Aden Court Care Home Also known as 1-142456887

People’s experience of using this service and what we found

People who were more able had a more positive experience than those who had higher dependency needs. People who relied mostly on staff to support them had inconsistencies in their care and support. Risks to individuals and within the service were known by staff, although systems and processes for managing and responding to risks needed to be improved.

Staffing levels were kept under review and a dependency tool was used to assess the numbers of staff needed. People, staff and relatives gave mixed feedback about whether there were enough staff available to meet people’s needs in a timely way. We made a recommendation the provider continues to keep people’s needs under review, along with the deployment of staff within the home, to ensure people’s needs are attended to in a timely way. Recruitment was ongoing to ensure staffing levels were adequate, although checks had not always robustly been completed before staff started working at the service.

Staff did not always follow correct procedures to control the spread of infection with regard to their own symptoms of illness. The home was visibly clean and mostly free from odours. Where more through cleaning was needed, this was identified by the management team and scheduled.

People were mostly supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to make decisions, although at times, some people felt they did not have a choice about whether they came out of their room if they relied on staff to help them.

Care and support not always planned in a way that met people's needs. Care plans were not always person-centred and did not always guide staff on people's current care needs. People’s preferences around end of life care were not recorded. Daily care records were not completed or sufficiently reviewed to show personal care was managed in line with people’s needs and wishes.

Systems to assess, monitor and improve the service were in place but not always effective. Quality checks and audits did not always identify actions or timescales, or result in sufficient improvements where actions were identified. There were systems in place to gather feedback about the service. There was evidence of the service working in partnership with health and social care professionals.

The provider was responsive to the inspection findings and sent information to show they were taking action to address the areas of risk identified at the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 14 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, quality of care and management of the home. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aden Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aden Court 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. Aden Court is registered to provide residential and nursing care for up to 40 people. The home has a reception area, a large dining room, a choice of lounge areas and an activities room. All bedrooms are en-suite. At the time of our inspection there were 37 people living at the home, with 14 people receiving nursing care and 23 people receiving residential care.

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 told us they felt safe living at Aden Court and staff were well-trained and knowledgeable about safeguarding procedures. Measures were in place to help keep people safe in an emergency.

A person had not received the support advice given from a visiting health professional, whilst the health professional confirmed this had not had a detrimental impact on the person, measures were not robust to ensure appropriate action had been taken. People had good access to health professionals and visiting health professionals spoke highly of the service.

Risks to people were individually assessed, reviewed regularly and consideration was given to maintaining people’s independence.

There were sufficient staff to support people and people’s dependency was regularly checked to ensure this.

Medicines were administered safely and best practices were followed. Regular checks took place to ensure this.

Accidents and incidents were monitored and analysed to ensure the home improved and learnt lessons were applicable.

Premises and equipment were well-maintained and regular checks took place in line with legislation.

There was some evidence people were involved in their care planning and some relatives told us they felt involved in their relative’s care.

People’s mental capacity was assessed and staff showed a good understanding of this and in how they promoted people’s choice and independence.

People told us they felt staff were well-trained and staff were positive about the quality of the training they received. Not all staff had received training in line with the provider’s policies however plans were in place for this to be completed by the end of January 2019.

Recruitment processes were robust and new staff completed an induction to ensure they were knowledgeable about the service and the people living at Aden Court.

People were supported to maintain a balanced diet and people and relatives spoke highly about the quality of the food. People’s weight was monitored to ensure they were not a risk of malnutrition.

People were involved in the decoration of the home and bedrooms and communal areas were personalised.

People and relatives told us staff were caring and we observed staff supporting people with compassion, dignity and respect.

Staff were knowledgeable about people, their life history and preferences. People had regular access to a range of group and individual activities which supported their individual needs.

Compliments and complaints were monitored and people felt able to raise concerns with staff and managers.

People, relatives and staff spoke highly of the registered manager. The registered manager told us they felt well-supported by the provider.

People, relatives and staff were regularly consulted, meetings were held and documented, and they were involved in the running of the home.

Aden Court is registered to provide residential and nursing care for up to 40 people. The home has a reception area, a large dining room, a choice of lounge areas and an activities room. All bedrooms are ensuite. At the time of our inspection there were 37 people living at the home, with 14 people receiving nursing care and 23 people receiving residential care.

There was a registered manager in post and this was a different registered manager since the last 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 told us they felt safe living at Aden Court. Appropriate safeguarding policies and procedures were in place, which staff understood, to protect people from abuse.

Risks to people had been assessed and a range of measures were in place to reduced identified risks.

Staff were recruited safely, with appropriate pre-employment checks taking place. Sufficient numbers of staff were deployed to keep people safe, however, some people felt improved quality of care could be provided if additional staff were deployed.

Regular safety checks took place such as those in relation to fire, gas and electrical systems. Plans and evacuation equipment were in place to safely evacuate people in the case of emergencies. Staff had been trained to use evacuation equipment effectively.

Actions had been taken to improve the management of medicines since the previous inspection. Medicines were managed and stored appropriately, although we did identify some missing information in relation to, ‘as required’ medicines on a small number of medication administration records.

People were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible; the policies and systems in the home supported this.

Staff had received training in relation to the Mental Capacity Act 2005 and demonstrated a good understanding of the requirements of the Act. Decision specific mental capacity assessments had been completed for people who lacked capacity to make specific decisions, as required by the Mental Capacity Act 2005.

Care and support staff told us they felt supported. Staff received regular supervision, although this was sometimes to address specific issues, as opposed to a supportive two-way discussion.

Our observations indicated staff treated people with kindness and compassion. People told us staff were caring and we observed people’s privacy and dignity being respected. There was a pleasant atmosphere in the home. People’s cultural and religious needs were considered.

End of life care plans had been developed where appropriate and, where people did not wish to discuss this aspect of care, this was recorded and respected.

Care records were person centred and reviewed regularly. A ‘resident of the day’ system was being introduced, which was not yet fully embedded, to help ensure people were regularly involved in reviewing their care and support. People told us they could make their own choices in relation to their daily lives.

Staff told us they felt supported by the registered manager and people and their relatives spoke positively about the registered manager. Regular audits and quality assurance checks took place. It was evident the home was continuing to improve since the last inspection and the registered manager acknowledged this was ongoing.

The home was last inspected on 05 August 2013. We found it was compliant in all the aspects of care we inspected at that time.

Aden Court is a privately owned home providing nursing and residential care for up to 40 older people. It is situated in the Moldgreen area of Huddersfield. At the time of our inspection the home was fully occupied, with 17 people receiving nursing care and 23 people receiving residential care.

The ground floor of the home has a reception area, a large dining room, a choice of lounge areas and an activities room. All bedrooms are ensuite; some are located on the ground floor with the rest on other floors. There is a lift for access.

The home 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.

Most medicines were managed properly and we saw their administration was person-centred. However, we found there were a lack of protocols for ‘as required’ medicines, the administration of topical creams was not recorded and the temperature of the clinic room where medicines were stored had frequently been above 25°C in recent months.

Risk to people was not always assessed and managed appropriately. Issues arose as care plans had not been updated when people’s circumstances or health had changed. One person had become trapped in their bedrails; the home’s response in terms of minimising the risk of this happening again was not documented.

People told us they could not always use the toilet when they needed to due to a shortage of care staff. Relatives and care staff also thought the home was understaffed and the rota showed this had been the case in recent weeks. The registered manager was in the process of recruiting more care workers to address this issue.

We noted people’s access to baths and showers was structured and not person-centred. Care staff did not always close people’s bedroom doors when providing personal care because they said they could not hear call buzzers.

We found issues with record-keeping and incident follow up at the home which had not been identified by audit and monitoring.

We found breaches of regulation during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

The recruitment for new care staff at the home was robust and staff had received training in safeguarding and could demonstrate a good knowledge of the subject. However, no documentation was available to show a regular volunteer had been checked to ensure they were suitable to work with vulnerable people.

Staff received the training they needed to meet people’s needs. Supervision records showed sessions focused on addressing issues and problems rather than providing the staff member with support. Annual appraisals were thorough and records were detailed.

Care workers’ knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) was appropriate for their roles. Applications for DoLS authorisations had been submitted to the local authority for people who needed them; however, no assessments of people’s capacity to make other decisions had been made.

People said they enjoyed the food at Aden Court. We saw they were provided with a choice each mealtime and had access to drinks and snacks in between meals. We found issues with the level of detail in records care staff kept for people at risk of weight loss.

Care files showed some people and their relatives had been involved in planning their care. Other care plans had been signed by relatives only, and the involvement of the person was not clear. The home was about to implement a ‘resident of the day’ system whereby each person had a set day of the month where they and their relatives would be invited to assist care staff to review and update their care plans.

Care staff could recognise when people needed advocacy services and knew how to make referrals when they needed to. At the time of the inspection the provider was investigating a serious complaint about end of life care at the home. We spoke with people, their relatives, the staff at the home and checked people’s future wishes care plans. Whilst end of life care training for staff was lacking, appropriate care plans were in place and feedback from relatives whose family members had received end of life care at the home was positive.

People’s care files contained risk assessments and care plans for a range of care aspects. Of the four files we inspected in detail, three contained care plans which had been reviewed and evaluated regularly. One other care plan had not been reviewed for over three months because the named nurse responsible had been absent from work and another nurse had not been allocated to cover. Daily records did not always evidence people had been supported according to their care plans.

We saw the home was clean. Regular safety checks had been completed on the building, facilities and equipment used to support people. Contingency plans were in place for fires, floods or other emergencies and people had personalised plans which emergency workers could use to help them evacuate, if required.

People had access to a range of healthcare professionals to help them maintain their holistic health. Healthcare professionals we spoke with who helped support people living at the home gave us positive feedback about the home’s staff and the care they provided.

People told us they were treated with dignity and respect by the staff. Staff knew people well as individuals and could describe their likes, dislikes and preferences.

People enjoyed the range of activities on offer at Aden Court; this included those nursed in bed. Relatives were encouraged to take an active role within the home and told us they were always made to feel welcome. We found the atmosphere at the home was warm and friendly as a result.

None of the people or relatives we spoke with told us they had ever made a formal complaint. Those who had either raised concerns or given feedback said it was acted upon quickly. All those we spoke with said they would feel comfortable raising any issues with the registered manager or other staff at the home. People and their relatives were asked to feedback about the service so improvements could be made.

People's diversity, values and human rights were respected. We observed staff speaking to people in a kind and respectful manner as they responded to their needs and wishes.

Before people received any care or treatment they were asked for either, their verbal or written consent and the staff acted in accordance with their wishes.

All staff observed interacted with residents in a positive way. Visitors told us they felt welcome in the communal lounge where they sat with relatives.

We saw that staff were caring, sensitive to people’s needs and responded to those needs in a timely manner.

Comments from individual people who used the service included:

“The staff are lovely, the manager is very nice to us. It’s like being part of a family.” Another person said, “It does get lonely sometimes but they always come and encourage me to take part in things.”