Aran Court Care Home

Aran Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 home is registered to provide accommodation and nursing care for up to 86 older people. There were 54 people living in the home at the time of our inspection visit.

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

We found a number of issues identified with the management of sharps. Several sharp containers were not signed for when brought into use and not disposed of within a timely manner.

We found in one of the medicine rooms, the stock medication was not appropriately stored in a locked cabinet. There was a suitable lock attached to the doors however this was not being used and the doors were held closed by a rubber band.

We found care records reviewed did not always have relevant information in order to confirm when changes occurred to people’s health conditions. We found reviews of care were not being undertaken with people or relatives. In addition, we found some people's care records did not consistently demonstrate that risk assessments were being followed.

The provider had safeguarding systems and processes in place to keep people safe. Staff knew the risks to people and followed the assessments to ensure they met people's needs. People felt safe and were supported by staff who knew how to protect them from avoidable harm.

Staff were recruited safely and there were enough staff to meet people's needs. Staff followed the infection control procedures the provider had in place.

Risks to people's health and well-being had been assessed and monitored to ensure they were kept safe. People received their medication as prescribed.

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.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

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

Rating at last inspection:

At the last inspection we rated Aran Court as 'Requires Improvement' (report published 13 June 2019). At this inspection the overall rating has remained as 'Requires Improvement.'

Why we inspected

We received concerns in relation the management of safeguarding incidents. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only. We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. Please see the Safe and Well-Led sections of this full report.

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

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.

Aran Court is a ‘care home’ that is registered to provide nursing or personal care to up to 86 people. There were 49 people living at the home on the days of the inspection.

People’s experience of using this service:

Since the last inspection in November 2017 there had been a change in the management team and a new registered manager had been appointed. We found some improvements had been made to address the areas we identified as requiring improvement, however this inspection found further improvements were needed. For example, we found improvements could be made in some records and in the unit for people living with dementia to support people’s orientation. We also found that people’s access to information could be improved and dining experience could be improved to better support people make informed choices.

People were supported by staff to stay safe and who treated them with respect and dignity and encouraged them to maintain their independence.

People were supported to receive their medicines as required to support their wellbeing, however improvements could be made to ensure times were recorded where appropriate.

People’s consent was sought before providing support. However, staff we spoke with were not clear about their role and responsibilities with regards to DoLS and what this meant for individual people.

Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing and provided care in the way that people preferred, and people felt able to raise any concerns they may have with staff.

People gave mixed feedback about the meals provided and felt the menu could be improved to better reflect people’s preferences.

People, relatives and staff all told us there had been an improvement in the activities provided and we saw people enjoyed a range of activities.

The provider had quality assurance systems in place and we saw where action had been taken to make improvements. The provider noted these improvements but acknowledged that further improvement was needed.

Staff felt supported and said they could talk to management and felt confident any concerns would be acted on promptly.

People, relatives and staff spoke of improvement within the service since the last inspection. The provider had a home improvement plan in place to develop the service further and they worked in partnership and collaboration with other key organisations to support care provision.

Rating at last inspection:

At the last inspection we rated Aran Court as ‘Requires Improvement’ (report published 21 April 2018). At this inspection the overall rating has remained as ‘Requires Improvement.’

Why we inspected:

This was a planned inspection based on the rating at the last inspection. Prior to the inspection we received some concerns about the way in which the home was managed. These concerns were addressed as part of the inspection.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up:

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

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

The service is required to 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. At the time of our inspection the registered provider had not completed the process to replace the previous registered manager who had left the service in March 2017. This is a breach of Section 33 of the Health and Social Care Act 2008.

In addition during the inspection we found another breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service was transferred in its entirety to the current registered provider in December 2016. The last inspection report for the service operated by the former registered provider was published in January 2017 and rated the service as Requires Improvement overall. The current registered provider had access to the findings in the report and the identified areas for improvement for the service they had taken over. We found that the actions required to improve the service had not been fully implemented.

Aran Court Care Home is a service registered to accommodate up to 86 adults who require assistance with personal care or require nursing care. At the time of our inspection visit 56 people were being accommodated, the majority of whom were living with dementia or physical disabilities. 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.

Aran Court Care Home is divided into three separate units, one of which is used for people primarily living with dementia. Prior to our visit the provider had closed one of the nursing units due to difficulties in recruiting suitable nursing staff. The care home is adjacent to another of the provider’s services and shares the kitchen and laundry facilities with it.

At this inspection we found

People felt secure and safe with their regular care workers and nursing staff.

People had risk assessments in place to identify and reduce the risk of harm; however these did not always reflect the current risks for people and potentially placed people at the risk of harm.

People were able to have their needs met on most occasions by care workers and nursing staff that had developed personal knowledge of them. However people were concerned that agency workers engaged by the provider did not have sufficient knowledge of their care needs.

The provider had recruitment procedures for the safe employment of care workers and nursing staff with processes which ensured they received the necessary induction and training to meet the care needs of people living at the service.

People were supported and received their medicines from specialist care workers and nursing staff who were trained and subject to regular competency checks.

The provider had failed to consistently comply with the legal requirements of the Mental Capacity Act 2005 and associated guidance. This was a breach of Regulation 11(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 support this practice.

People’s ability to be involved in activities was sometimes limited by the support available.

People were provided with a choice of appropriate food and drink for their needs although the mealtime experience for some people was not always pleasurable.

People's mental health and physical health needs were assessed and people were supported to access health care professionals when required.

People living with dementia were not provided with an environment suitable for their needs. We therefore recommended that the service consider current guidance in relation to the specialist needs of people living with dementia.

People were usually supported by caring and respectful care workers and nursing staff who maintained their privacy and dignity.

People's support needs were recorded in care plans which were regularly reviewed but were not always updated to provide assistance to care workers or nursing staff who were unfamiliar with the person.

People and their family representatives knew how to complain about the service they received and were encouraged to make complaints and discuss issues of concern.

The provider had introduced new policies and documentation to improve the consistency of the service and to meet people's needs.

The provider had systems to assess and monitor the quality of the service but these were not consistently effective in identifying issues with the service requiring improvement.