This was an unannounced comprehensive inspection that took place on 23 November 2016. At the last inspection completed on 2 December 2014, we found the provider had not met the regulations for ensuring that staffing levels were sufficient to meet people's needs in a timely manner. These matters were a breach of Regulation 22 of the Health & Social Care Act 2008 Regulated Activities Regulations 2008 which now relates to Regulation 18 of the Health & Social Care Act 2008 Regulated Activities Regulations 2014. At this inspection we found the provider had made the required improvements and the regulations were being met.

The service provided residential and nursing care for up to 60 adults most of who were aged 65 years and over. At the time of our inspection there were 55 people using the service 38 of whom required nursing care.

The service had 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.

There were enough staff on duty to meet people’s needs. People told us that staff responded promptly when they requested support from them. Since our last inspection, the registered manager had introduced some additional staffing arrangements to ensure people’s needs were met. We saw that staff were deployed effectively to meet people’s needs in a timely manner. We also noted that the provider had safe recruitment practices which assured them that staff were safe to support people before they commenced their employment with the service.

People were supported to have their medicines. This included where people were independent with taking their own medicines or where they received their medicines covertly. Medicines were only administered by staff who were suitably trained and assessed to complete this task. Medicines were mostly stored safely. However, we saw that staff did not always follow current guidance to date when they opened certain medicines. This is good practice to ensure that medicines and prescribed cream are used within safe timescales. We did not see that this had had an adverse effect on the support that people received to have these medicines.

People had care plans which we found variable in the detail of information that they contained. People’s records did not always reflect the support they received. However, we saw that staff were knowledgeable about people’s preference and provided the support that people required. We also saw that there was a low turnover of staff and that agency staff were not used in the service. This meant the staff on duty knew the people they were supporting.

People felt safe living at Aylesham Court Care Home. They told us that they felt safe when in the company of other people that used the service and with staff. They were supported by staff who knew their responsibilities to keep people safe from avoidable harm and abuse. Staff assessed risks associated with the provision of people’s care and support and provided any required support in a safe and non-restrictive manner.

Staff had the skills and experience to support people effectively. They had access to an induction when they started their role and had regular training as required. Nurses were supported to remain competent and maintain their qualifications.

The staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this. Staff supported people according to the conditions of the DoLS.

People received the support that they required to meet their nutritional needs. This includ

This inspection took place on 2 December 2014 and was unannounced.

Aylesham Court Nursing and Residential Care Home is a care home that provides residential and nursing care for up to 60 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. There were 46 people living at the home when we visited.

At the last inspection on 27 June 2014, we asked the provider to make improvements to the management of medicines, management of risks, provide an environment that was safe and secure, and improve the systems to effectively assess and monitor the quality of care provided. The provider sent us an action plan outlining how they would make improvements. During this inspection we found that the provider had made improvements in all of the identified areas.

A registered manager was 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.

Since the last inspection in June 2014 a number of concerns had been brought to our attention with regards to the health, safety and wellbeing of people who used the service. The local authority’s safeguarding team were continuing their investigations into concerns about the quality of care provided. The provider was working with the local authority to ensure that people’s needs were met and improvements were sustained.

People we spoke with told us that their care needs and support were provided safely. However, the staffing levels did not always ensure people’s care needs could be met safely and in a timely manner because there were not enough staff available.

People’s needs and associated risks in relation to their care and support needs had been assessed and plans of care detailed the support required.

People were supported by staff that had been checked as to their suitability to work with people and nurses were registered with the relevant professional body. Staff had undergone training relevant to their job role and their competency assessed in relation to meeting the needs of people in their care.

People told us they felt safe and protected from harm and abuse. People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. Staff had a good understanding of what abuse was and their role in reporting concerns.

People lived in an environment that was comfortable and promoted their safety and wellbeing. The provider had taken steps to ensure each room had suitable secure storage and locks were fitted to bedroom doors to promote people’s privacy. All areas of the home including the outdoor space were made safe and accessible.

Medicines were managed safely and steps had been taken to ensure the storage, ordering and receiving of medicines into the home and administration of medicines were safe.

People’s assessments and plans of care had been reviewed regularly, which provided staff with guidance as to the needs of people and their role in delivering the appropriate care and support. Staff had a good understanding of how people wished to be supported even though individual preferences were not recorded in people’s plans of care.

People told us they enjoyed their meals which were nutritionally balanced and met their dietary needs. Drinks and snacks including fresh fruits were readily available. Staff monitored people’s health and wellbeing and were referred to relevant health care professionals when there were any concerns about their health. People had access to health care support in order to meet their health needs.

Staff had undertaken training in promoting people’s dignity and rights. We observed staff treating people with care and compassion throughout our inspection visit.

The management team and staff knew how to protect people under the Mental Capacity Act, 2005 and the Deprivation of Liberty Safeguard and were complying with the conditions authorised. Records showed that people made decisions on occasions about their care and support needs. Although a person’s family or their representatives and other healthcare professionals had been consulted with regards to any best interest decisions those discussions were not always recorded clearly.

People were supported to take part in hobbies and activities that were of interest to them, which helped to protect people from social isolation. Staff had a good understanding of people’s individual interests and offered a choice of activities that they enjoyed.

People were encouraged to develop and share their experience of the service at meetings to review their care needs, ‘resident’s meetings’ and through satisfaction surveys. The provider’s complaints procedure was accessible to people who used the service, relatives and other visitors to the home. Advocacy services were available to people if they needed support to make comment or a complaint. The provider took action in response to concerns and individual issues raised about any aspects of the care delivered.

The registered manager understood their responsibilities and demonstrated a commitment and clear leadership to continually improve the service. The registered manager was supported by the deputy manager and senior staff. They had an ‘open door’ policy and welcomed feedback from people who used the service, relatives of people who used service, health and social care professionals and staff. The registered manager works with the commissioners such as the local authority that monitors the service for people they fund to ensure people received care that was appropriate and safe.

Staff knew they could make comments or raise concerns about the way the service was run with the management team and knew it would be acted on. There was a clear management structure and procedures in place to ensure concerns were addressed. Staff received support and training for their job roles to ensure their knowledge, skills and practice in the delivery of care was in line with best practice.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment, which was well maintained and safe. Monitoring systems were in place to check the quality and safety of the service provided and action was taken to address any deficiencies found and was monitored to ensure the steps taken were effective. The provider’s internal inspections helped to ensure them that people received quality care.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to inadequate staffing. You can see what action we told the provider to take at the back of the full version of this report.

We recently undertook an inspection visit to Aylesham Court Nursing and Residential Home. We spoke with 23 people who used the service and reviewed four people’s care records. We spoke with seven relatives. We spoke with five staff supporting people, the manager and the deputy manager. We also reviewed the records in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

People we spoke with had different experiences of feeling safe. Whilst some people felt safe because their needs were met others told us that staff did not always to respond in a timely manner. This meant that they were not always safe and at risk of injury or their dignity was compromised.

People could not always be assured that they received their medicines at the right time and as prescribed. A relative said “The medication patch came off. They later arranged it to be placed on her back after we had raised a concern.” The arrangement for receiving medicines into the home and storage was not always safe, and the medication administration records were not always completed accurately.

Staff we spoke with showed a good understanding of each person’s needs and described how they supported people. Care plans and risk assessments were not personalised, lacked information about people’s health conditions that could affect how the care and treatment was provided.

People were cared for in an environment that was decorated to create a homely ambience, maintained and was generally safe. The communal lounges, dining room and a conservatory were furnished to a good standard that created a comfortable place to live. The bedrooms had en-suite facility. However, there were no locks on bedroom doors to promote people’s privacy. Some areas of the home needed to be kept secure were left unlocked that meant people were not fully protected from risk of harm or injury.

We, the Care Quality Commission, monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had proper policies and procedures in place and staff understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Records showed that the provider had not assured themselves that the correct procedures were used when decisions were made about people’s care.

Is the service effective?

People’s experience of the care provided varied. Some people told us that staff helped them with their daily care needs but would have to wait if staff were busy. People who used the service and their relatives were not always provided with a copy of the care plan to make sure their needs and preferences were recorded to help staff to support people appropriately.

Care records we looked at were not personalised to ensure people’s needs were met. Qualified nurses completed the care plans and daily records to show that care was provided even though it was the care staff who supported people with their personal care tasks. This meant people’s care needs and general wellbeing could not be effectively monitored.

Is the service caring?

People told us that most staff were caring and helpful. One person said “They are really good and caring, on her birthday we had a private room to celebrate her birthday – that was really nice.”

Throughout our inspection visit we saw staff were caring and treated people with respect. Staff had a good understanding of people’s needs and showed genuine care for the people they looked after.

Is this service responsive?

People told us that staff did not always respond to their needs promptly. One person said, “I’m just waiting for the carer to come and help me. Lunch is already being served so I’m a bit late.” Other comments received showed that people regularly had to wait to be assisted to use the toilet. Risks to people following an incident were not always reviewed to help ensure that the measures in place remain appropriate.

Is this service well led?

People who used the service and their relatives were supported to make comments and share their views about the service. The complaints policy and procedure was used effectively for the benefit of people living at the home. People knew how to make a complaint but they found that steps were not always taken prevent things from happening again.

People’s personal care records and other records kept in the home were not personalised and lacked sufficient detail to help ensure staff knew how best to support people safely. People‘s care needs were reviewed regularly to make sure any new needs could be met reliably but this did not always involve the person or their representatives.

Information from incidents and accidents had been analysed and used to identify changes and improvements. There were systems in place for regular checks to be carried out that ensured the health and safety of everyone was protected. However, improvements were not always sustained as a result of some audits. For instance the medication audits still showed that there were missing signatures on the medication administration records.

The provider and manager should assure themselves and others that appropriate steps have been taken to prevent the potential risk of harm or injury to people who used the service, staff and others.

We spoke with 11 people who used the service and eight members of staff. We also reviewed seven care records.

During this visit we reviewed seven care records. All the records had been recently reviewed and every record demonstrated clearly that the care had been discussed with the person using the service or their representative. We also noted that discussions with family members were documented within the care records.

We saw evidence that all care records had been extensively and comprehensively reviewed since our last visit. We asked for and received the corresponding daily records and monitoring checks. We found them to show that people’s needs were assessed and care and treatment was delivered in accordance with their care plan.

We observed the lunchtime meal in three dining rooms. The tables were nicely laid and the menu was on the table. We also saw good staff interaction with people.

People indicted to us that there had been an improvement in the number and consistency of staff since our last visit. One person told us: “There used to be a lot of agency staff working here. Nobody had any time to talk to us. It has changed recently and is getting much better.”

We spoke with eight people who used the service, one carer and six members of staff. We also reviewed five care records.

All the people we spoke with told us they were happy with the care they received but were unable to recall whether they had consented to their care plan. One person told us: “The staff offer me choices and I can agree or not but I have never signed anything”.

We observed the people who used the service appeared in good health, were well presented and were cared for in a clean and pleasant environment. All the people we spoke with told us they felt well cared for.

All the equipment we saw was clean and in good condition. One person who used the service told us:” My wheelchair is always clean. The maintenance is very good and all repairs are undertaken very quickly”.

One qualified member of staff told us:” I feel the number of staff employed is adequate but we sometimes lack enough experienced senior staff to deal with the level of care required for some people. Another member of staff agreed and told us:” There are staff who are new and inexperienced. It is not unsafe but can be hard work because I can not always delegate care to staff because of their inexperience”.

One person told us “I have not needed to complain. The new manager has already told us if we have any issues at all we should feel free to raise them immediately with them”.

We spoke to 9 people who use the service, 6 members of staff, 2 relatives, 3 staff files and we reviewed 5 care records.

People told us they were happy and felt safe. One person told us “I am one very satisfied customer.” Another person told us “I said I was bored and they came up with painting by numbers for me”. However another person told us “The care here is good but I am young and get very bored here, I do have hand massages.”

The staff we spoke with told us that they were well supported and that “Bupa is very good at developing staff”. We saw signed training records and reviewed the training matrix for 2012. The training matrix detailed a robust system for ensuring training was undertaken. The staff told us that the management were very approachable.

Two people told us that “I often have to wait a while before they respond to call bells at night”. We saw that steps were being taken and staff had recently been recruited and consideration had been given to introducing another shift to cover evenings between 4pm and 10pm.

We saw an extensive audit and checking programme to ensure the quality of service provision was monitored.

We were unable to speak to the people we ‘pathway tracked’ during our visit. People we ‘pathway tracked’ appeared content and comfortable.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

We spoke with ten people who used the service, two visitors to the service, five members of staff and three visiting health care professionals. We also reviewed six care records and three staff files. We spent time in two communal areas observing care being provided to people and observed a lunch time meal in the upstairs dining room.

We observed some good interaction between staff and the people using the service. For example, we saw evidence of choices being given to people and verbal consent gained before carrying out care. However, people’s legal rights were not upheld where they lacked the capacity to consent to their care and treatment.

All the people we spoke with told us they felt well cared for. One person told us: “I like it here, it’s a lovely place. The care workers are lovely”. Another person told us: “I’ve been to lots of homes and this is the best by far”. We also had a conversation with the relatives of a person who used the service and asked them their views in relation to the care their relative received. They spoke very highly regarding the quality of care and felt their relative always looked well care for.

We found that the service had assessed people’s needs and planned care to meet those needs. However, records did not assure us that people had always received the care they required. We also observed people being transferred from their armchairs to wheelchairs in an unsafe manner. We raised this with the management immediately.

People were given a choice about their meals and kitchen staff took account of people’s dietary needs and requirements. Although people’s nutritional needs had been identified, records did not assure us that people’s nutritional needs had always been met.

The service had appropriate arrangements in place to ensure that people were protected from the risk of abuse and staff were aware of their responsibilities in this area.

People we talked with spoke highly of the staff team and we saw many occasions where interactions with staff were positive and warm. However, we found that the service did not have enough suitably qualified, experienced and skilled staff to meet people’s needs at all times.

Staff had been supported through the use of supervisions and there was a programme of training in place for each staff member at the service.

The service had a new management team that had been in place from July 2013, who had already identified a number of concerns with the service. We saw evidence that the service was taking action to address the issues and was prioritising accordingly. However, at the time of our inspection the service had not made sufficient improvements to be compliant with all the regulations we inspected.