Ayresome Court

We found the following examples of good practice.

Visitors to the home were asked to produce evidence of a negative lateral flow test (LFT) and show their COVID passport as evidence of vaccination. In addition to these checks, visitor temperatures were taken and relevant health questions asked to ensure people were not displaying any symptoms prior to entry. Visiting was taking place in line with current government guidance.

The home was clean, tidy and well ventilated. The furniture in communal areas was spaced out well in order to enable safe social distancing. The home had an outdoor space which can be used in nicer weather.

The registered manager had introduced changes to the environment to minimise risk of cross contamination. The number of people using the same dining table had been limited and there were Perspex screens between people to further reduce risk. Chairs in lounge areas were spaced out to encourage safe social distancing. Staff worked in only one area of the home wherever possible.

People were admitted to the home safely and isolated in line with current guidance. People were allowed into the garden whilst isolating to give them opportunity to get out of their room and make the experience less stressful for them.

The home had no issue with the supply of PPE. Staff had been trained in the safe use of PPE and regular observations and competency assessments were done to ensure staff were following the correct procedure. Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

Testing was done in line with government guidelines. Positive test results triggered appropriate action such as staff staying at home and people self-isolating in their room wherever possible.

A range of relevant COVID-19 risk assessments, policies and procedures were seen. A business continuity plan was in place with reference to COVID-19. Regular environmental checks and IPC audits were taking place.

Ayresome Court is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 43 people.

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

The service provided people with outstanding, responsive care. The service invested time in getting to know people. Staff empowered people to keep control over their lives, involving them in decisions about their care and making future plans. People and their relatives were fully involved in how their care was delivered.

The registered manager and staff were passionate about promoting people’s independence whilst respecting their privacy and dignity. Staff were highly skilled at supporting people at the end of their life and worked closely with other organisations to ensure peoples end of life wishes were respected and fulfilled.

People were provided with good quality care and support. The registered manager directed the service in delivering a person-centred approach, which was embedded loyal, committed staff. The friendly atmosphere and the kind, compassionate nature of staff, provided an open and transparent service which empowered people. We received positives comments from a visiting health professional.

People were actively listened to and staff took time to find out what was important to them. All feedback received was extremely positive, about the service provided to people.

Staff were very proud to work for the service. They undertook their roles with ease and confidence and demonstrated effective skills in communication. Staff received training and support to enable them to carry out their role effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People received their medicines safely and on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing.

The registered manager provided strong leadership and constantly considered how they could enhance the service. There was excellent team work within the service.

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

Rating at last inspection

The last rating for this service was requires improvement (published 7 March 2017). There was also an inspection on 14 March 2018. However, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ayresome Court Nursing Home was last inspected by the Care Quality Commission (CQC) on 18 January 2017 and was rated Requires Improvement overall and in two areas, Safe and Well led. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments and regulation 17 regarding governance and monitoring of medicines and risk assessments.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider had completed actions necessary to meeting the above regulations.

Ayresome Court Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ayresome Court Nursing Home provides nursing and personal care for up to 43 people. At the time of our inspection there were 37 people living at the home.

There was 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.

At the last inspection we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. This was in regard to the preparation of medicines for administration and also incorrect administration of covert medicines (medicines are given disguised in food)

At the last inspection we found risk assessments were not managed or monitored appropriately. At this inspection we found that risks to people were assessed and monitoring had improved. Risk assessments were up to date and individualised. These were in place to ensure people could take risks as part of everyday life and minimise any potential harm by mitigating risks.

Accidents and incidents were monitored by the registered manager to highlight any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

The premises and people’s rooms were exceptionally clean and tidy and throughout the inspection we saw staff cleaning communal areas. Staff had access to plenty of personal protective equipment.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

Staff were regularly supported to maintain and develop their skills through a range of training and development opportunities.

Staff were encouraged to become ‘champions’ in selected areas to increase their knowledge in a subject area and also share learning with the rest of the team.

We found the registered manager had completed regular supervisions and appraisals with staff, which gave them the opportunity to discuss their care practice and identify further training needs.

People’s health was monitored and referrals were made to other health care professionals where necessary, for example, their GP.

People’s rights were valued and people were treated with equality, dignity and respect.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

Consent to care and treatment records were signed by people where they were able.

People’s nutrition and hydration needs were met and were supported to maintain a healthy diet, and where needed records to support this were detailed.

People enjoyed their dining experience and we received positive feedback regarding the food and the choices on offer.

Throughout the day we saw that people who used the service, relatives and staff were comfortable, relaxed and had a positive rapport with the registered manager and also with each other.

People could access advocacy services if required and this was promoted.

Procedures were in place to provide people with appropriate end of life care.

People’s needs were assessed before they moved into the service. Care plans were then developed to meet people’s daily needs on the basis of their assessed preferences. Plans were person centred regarding people’s preferences and were updated regularly.

A registered manager was in place and understood the importance of monitoring the quality of the service and reviewing systems to identify any lessons learnt. The service regularly consulted with people, relatives and staff to capture their views about the service.

The registered manager notified the Care Quality Commission of all significant events which have occurred in line with their legal responsibilities.

Ayresome Court is a 43 bedded purpose built care home providing both nursing and personal care primarily to older people. It is situated on the outskirts of Yarm and in close proximity to public amenities.

There was a registered manager in place who had been registered with the Care Quality Commission since 2014. 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 systems were not always in place to ensure that people received their medication as prescribed. One person who was having their medicines crushed had no record from the pharmacist or GP giving permission to do this, and no record was in place in the person’s care plan. Another person self-administered their medication but there was no record of a risk assessment or a check to make sure this person was, and continued to be, competent to self-administer their medicines.

Risk assessments relating to peoples’ health and support needs needed more detail and updating to ensure they reflected the individual’s current needs. Risks were still in people’s care plans when they were no longer relevant. The service used a form called ‘recent daily records,’ which staff used to document fluid input and output, however these were not always completed. When people took their food and fluid via a Percutaneous Endoscopic Gastrostomy (PEG) feed, the records did not always match with the dieticians feeding regime.

Risks to people arising from the premises were assessed, and plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.. Staff were given effective supervision and a yearly appraisal.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The registered manager understood their responsibilities in relation to the DoLS that were in place.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

We found the interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received. People had access to a wide range of activities, which they enjoyed.

Procedures were in place to support people to access advocacy services should the need arise. The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had.

Care was planned and delivered in way that responded to people’s assessed needs. Plans contained detailed information on people’s personal preferences, and people and their relatives said care reflected those preferences.

The registered manager was a visible presence at the service, and was actively involved in monitoring standards and promoting good practice. Feedback was sought from people, relatives, external professionals and staff to do assist in this. The service had quality assurance systems in place, although the registered manager had recognised the lack of recording on some forms and brought this to the attention of staff at meetings. The registered manager discussed the need to take more appropriate action around the gaps in recording. Staff were able to describe the culture and values of the service, and felt supported by the registered manager in delivering them.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.

All of the people we spoke with were very satisfied with the care they are receiving. One person said, 'The carers are angels.' Another said, "The staff are marvellous. They make this place like a home from home'. Another commented, "The carers are excellent. They do the extra little things we need'.

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for help. We saw that staff communicated well with people and explanations of care were given.

We found that people had nursing and care plans in place that were up to date and reflected their nursing and care needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that people lived in an environment that was homely, clean, well maintained and safe. Although, some upgrading was needed to areas, which we found the provider had planned to complete.

We found that people's needs were generally met by sufficient staff, although additional recruitment was underway for registered nurses and bank care workers.

People spoken with were confident that their nursing and care needs had been met. They said, "They know you as a person, not just a number and we know each other well enough so we can tease each other." A relative said, "They are so kind to the residents, always stop and chat, they show respect and are kind."

People had their nursing and care needs assessed, however we found that records were not always detailed enough, appropriate or available, which meant that there was the potential for people not to have their needs met.

From the records we looked at, we saw that there were good systems in place for ensuring effective recruitment of staff and that the environment was safe.