Aria Court

We found the following examples of good practice.

The provider followed good infection control practices. Staff were required to have their temperatures checked at the start of each shift, wash their hands and were part of a regular testing programme.

Visitors were required to take a Lateral Flow Test (LFT) this gives a quick COVID-19 result. Service users were given the choice if they wanted to see a visitor or not. Personal protection equipment (PPE) is provided by the provider for staff and visitors.

At the time of our inspection several service users were coming to the end of their isolation, clear signage identified areas where people may have COVID. All people showing signs or who had had a positive result were supported by staff who wore full PPE, this is called barrier nursing. This is to protect both staff and people who lived at the service. There were clinical bins for the disposal of PPE equipment in people’s rooms.

The home had four separate areas for people, called communities and this supported zoning. Staff were cohorted to the different communities, this showed good infection control practice and limited staff movement within the home. Staff rotas had been changed to ensure staff took staggered breaks and social distancing was supported through the home where possible.

All staff received training in infection control and how to put on and remove their PPE. There were two infection control champions who ensured best practice was followed and updates communicated. The registered manager completed visual checks and all staff had competency assessments on the use of PPE and infection control.

The building looked clean and free from clutter. Appropriate cleaning products were used, to ensure good infection control was maintained. All high touch points were cleaned regularly for example, door handles and handrails. The registered manager ensured regular infection control audit checks were completed this included staff practice and use of PPE.

The manager told us that they were working collaboratively with colleagues from the Local Authority and CCG (Clinical Commissioning Group) and received good support and advice. They were also very proud of how the team worked and supported each other and service users.

Aria Court provides, accommodation, nursing and personal care for up to 92 adults; some of whom have dementia. It is also registered to provide the regulated activity; treatment, disease, disorder and injury. At the time of this inspection there were 84 people living in four areas of the service, called communities, each of which had separate adapted facilities and communal areas for people and their visitors to use. The communities were Nene, Eastwood, Heron and Wendreda.

At the last inspection on 26 September 2017, the service was rated 'requires improvement' as three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. These breaches were, a lack of activities to promote people’s social inclusion and stimulation. People’s dignity was not always maintained by staff and there were insufficient suitably qualified and competent staff in place to meet people’s needs. Following the last inspection, we asked the provider to complete an action plan to show what they would do by 31 January and 31 March 2018 to improve the key questions is the service safe, is the service caring, is the service responsive and is the service well-led? At this inspection, we found the service had made improvements under the questions is the service caring, responsive and well-led? However, the service needed to make further improvements for the questions of, is the service safe? The service is now rated as good.

Aria 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.

There was a registered manager 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 medication was not managed safely as accurate records documenting people’s medication administration and medication stock tallies were not always correct due to poor record keeping by staff.

Since the last inspection improvements in activities were now in place to support people’s interests and well-being. However, there were missed opportunities for two staff to engage with the people they were supporting.

Staff had been recruited safely prior to working at the service. Improvements since the last inspection showed that a sufficient number of staff were deployed in a way which met people's needs in a timely manner. People received an effective service that met their assessed needs by staff who had been trained to have the skills they needed. Actions were taken to learn any lessons when things did not always go as planned.

Improvements had been made since the last inspection. People’s privacy was promoted and maintained by staff and people’s dignity was supported by staff assisting them. People received a caring service as their needs were met in a considerate manner and staff knew the people they cared for well. People were involved in their care and staff encouraged people’s independence as far as practicable.

Equipment and technology was used to assist people to receive care and support. However, moving and handling techniques that could put a person and two staff at risk of harm were observed during this inspection. We have made recommendations in regard to further moving and handling training and competency checks for staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported by staff who were knowledgeable about safeguarding and its reporting processes. Risk assessments were in place as guidance for staff to support and monitor people’s assessed risks. People’s confidential records were held securely.

Systems were in place to promote and maintain good infection prevention and control.

People were supported with their eating and drinking to promote their well-being. Staff supported people to access healthcare professional services when this was required. The registered manager and staff team worked with other health and social care organisations to make sure that people's care was coordinated and person centred.

Compliments were received about the service and complaints investigated, responded to and resolved where possible to the complainants’ satisfaction. The registered manager and their staff team worked together with other organisations to ensure people’s well-being. Staff worked well with other external health professionals to make sure that peoples end-of-life care was well managed and this helped ensure people could have a dignified death.

The registered manager led by example and encouraged an open and honest culture within their staff team. Improvements had been made since the last inspection with the monitoring of the service using audit and governance systems to drive forward any improvements required.

Further information is in the detailed findings below.

At this comprehensive inspection carried out on 26 September 2017, we found that the service still needed to make further improvements and is still rated as requires improvement.

There was no registered manager at the time of this inspection. However, a general manager was in post who was responsible for the day to day running of the service. They had applied with the Care Quality Commission (CQC) to become the 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 was a documented process to determine safe staffing levels in conjunction with people’s assessed dependency needs. However, there wasn’t sufficient staff employed at the service and staff had become task orientated in their approach to assisting people. Staffing levels meant that people, who were well enough and/or chose to leave their rooms, spent a lot of their day in communal areas of the service. People were sat in one place, without stimulation or activities to alleviate boredom. Staff didn’t have sufficient time to spend with people and time to always support people’s choices and wishes.

People were not always supported to have maximum choice and control of their lives. Staff were not always able to support people in the least restrictive way possible.

Staff assisted people in a way that promoted their safety. Staff knew how to report incidents of harm and poor care. They were aware of their duty to report any concerns. People’s privacy and dignity was not always promoted and maintained by staff.

Staff were trained to provide effective and safe care. Staff understood their roles and responsibilities. However, not all staff received regular supervision and appraisals in line with the provider’s policy. Pre-employment checks were completed on new staff members before they were deemed to be suitable to look after people living at the service.

People were supported to safely take their medicines as prescribed.

The majority of people and their relatives or advocates were involved in the setting up and agreement of their or their family member’s care plans. People’s care records took account of people’s wishes and any assistance they required. Risks to people who lived at the service were identified and adequate plans were put into place by staff to minimise and monitor these risks. However, these plans were not always a detailed record and were not always read by staff; prior to them delivering care to the people they assisted.

People were supported to eat and drink sufficient amounts of food and fluids. However, unclean crockery and cups were not always cleared away by staff in a timely manner.

Staff monitored people’s health and well-being needs and acted upon issues identified. Staff supported people to access a range of external health care services where needed and people’s individual health needs were met.

Some staff did not always feel supported by the management team. This was because they felt that they didn’t always listen when concerns around staffing levels were raised.

People maintained contact with their relatives and friends and they were encouraged to visit the service and were made welcome by staff.

There was a formal process in place so that people’s concerns and complaints could be listened to and acted upon. Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. People who lived at the service, their relatives and staff were able to share their views and feedback about the quality of the care and support provided. Actions were taken as a result to drive forward any improvements required. However these improvement actions were not always embedded into the service culture and sustained.

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

This comprehensive inspection took place on 7 December 2016 and was unannounced.

The provider is required to have a registered manager as one of their conditions of registration. A manager was in post at the time of the inspection and the CQC was considering their completed application to be registered. A registered manager is a person who has registered with the CQC to manage the home. 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 were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. The provider was aiming to reduce the number of agency staff by recruiting permanent staff into vacant positions. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were supported to take their medicines as prescribed. Audits of people’s medicines were carried out although this was an area for improvement. This was to ensure that people’s medicines continued to be managed safely.

People were supported to eat and drink sufficient amounts of food and drink. They were provided also with choices of food and drink to meet their individual dietary preferences and requirements. However, additional helpings were not always offered. Menus were not consistently followed as the catering staff had the need to make changes on the day. Nevertheless, people were satisfied with the changes. People were helped to access health care services. This was to ensure that their individual health needs were met. However, the management of some people’s individual health needs placed them at risk of harm to their health and well-being.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People’s mental capacity was assessed and people were able to make decisions about their day-to-day care. Staff were not yet fully trained in the application of the MCA: there was an inconsistent level of understanding about this piece of legislation and the application of this in staffs’ working practice.

People were looked after by staff who were trained in some areas and supported to do their job. Staff were supervised and worked well with each other. Induction training and on-going training programmes were in place to keep staff up-to-date to provide people with the right care.

People were often looked after by kind staff who treated them with respect and dignity. Most, but not all, staff respected people’s right to confidentiality and privacy. This was because some staff members inappropriately discussed some people’s sensitive information in communal areas where other people were in hearing distance. Staff were attentive to people but this was not carried out in a consistent way. People living with dementia, and who were of a quieter nature, had less staff interaction than other people who were more vocal and active. People and their relatives were given opportunities to be involved in the setting up and review of people’s individual care plans. People were able to receive their guests at any time and had made friends with other people living at Aria Court. Information about advocacy services had not yet been made available.

Care was based on people’s individual needs and helped to reduce the risk of social isolation. However, in some instances, the care provided failed to meet people’s individual social and care needs. Recreational activities were limited and people living with dementia did not always have the right care to meet their individual needs. Furthermore, there were delays in helping people to be more comfortable and help to eat their meals. Staff had access to up-to-date care plan guidance and had knowledge about meeting people’s individual care needs. There was a process in place so that people’s concerns and complaints were listened to and action was taken to address them.

The manager was supported by a team of management staff, ancillary staff and a team of nursing and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken, or planned, where improvements were identified. A number of changes had been made to improve the culture and quality of people’s care. Work was in progress to embed such changes into practices and overall improve people’s experience of living at Aria Court. There were community links with various external agencies. Not all staff were aware of the whistle blowing policy and procedure. This reduced the provider’s ability to demonstrate their aim to operate an open and transparent culture.