the senior management team.

At the time of our visit an interim manager was in post but was not on duty on the day of our visit. The senior management team were at Aston Court on the day of our visit and confirmed that they had recently been relocated to oversee the management of Aston Court. This meant there had been changes to the whole management team at Aston Court.

On this inspection a pharmacist inspector looked at the arrangements in place for the management of medicines and only assessed whether the service was safe in this regard.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The management team told us about the improvements that had been made to medicine safety following concerns raised by the Clinical Commissioning Group (CCG) Medicine Management Care Homes Team. The improvements included better medicine storage arrangements, medicine training for nurses and increased checks on medicine administration records. We also spoke with one person about their medicines. They told us ‘’I am quite happy looking after my medicine. This is a five star service’’. However, despite these improvements we found similar medicine safety concerns as the CCG. We therefore informed the management team that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines. We were told that all issues identified by the inspection would be investigated and action taken.

Our visit to Aston Court was an unannounced, scheduled inspection. This meant that the home were not aware that we were going to visit. We met with the acting manager, three members of staff, seven people who lived at the home and one visiting relative.

A safeguarding matter was still under investigation at the time of our visit. Systems had been put in place to protect staff and those that live at the home until the outcome of the investigation is available.

Care plans contained detailed information to enable staff to provide care and support to people living at the home. A varied activities programme helped to ensure people's social and leisure needs were met.

Meals were well presented and offered a choice. People told us that there had been improvements in the food recently. The acting manager had introduced systems to ensure that the quality of the meals met people's expectations.

The home had been refurbished and provided a pleasant, homely environment which was well maintained.

Staff received training in order for them to provide care and support to meet the individual needs of people living at the home. Staff told us that they felt well supported and said that the acting manager was approachable.

Complaints received were investigated and responded to in a timely manner. New systems were put in place where deficiencies were identified. Records were kept of all complaints received. People were made aware of the procedure for making a complaint.

We saw that people were given a choice of food and we were told that there was a choice of two or three meals each day. People told us that they could choose where to spend their day and what time to get out of bed in the morning and retire to bed at night. People spoken with did not raise any concerns regarding the choices available to them in their daily life.

We looked at three care files and saw detailed information recorded about people's needs and abilities and any equipment and or staff assistance that was needed to be able to meet those needs. People told us, "I know I could make changes to my care if I wanted to." "Staff always call the doctor if she is unwell." "Everything is generally OK, I will settle for spending the rest of my days here." People we spoke with looked well cared for and were dressed appropriately for the time of year.

People told us that staff gave them their medication at the same time each day.We were told that medication audits had recently been undertaken and that staff had received medication administration training.

People we spoke with did not raise any concerns but some suggestions for improvements were made such as staff making their beds every day and improvements to the quality of the food served. We were told that people could occasionally be left waiting to receive assistance but that generally staff were kind and helpful. People told us that they would raise any complaints with staff.

We spoke with several of the people who used the service. Some people were unable to speak with us due to frailty. We spoke with the registered manager, four nurses and three care staff.

We spent time sitting in the communal areas observing how staff and people got on with one another. We saw that many people stayed in their own rooms for most of the day this being their personal preference, or their ill health and frailty.

We spoke with staff about the care, support and treatment they provided to people each day. We looked at a selection of care plans and records and found that the information held within them was an accurate reflection of the care people needed.

People who used the service were protected from the risk of abuse or harm. Staff we spoke with were sure of the procedures for dealing with any concerns or suspicions of abuse.

There was enough qualified, skilled and experienced staff to meet people’s needs.

As part of our ongoing monitoring of services we use information passed to us from other professional bodies. Before our visit to Aston Court we had been told by Staffordshire County Council that a safeguarding alert had been raised with them. Safeguarding alerts are raised when concerns are identified in the home. Because of the information we had received we decided to do a responsive review to the service to see how people were being cared for.

The concerns are currently under investigation and will not form part of this review.

We asked people living in the home about the care they received on a daily basis, if they had any concerns, and if when required other health professionals were involved in their care. We asked people if they felt safe and secure.

We spoke with four people who live in the home. Overall people told us they were happy with the service being provided. Comments included:

“Staff treat me with respect; they always ask if they can come in to my room. The food is good. If I have any problems I just tell the staff and they sort it out for me''.

People told us they were offered choices at meal times and that they could choose where they ate their meals.

Comments received included:

“Food is good''.

“I like the food''.

People told us the staff ask how they are each day and make sure they have want they want.

People told us if they needed a doctor then they only had to tell staff that some thing was wrong and a doctor would be called.

People told us they see chiropodists, dentist,doctors, and other health care professionals. They told us family and friends can visit when they want, and are made to feel welcome.

One person told us they go out for a curry with their family regularly.

One person said that they have always had a glass of wine with their meals and they do now.

Peoples told us they felt safe in the home and supported by caring staff.

At the time of our visit to the service on 11 November 2011, there was an investigation by Staffordshire Social Service under the safeguarding procedure following an injury to a person living in the home. At the time of finalising this report, the investigation had not been completed. We may at any time reassess the service pending further information from the investigation.