Aston Court Care Home

Aston Court Care Home is a nursing home providing accommodation (over two floors) and nursing and personal care to a maximum of 52 older adults. At the time of our inspection 37 people lived at the home some of whom experienced dementia.

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

Staffing did not always meet people’s needs in a timely manner.

Governance systems were not entirely effective as they had not identified all issues found at this inspection.

The home was visibly clean but some improvements were required in relation to the maintenance of bathrooms.

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.

People were treated with kindness and respect and their independence and privacy were promoted.

The management team welcomed our inspection and understood the need to be open and honest about things that required improvement.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28/03/2020) and there was a breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of that regulation and we found a further breach.

We will describe what we will do about the repeat 'Requires Improvement' rating in the follow up section below.

Why we inspected

This inspection was to review our findings from our previous inspection.

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 remained requires improvement based on the findings of this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

The last rating for this service was requires improvement (published 28/03/2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

We have found a repeated breach in relation to good governance risk management at this inspection and one other breach relating to staffing. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of

our regulatory functions. We checked whether the provider was meeting the legal requirements and

regulations associated with the Act. We looked at the overall quality of the service and provided a rating for

the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector, an assistant inspector, a specialist advisor. A specialist advisor is a qualified health professional. Our specialist advisor was a registered nurse who had expertise in supporting people living with dementia.

Service and service type

Aston 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.

The service had a manager who was applying to be registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback

from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service and two relatives about their experience of the care provided. We spoke with six members of staff including the manager, the deputy manager and two senior managers. We observed the interactions between people and the staff team throughout the day.

We reviewed a range of records. This included four people's care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. The manager sent us the information we had requested.

Aston Court Nursing and Residential Home accommodates up to 52 people in one adapted building over two floors. At the time of our inspection, 42 people (who had physical health needs and/or were living with dementia) were using the service. Our last inspection took place in March 2016, and the service was rated as Good. At this inspection, we found the service remained Good.

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.

At our last inspection, we asked the provider make improvements to ensure the service was effective. We had found that when people were not able to make certain decision for themselves, this had not been reflected in their care plans or reviewed. At this inspection, we found the required improvements had been made. 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 continued to receive care that was safe. Staff understood their responsibilities to protect people from possible harm. Risks to individuals were assessed, monitored and reviewed, and staff followed safe working practices. There were enough staff to meet people’s needs and the provider ensured staff were suitable to work with people. People received their medicines as prescribed, and were protected from any risks associated with them.

Staff had the knowledge they needed to carry out their roles and received training to develop their skills. People were enabled to maintain a balanced diet and were able to access health care services when needed. They were supported by staff who knew them well and treated them with dignity and respect. Staff were patient and kind and promoted people’s independence. People were able to maintain relationships that were important to them, and there were no restrictions in place for visitors.

The care people received was individual to them and responsive to their needs. They were able to participate in activities they enjoyed and follow their interests. The care records in place reflected the support that people needed, and gave staff information to support them in providing personalised care. People knew how to raise any concerns and the provider had responded to any issues in a timely manner.

There was a positive, open culture at the service, and people were happy with the support they received. Staff were supported and enjoyed their jobs. The registered manager had effective systems in place to drive continuous improvement, and they sought feedback from people who used the service and their families.

We returned to inspect this service in January 2016 following information received regarding the moving and handling practices when using bath hoists. We found that the service was meeting the regulation that we checked but we did ask the provider to make some improvements to ensure staff had clear direction and training on how to use this equipment safely. At this inspection we saw that improvements had been made.

Aston Court provides accommodation and nursing care for up to 55 people. On the day of our inspection 43 people were using the service; this included 12 people from the local hospital that required rehabilitation prior to being discharged home.

A registered manager was 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 capacity was not always reflected in their records or reviewed in a timely way, but the manager had identified that this was an area for improvement and was taking action to address this.

People felt safe and staff understood their role in protecting people from the risk of harm. Checks were carried out prior to staff starting work to ensure their suitability to work with people and staffing levels were monitored to enable people’s needs to be met. Medicines were managed safely and people received their medicines at the right time, as prescribed. Staff had clear direction and training on how to use this equipment safely.

People were supported by staff who had the knowledge and skills to provide safe care and support People received food and drink that met their nutritional needs and preferences. Health concerns were monitored and people received specialist health care intervention when this was needed.

People’s preferences were considered and incorporated in their support plan. There were regular reviews of people’s care to ensure it accurately reflected their needs. People were able to take part in social activities. People liked the staff and their dignity and privacy was respected by the staff team. The staff team were approachable and made visitors feel welcome.

People knew who to speak with if they had any concerns and they felt these would be taken seriously. Arrangements were in place so that actions were taken following any concerns which were raised.

There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt confident that they could raise any concerns with the registered manager. People felt the service was well managed and systems were in place to monitor the quality of the service to enable the manager and provider to drive improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Aston Court Nursing and Residential Home on our website at www.cqc.org.uk

Aston Court provides accommodation and nursing care for up to 55 people. There were 48 people who used the service at the time of our inspection.

The service 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.

Staff had equipment they needed to assist people. However they had not been trained in the safe use of some pieces of equipment in use at the service. Documents for safe working practices, policies and procedures did not always specify or identify how some equipment was to be safely used.

At this inspection, we found that the warning notice had been met. Appropriate arrangements were now in place to ensure that medicines were managed safely.

At the time of our visit 37 people were using the service. We spoke with 15 people that were using the service and five people's relatives. Below is a summary of our findings based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask.

Is the service safe?

We checked to see if improvements had been regarding the management of medicines since our inspection on 12 June 2014. Although there was some improvement in medicine administration recording we also found further areas of concern with medicine safety.

The majority of people using the service that we spoke with and people's visitors told us that there were not enough staff on duty to ensure their needs and preferences were met in a timely way. One person told us; 'I have to stay in bed until the staff come to get me up as they have to hoist me in and out of bed. Sometimes it can be as late as 2pm before I get up that means I have to have my meal in my bed.' One person's visitor told us; 'The care is good but there are not enough staff to help my relative. My relative has to wait to be taken to the toilet; this can be a long wait sometimes which is not good. They treat my relative very well so it's not the care I have concerns with.'

The staff rotas seen demonstrated that sufficient staffing levels were not always maintained to ensure people's preferences and needs were met in an effective and timely way.

Is the service effective?

When people lose the capacity to make some decisions through illness or disability other people can be authorised to make decisions on their behalf as long as they are in the person's best interests. Records such as a mental capacity and best interest assessments should then be in place to ensure the person's rights are protected. We found that mental capacity assessments and best interest assessments were not always in place when people lacked capacity.

We saw that call bells were not always in reach for people to use if they needed to call for staff support and although care plans were in place they were not always followed in practice. This meant that people could not be assured that their needs and preferences would be met.

Prior to this visit people's relatives had raised concerns with us and the local authority regarding the quality of meals served at Aston Court. We found that there had been some improvements to the quality of meals served and new menus were in place and accessible to people using the service. Some people told us that the quality of the meat served was not always good and we discussed this with the area manager who said that this had not been reported back to the supplier to address but confirmed this would be done.

The staff training record and discussions with staff demonstrated that staff were provided with training on an ongoing basis. This meant that staff were provided with essential training to enable them to support people effectively.

Is the service caring?

People using the service and their relatives were in general complimentary about the staff team. People told us; 'The staff are very kind and compassionate to me.' And 'When staff give me personal care they are gentle with me.' One person told us that some staff were more respectful towards them than others but told us; 'If I wasn't happy I would complain to the staff.'

Is the service responsive?

A range of activities were available to people using the service which ranged from group activities to individual one to one sessions for people.

Due to the staffing levels we observed that staff could not always ensure that people's requests to participate in activities were met. One person on the day of our visit missed the majority of an exercise class because there was not enough staff available to support them to attend.

Is the service well-led?

Since our last inspection the acting manager who had been in post since April 2014 had left employment and the deputy manager had also left employment. Prior to this the previous registered manager had been in post for less than 12 months and then moved to another Bupa home. This meant that there had been some inconsistency in the management of the home. People's relatives told us that although meetings had been held with them they had been concerned as they hadn't been informed about the reasons for this by the senior management team.

At the time of our visit an interim manager was in post but was not on duty on the day of our visit. The senior management team were at Aston Court on the day of our visit and confirmed that they had recently been relocated to oversee the management of Aston Court. This meant there had been changes to the whole management team at Aston Court.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The management team told us about the improvements that had been made to medicine safety following concerns raised by the Clinical Commissioning Group (CCG) Medicine Management Care Homes Team. The improvements included better medicine storage arrangements, medicine training for nurses and increased checks on medicine administration records. We also spoke with one person about their medicines. They told us 'I am quite happy looking after my medicine. This is a five star service'. However, despite these improvements we found similar medicine safety concerns as the CCG. We therefore informed the management team that appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines. We were told that all issues identified by the inspection would be investigated and action taken.

A safeguarding matter was still under investigation at the time of our visit. Systems had been put in place to protect staff and those that live at the home until the outcome of the investigation is available.

Care plans contained detailed information to enable staff to provide care and support to people living at the home. A varied activities programme helped to ensure people's social and leisure needs were met.

Meals were well presented and offered a choice. People told us that there had been improvements in the food recently. The acting manager had introduced systems to ensure that the quality of the meals met people's expectations.

The home had been refurbished and provided a pleasant, homely environment which was well maintained.

Staff received training in order for them to provide care and support to meet the individual needs of people living at the home. Staff told us that they felt well supported and said that the acting manager was approachable.

Complaints received were investigated and responded to in a timely manner. New systems were put in place where deficiencies were identified. Records were kept of all complaints received. People were made aware of the procedure for making a complaint.

We looked at three care files and saw detailed information recorded about people's needs and abilities and any equipment and or staff assistance that was needed to be able to meet those needs. People told us, "I know I could make changes to my care if I wanted to." "Staff always call the doctor if she is unwell." "Everything is generally OK, I will settle for spending the rest of my days here." People we spoke with looked well cared for and were dressed appropriately for the time of year.

People told us that staff gave them their medication at the same time each day.We were told that medication audits had recently been undertaken and that staff had received medication administration training.

People we spoke with did not raise any concerns but some suggestions for improvements were made such as staff making their beds every day and improvements to the quality of the food served. We were told that people could occasionally be left waiting to receive assistance but that generally staff were kind and helpful. People told us that they would raise any complaints with staff.