The inspection of Aston Manor took place on 21 and 25 June 2018. We previously inspected Aston Manor in April 2017, at that time we identified multiple breaches of regulation. As a result, the home was rated as 'Inadequate' overall and placed in Special Measures. We also took enforcement action to cancel the registration of the registered manager and vary a condition of the provider's registration. We kept Aston Manor under review and inspected the service again in August 2017. We identified continuing breaches of regulation. As a result, the homes overall rating remained unchanged; 'Inadequate' and the home remained in Special Measures. We therefore, took further action in line with our enforcement procedures to prevent the registered manager and registered provider from operating this service. A further inspection in March 2018, identified improvements had been made therefore the home came out of Special Measures. However, we found the service was still breaching regulations related to person centred care, dignity, staffing and governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Aston Manor is a care home. 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. Aston Manor is registered to provide nursing and residential care for up to 32 people, at the time of this inspection there were 26 people living at the home. The home provides communal areas to the ground and first floor as well as single en-suite bedrooms.

The service had 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.

During this inspection, we identified that the service was breaching regulations related with person centred care, dignity and respect, consent, safe care and treatment and good governance.

We found staff recruitment was safe. Not all staff training was up to date however, we saw a number of training dates had been booked for the coming weeks. Staff received management supervision. We observed there was sufficient staff on duty to meet people’s needs although we noted people’s needs were not always met in a timely manner at mealtimes

The atmosphere at breakfast and lunch was calm, people received support and were enabled to make choices about where they sat and what they wanted to eat and drink. We saw examples of good practice but we also saw examples of where staff needed to improve their engagement with people. This was particularly evident where people’s ability to verbally communicate was compromised. We saw staff showed people two plated up meals so they could choose which they wished to eat but we did not see any other alternative form of communication being used. This meant people were not always supported to have maximum choice and control of their lives.

We found people who had recently been admitted to the home did not have risk assessments, care plans or capacity assessments in place.

Relatives told us their family member was safe, staff were aware of how to raise any safeguarding concerns. Medicines were stored and administered safely.

The home was clean and odour free. Some improvements had been made to the lounge and dining room. We identified areas where improvements were needed to fire safety.

We saw evidence staff spent time with people but the provision of meaningful activities for people remained inconsistent and records were not always accurate. There was little evidence that life his

The inspection of Aston Manor took place on 26 and 29 March 2018.

Aston Manor was last inspected in April 2017, at that time we identified multiple breaches of regulation. As a result, the home was rated as 'Inadequate' overall, as it was deemed to be 'Inadequate' in the key questions of Safe, Effective and Well-led, and 'Requires Improvement' in the key questions of Caring and Responsive. The home was placed in Special Measures on 6 July 2017. We also took enforcement action to cancel the registration of the registered manager and vary a condition of the provider’s registration.

We kept Aston Manor under review and inspected the service again in August 2017. We identified continuing breaches of regulation. As a result, the homes overall rating remained unchanged; 'Inadequate', as it was deemed to be 'Inadequate' in the key questions of Safe, Effective, Responsive and Well-led, and 'Requires Improvement' in the key question of Caring. The home remained in Special Measures. We therefore, took further action in line with our enforcement procedures to prevent the registered manager and registered provider from operating this service.

The inspection on 26 and 29 March 2018 was to see if any improvements had been made to the quality of care people received. During this inspection, we identified the service was breaching regulations related to person centred care, dignity, staffing and governance.

Aston Manor is a care home. 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. Aston Manor is registered to provide nursing and residential care for up to 32 people, at the time of this inspection there were 24 people living at the home. The home provides communal areas to the ground and first floor as well as single en-suite bedrooms..

The service had 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.

Risks to people were assessed although further work was needed to ensure they provided sufficient detail and were updated to ensure they were reflective of peoples current support needs. Accidents and incidents were recorded and analysed but the system in use did not enable the registered manager to easily identify patterns occurring over a period of months.

There was a system in place to ensure the premises and equipment were safe to use. Previous concerns regarding cold water temperatures and personal emergency evacuation plans had been addressed. Staff had received fire training but had not practised a simulated fire drill or been trained in how to use evacuation sledges.

There were no concerns raised regarding staffing levels at the home. There was no system in place to regularly check the professional qualifications of nursing staff employed at Aston Manor and personnel records did not always evidence the rationale for gaps in candidates employment history.

People’s medicines were stored and administered safely; improvements had been made to the management of creams. Where medicines were prescribed 'when required' all but one of the medicines we reviewed contained a protocol to reduce the risk of unsafe or inconsistent administration.

Relatives told us they felt their family member was safe and staff were clear about the types of abuse and their responsibilities in reporting any concerns.

New employees received induction when they commenced work at Aston Manor. Training involved both e-learning and face to face training. The training matrix evidenced not all staff had completed all the required training and records of staff supervis

We inspected Aston Manor on 30 and 31 August and 8 September 2017. The first day of inspection was unannounced. This meant the home did not know we were coming.

Aston Manor is a care home registered to provide nursing and residential care for up to 32 people. It consists of one building with two floors, although the upper floor has a split level. All bedrooms are single with ensuite facilities. At the time of this inspection there were 24 people living at the home.

On the ground floor there is a communal lounge and separate dining room. On the upper floor there is a communal lounge with dining area. Both floors have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

Aston Manor was last inspected in April 2017. At that time we identified multiple breaches of regulation. As a result, the home was rated as ‘Inadequate’ overall, as it was deemed to be ‘Inadequate’ in the key questions of Safe, Effective and Well-led, and ‘Requires Improvement’ in the key questions of Caring and Responsive. This inspection found some improvement had been made at the home but it was not sufficient to change the overall rating from the last inspection. The home is therefore still inadequate and remains in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Feedback from people and their relatives about safety at the home was mixed. People were seen using labelled walking frames, an improvement from the last inspection, but risk assessments and care plans had not been updated for people supported to transfer by staff using handling belts.

Most aspects of the building and its facilities, utilities and equipment were safe. However, personal emergency evacuation plans had not been updated for several months and a risk assessment of the water system in July 2017 concluded people were at risk of Legionella and effective action had not yet been taken.

People’s moving and handling risk assessments and care plans lacked the detail staff would need to support them safely to mobilise, and to bathe and shower. One person with swallowing problems had no choking risk assessment in place. Care plans to manage risk to people’s skin integrity were not clear. These were all issues raised at the last inspection.

Most medicines were managed and administered safely. However, medicine administration records for people’s topical creams were not always completed; some care plans for ‘when required’ medicines were missing or lacked pe

We inspected Aston Manor on 10, 13 and 19 April 2017. The first day of inspection was unannounced. This meant the home did not know we were coming.

Aston Manor is a care home registered to provide nursing and residential care for up to 32 people. It consists of one building with two floors, although the upper floor has a split level. All bedrooms are single with ensuite facilities.

On the ground floors there is a communal lounge and separate dining room. On the upper floor there is a communal lounge with dining area. Both floors also have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

At the time of this inspection there were 24 people living at the home; one person was in hospital.

Aston Manor was last inspected in July 2016. At that time it was rated as ‘Requires Improvement’ overall. It was deemed to be ‘Requires Improvement’ in the domains of Safe, Effective, Responsive and Well-led, and ‘Good’ in the domain of Caring. A warning notice for a breach of regulation relating to good governance from the previous inspection was re-issued. We asked the registered provider to send us an action plan to tell us how they were going to tackle breaches of regulation relating to safe care and treatment, safeguarding service users, receiving and acting on complaints and staffing. At this inspection we found on-going and multiple breaches of the regulations in relation to safe care and treatment, staffing, safeguarding service users and good governance and further breaches in relation to consent and dignity. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Not all incidents of abuse involving people living at Aston Manor had been reported to the local authority safeguarding team and to CQC, as is required.

One person was using mobility equipment they had not been assessed for. Care staff

The inspection of Aston Manor took place on 14 and 21 July 2016 and was unannounced. The previous inspection, which had taken place during November 2015, had found the service was in breach of specific regulations. We had issued warning notices to the registered provider and registered manager which meant they were required to take immediate action with regard to assessing and mitigating risks, detecting and preventing the spread of infection and assessing, monitoring and improving service provision. We had issued requirement notices and received action plans from the registered manager and registered provider to show how they would address other breaches we found with regard to providing person centred care, treating people with dignity and respect, staffing and meeting nutritional needs.

This inspection found improvements had been made in each of these areas. However, there were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, good governance and staffing. New breaches of the regulations were found in relation to safeguarding and the management of complaints.

Aston Manor is a nursing home, registered to provide care for up to a maximum of 32 older people. The home has two floors and provides care and support for people with nursing and residential needs, including people who are living with dementia. There were 27 people living at the home at the time of this inspection.

The service had a registered manager in post 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 registered manager and staff were aware of relevant procedures to help keep people safe and were aware of signs that may indicated someone was at risk of abuse of harm. However, on the day of the inspection, we identified a safeguarding concern that had not been reported and investigated. Not all staff had received up to date safeguarding training.

Risks to people had been assessed and risk reduction measures had been considered.

People were weighed regularly and appropriate referrals were made to healthcare professionals regarding diet and nutrition when necessary. People received appropriate support in order have their nutrition and hydration needs met.

Some moving and handling equipment was used for people whom had not been specifically assessed for the equipment.

The number of staff identified as being required were not always deployed. There was an instance of a nurse working a 24 hour shift.

Medicines were administered safely by staff who had received appropriate training to do so.

Improved practices were observed in relation to cleaning and the prevention and control of risks associated with spread of infection.

Staff had received induction to prepare them for their role, which included shadowing more experienced members of staff. Staff received regular supervision and told us they felt supported in their roles. However, not all staff training was up to date.

Where people lacked capacity and were deprived of their liberty, the registered manager had made appropriate applications to the supervisory body in order for this to be authorised. However, the registered manager did not always act in accordance with the Mental Capacity Act 2005. Decision specific mental capacity assessments had not always been completed when decisions were made in people’s best interests.

People were given choices throughout the day and we saw staff sought consent from people prior to providing care and support.

People’s rooms were clean and personalised. Pictorial signage was used throughout the home, to assist people to navigate around the home.

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The inspection ofAston Manor took place on 21 October 2014 and was unannounced.

Before this visit we had received information about people’s nutritional needs not being met, excessive build-up of domestic waste outside the service and flies in the building, contaminating food and settling on service users.

AstonManor is a nursing home currently providing care for up to a maximum of 32 older people. The service has two floors and provides care and support for people with nursing and residential needs including people who are living with dementia. The registered provider forAston Manor changed on 10 October 2014. The new provider was present on the day of our inspection.

The service did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

When we arrived at the service we saw an excessive build-up of domestic waste outside the building. We contacted the service two days after our visit and were assured the waste had all been removed.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us there had been no reduction in the nurses or care staff since the new provider had taken over the operation of the service.

On the day of the inspection we saw the food at lunchtime was appetising and served appropriate to people’s needs. We raised concern on the day of our visit that people were not being offered adequate drinks.

We checked the kitchen storage and saw the service had adequate stocks of food. The administrator told us a system was now in place to ensure the service had adequate supplies of food.

We observed staff were caring in their approach to people who used the service. We also observed staff speaking to people in a discreet and dignified manner. However, people’s needs were not always met promptly.

The support manager told us they had plans in place to arrange to meet with people who used the service and their families.

We saw people’s care plans and risk assessments were person centred and had been reviewed and updated by staff on a regular basis.

People were aware of how to raise a complaint about the service.

The support manager told us they had begun to look at documentation used by the service and had plans in place to allocate areas of responsibility to key members of staff.

We carried out this inspection on 4 and 6 November 2015. The inspection was unannounced.

Aston Manor is a nursing home currently providing care for up to a maximum of 32 older people. The service has two floors and provides care and support for people with nursing and residential needs including people who are living with dementia. On the day of our visit there were 31 people living at the home.

The service had a registered manager in post 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.

Staff were confident to report safeguarding concerns, although not all staff had a clear understanding of the safeguarding procedures to follow other than reporting to the manager.

Medications took a long time to administer and as a result, people were at risk of not receiving their medication on time. There were unclear practises regarding giving people medicines covertly.

Staff were not deployed effectively or with the right skills to meet people’s needs. One to one support for some people was not managed or reviewed to meet the needs of individuals.

Risk assessments and care plans were not adequate or detailed enough to ensure people’s safety or for staff to provide individual care.

Cleaning procedures were not always effective and there were strong offensive odours within parts of the home.

The registered manager was aware of the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

People reported they enjoyed the food, although we found mealtimes were not organised well and people’s weight loss was not managed effectively. People with diabetes did not receive sufficient support for their dietary needs.

People had little access to meaningful activities. Some resources were available but these were not always relevant to people’s interests.

Complaints were recorded and responded to and people knew how to complain if they wished to.

Some processes were in place for auditing the quality of service provision but these were not always robust.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the location will be inspected again within six months.

You can see what action we told the provider to take at the back of the full version of the report.