Archived: Aarondale Care Home

Aarondale Care Home is a residential care home that was providing personal care to 30 people at the time of the inspection. The service can support up to 48 people. The home accommodates people across three floors, each having separate adapted facilities, a lift and a stair lift. Some of the people living in the home had a diagnosis of dementia. The home is situated in Chorley, Lancashire.

People's experience of using this service and what we found:

Generally medicines were managed safely but further improvement was required to ensure people always received their medicines as prescribed by healthcare professionals. We have made a recommendation about this that can be seen in the ‘safe’ section of this report.

People were happy with the care and support they received in the home. They told us staff were kind, caring and respectful of them. Relatives also spoke positively about the care their family members received.

People were supported to be safe and said that they felt safe. Staff received safeguarding training and had a good understanding of the principles involved in acting when abuse was suspected.

People's needs were met through assessments and support planning. The service worked with health and social care professionals to achieve positive outcomes for people. Staff had good knowledge and skills and this ensured people's needs were well met. We saw good examples of when people had been supported to maintain a healthy and balanced diet.

The provider had a robust recruitment process. This meant that staff were recruited safely. Any issues with staff were dealt with promptly using a fair and thorough disciplinary process. Staff were properly supervised and supported. They said that the home had improved substantially since the last inspection in November 2018.

Staff were observed to be kind, caring and respectful towards people. They demonstrated a commitment to providing high quality care and supported people to be as independent as possible.

People received care and support that was person-centred. We saw examples of how the care and support people received enriched their lives through meaningful activities. The service had a robust complaints policy.

The values and culture embedded in the service ensured people were safe and at the heart of the care and support they received. The registered manager and senior staff planned and promoted holistic, person-centred, high-quality care resulting in good outcomes for people. People knew how to feedback their experiences and this was considered and acted upon by the registered manager and provider representative.

People were 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.

There was an end of life policy in place that could be used if appropriate. Some staff had been trained around this and the home were involved with local organisations to ensure best practice was applied during times when people were at the end of life. Relatives were complimentary about the support that was provided at this sensitive time.

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 requires improvement (published 23 April 2019).

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

We undertook an unannounced focused inspection of Aarondale Care Home, Chorley on 27 November, 3 December and 11 December 2018. This inspection was undertaken due to concerns raised with us about the safety of people using the service. We wanted to be sure people were safe and concerns raised were being managed. We inspected the service against two of the five questions we ask about services; is the service safe and is the service well led.

No other risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity between 27 November 2018 and 11 December 2018 so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At the time of the inspection the service did not have 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.

The former registered manager had resigned their position in September 2018 and the provider was in the process of recruiting a home manager at the time of the inspection. In the absence of a registered manager, the CQC had spoken with the provider prior to the inspection around concerns in the management of the home. As a result of this, the provider had put an area manager in place who was managing the home. This person was present at the time of the inspection.

We initially became concerned about safety at the home when we were alerted about a significant medications error on the evening of 19 November 2018. We entered into dialogue with the registered provider around the measures that were to be put in place to avoid a repeat of the concerns. Thereafter, we received information from people's relatives and the provider that supported that there had been further failings in the delivery of safe, quality care. As a result, we conducted a unannounced inspection on 27 November 2018. This part of the inspection process resumed on 3 December 2018 when we were assured by the provider around the implementation of robust systems to avoid any further concerns and the recruitment of a new home manager who was to apply for registration with the CQC.

We were further alerted around a repeat of the 19 November 2018 medications issue on 7 December 2018. Immediate steps were put in place to ensure that people received their medicines as prescribed by health care professionals and we received documentation from the provider that supported a robust set of systems and the temporary recruitment of qualified nurses to supervise the medicines' administration processes. The unannounced resumption of the inspection process on the evening of 11 December 2018, was to check that the assurances that we had been provided were in place and effective. On that occasion, we noted that two registered nurses were involved in the administration of medicines and that the processes that we had been assured about were working effectively.

During the course of these concerns, the registered provider had kept in regular contact with the CQC and had made notifications to the authorities and CQC consistent with their legal obligations. However, during this inspection we found that the service was in breach of regulations in relation to medicine's management, poor recruitment processes, concerns around staffing and poor management and governance. These breaches are under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and are summarised below. For full details, please refer to the 'safe' and 'well-led' sections of this report. You can see what action we told the provider to take at the back of the full version of the report.

The service was not safe because medicines administration had been chaotic and there had been three significant errors that put people at risk of harm. Risk management systems around this were inadequate and the registered provider only established a robust system after people had been put at risk.

Staffing arrangements were not appropriate. The service relied heavily on agency staff and had only managed to retain one senior carer who was qualified and trained in medicine's administration. The significant issues where people had not received their medicines as prescribed by health care professionals was because of a breakdown in communications between permanent and agency staff. There was also a lack of management oversight and supervision during these processes.

The service had a recruitment policy in place to guide the temporary manager on recruitment processes but failures to adhere to policy and legislation may have meant that staff had not been safely employed.

Records we looked at also showed that checks of staff competence and suitability was monitored through supervisions and appraisals. However, staff said that they had not been involved in a formal supervision session since the former registered manager had left the home in September 2018.

We noted records were kept in relation to any accidents or incidents that had occurred at the service, including falls. There was however a lack of checking and investigation around these matters.

All of the staff we spoke with told us the service was not well run. They said that in the absence of the registered manager there had been a lack of supervision and oversight at the service.

All the staff we spoke with confirmed they had received safeguarding training and that safeguarding policies and procedures were in place to guide them in their roles. Training records we looked at showed that safeguarding adults was an annual, mandatory course. Other safeguarding records we looked at showed the registered provider had notified the appropriate authorities when a safeguarding concern had been raised.

We looked at how risks to people’s individual safety and well-being were assessed and managed. Care records contained risk assessments in relation to areas such as pressure ulcers, skin integrity, medicines and moving and handling.

Some people who used the service required equipment such as hoists to assist them to move. All the staff we spoke with told us they had received moving and handling training. We noted that there was regular maintenance and safety checks on the equipment that was in use at the home.

All the staff we spoke with, told us they had received training and were aware of their responsibilities in relation to infection control. The service had an infection control policy to guide staff in their roles and to reduce the risk of cross infection.

Throughout our inspection we were assisted by the area manager and a nurse specialist who had visited the home to complete a full review of medicines practices. We found that these senior staff were knowledgeable about the service and people who lived there but that these senior members of staff had only been put in place on a full-time basis after the first significant medicines issue had been established on 19 November 2018.

At our comprehensive inspection on 18 and 25 October 2016, we found several breaches of legal requirements. Some medicines’ administration practices were unsafe and infection control measures were not robust.

In addition, people’s dietary requirements were not always catered for, the service was not conducting effective mental capacity assessments and was not seeking consent from some people in relation to 'do not attempt cardio-pulmonary resuscitation’ (DNACPR) forms.

There were also issues with auditing and checking on the provision of care and failure to spot the issues that we found during the inspection.

In addition to the breaches of the regulations, we made recommendations around areas involving potential fire hazards with soft toys, staffing levels, complaints’ processes, areas of the home that required updating and that the service should look at ways of engaging people who use the service and provide activities.

We rated the home as 'Requires Improvement' and asked the provider to make improvements in all of these areas. They kept CQC informed of the changes that had been made.

At this inspection in February 2018 we found that significant improvements had been made in all these areas but have made a continuing recommendation around the need to provide variation in the provision of activities. We have now rated the home as 'Good'.

Aarondale Care Home is a ‘care home’ located in the Coppull in the county of Lancashire. The service does not provide nursing care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 48 people. At the time of the visit there were 39 people who received support with personal care.

The service was managed by 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.

We found that people were not being deprived of their liberty inappropriately, DoLS applications were being made and the registered manager and staff were aware of the need to seek consent in line with the MCA.

Proper assessments were being made around ways of protecting people and people were being supported by well-trained staff.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported.

There was a whistle-blowing procedure available and staff said they would use it if they needed to report poor practice. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. Although improvement could still be made, there was a range of appropriate activities available for people to enjoy.

People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The registered manager and provider conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home.

Staff said they enjoyed working at the home and received appropriate training and good support from the registered manager.

The last inspection of this location was conducted on 4 September 2013, when all outcome areas assessed at that time were being met. This inspection was conducted on 18 October 2016 and 25 October 2016. The first day was unannounced, which meant that people did not know we were going to visit the home. The registered manager was given short notice of the second day of our inspection.

A registered manager was in post at the time of our inspection. However, she was not on duty on the first day of our inspection, but she was present on the second. 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager was in charge of the home on the first day of our inspection.

The care planning system was, in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed regularly.

Risks to the health, safety and wellbeing of people who used the service had, in general been assessed. However, where risks were identified these were not consistently incorporated into the care planning system.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided good information about how people needed to be assisted from the building, should the need arise.

A range of internal checks were regularly conducted and environmental risk assessments were in place, showing that actions taken to protect people from harm had been recorded. However, we found that several fire doors did not fully close into the door frames. This created a potential fire hazard. We observed that in one person’s bedroom there was a very large stuffed toy and an abundance of smaller soft toys. None of those we looked at were labelled as being fire retardant. We have made a recommendation about this.

Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer’s recommendations. This helped to protect people from harm. Infection control practices could have been better in some areas.

Records showed that Mental Capacity Assessments had been conducted in some cases, in order to determine capacity levels. However, there was a ‘Do Not Attempt Cardio-Pulmonary Resuscitation’ record on one care file, which was not fully completed or signed by a medical practitioner.

The rights of people were not always protected as applications to deprive someone of their liberty for their own safety had not always been obtained for restrictive practices. People's privacy and dignity was consistently respected.

The service had reported any safeguarding concerns to the relevant authorities and suitable arrangements were in place to ensure that staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. A range of training for staff was provided. However, staff on duty appeared to be rushed during busier periods of the day, such as meal times. We have made a recommendation about this.

Recruitment practices adopted by the home were robust. Appropriate background checks had been conducted, which meant that the safety and well-being of those who used the service was adequately protected. We observed that staff were rushed during the busier periods of the day, such as meal times. We have made a recommendation about this.

There were systems in place for monitoring the safety and quality of the service. Audits viewed had identified areas which were in need of improvement and action was taken to address these shortfalls.

People we spoke with were aware of how to raise concerns, should they need to do so. A complaints procedure was in place at the home and a system had been implemented for the recording of complaints received. However, we did not see any evidence to demonstrate that complainants were formally informed of the outcome of an internal investigation. We have made a recommendation about this.

During the course of our inspection we assessed the management of medications. These were not always dispensed safely. The service worked well with a range of community professionals. This helped to ensure that people's health care needs were being appropriately met.

We found the management of meals to be somewhat disorganised and the provision of leisure activities was limited. We have made recommendations in these areas.

People we spoke with were, in general complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the services provided. However, the records for the provision of personal care did not accurately reflect the care people said they were receiving. We have made a recommendation about this.

Regular meetings were held for those who used the service and the staff team. This enabled people to discuss topics of interest in an open forum and people's views were also gained through processes, such as satisfaction surveys.

Although we found the management team co-operative and helpful at the time of the inspection we found that quality monitoring systems had not identified shortfalls recognised by the inspection team.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, Safeguarding service users from abuse and improper treatment, person centred-care and good governance.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

Staffing levels were found to be sufficient to ensure the safety of residents at all times throughout the day and night. A suitable system was in place to ensure that residents' needs were catered for with extra staff being introduced if needed.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.