Archived: Aaron House Care Limited

Aaron House Care Limited is a care home registered to accommodate up to 6 adults with a learning disability or autistic spectrum disorder in 1 adapted building. At the time of our inspection 4 people were using the service.

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

Since our last inspection, the provider had made some improvements to the service. However, not all of the requirements of the warning notices had been met.

The new manager had implemented some systems to monitor some aspects of the service such as medicines stock and people’s finances. However no other systems to monitor, assess and improve the quality of the service delivery had been implemented. Concerns we identified at this inspection had not been identified by the provider's own systems.

People's care plans had not been reviewed to reflect the concerns we identified at our last inspection. Care plans were not always current and reflective of people's needs.

People's individual risks were not always identified, assessed and mitigated. Staff were not given clear guidance or information on how to protect people from associated risks. People's medicines were not always managed safely. A robust system was not in place to ensure the provider had oversight of all incidents or accidents.

We received mixed feedback from people and their relatives in relation to people’s safety at Aaron House.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies highlighted these practices, however the systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted.

Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.

Based on our review of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right care, Right support, Right culture.

Right support: The provider was not always able to demonstrate how they planned the needs of people with a learning disability in line with best practice guidance. People's care records did not reflect the support that had been planned and delivered.

Right care: Care was not always person-centred and did not always promote people's dignity, privacy and human rights.

Right culture: The lack of quality audits did not support the development of an open and transparent service. The new manager was engaging with people’s relatives for feedback.

At the last inspection, the provider was signposted to the Right support, Right care, Right culture information on the guidance for providers page on our website, however at this inspection we found that the provider was unable to demonstrate how they met the underpinning principles of the guidance.

Improvements had been made to the management of the risk of fire, however there were still actions required to ensure people were fully protected from the risk of legionella.

Improvements have been made to infection and prevention control, however there were still some actions required to ensure people were fully protected.

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 the service was Inadequate (published 26 April 2023).

Why we inspected

We undertook this targeted inspection to check whether the warning notices we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. CQC took enforcement action against the provider.

Following the inspection, the local authority took action to keep people safe by removing them from the service.

Aaron House Care Limited is a care home registered to accommodate up to six adults with a learning disability or autistic spectrum disorder in one adapted building. At the time of our inspection six people were using the service.

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

The service did not have manager in place at the time of the inspection. In the absence of a registered manager, the service was managed by the team leader with some support from the provider. However, we found ineffective governance systems and monitoring roles and responsibilities were not clearly allocated and defined.

A comprehensive, effective quality monitoring or audit system was not in place to ensure the quality of care and risks were monitored and improved where needed. The provider had therefore not identified the concerns we found at this inspection.

People and their relatives told us they felt safe living at the service. However, we found shortfalls that placed people at risk of receiving unsafe care.

People's individual risks were not always identified, assessed and mitigated and staff were not given clear guidance or information on how to protect people from associated risks. Not all staff knew what to do in an emergency. People's medicines were not managed safely. A robust system was not in place to ensure the provider had oversight of all incidents or accidents.

Systems to ensure safe staff recruitment practices were not in place.

Infection prevention and control was unsatisfactory. This placed people, visitors and staff at risk of infections. People were not always protected from the risks of their environment. The provider had not always undertaken effective measures to ensure that people would be protected from risks associated with fire safety and legionella.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and/or who are autistic.

Based on our review of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right care, Right support, Right culture.

Right support: The provider was not always able to demonstrate how they planned the needs of people with a learning disability in line with best practice guidance. People’s care records did not reflect the support that had been planned and delivered.

Right care: Care was not always person-centered and did not always promote people’s dignity, privacy and human rights. .

Right culture: The lack of quality audits and absence of feedback systems did not support the development of an open and transparent service.

We sign posted the provider to the Right support, Right care, Right culture information on the guidance for providers page on our website.

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

Rating at last inspection and update

The last rating for this service was good (published 14 June 2018).

Why we inspected

We received concerns in relation to several aspects of the management of the service and the quality of people’s care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 Aaron House Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management, safe staff recruitment, good governance and safeguarding.

Please see the action we have told the provider to take at the end of this report.

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.

At our last inspection on1 and 2 October 2015 we rated the service as overall ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’. There was no evidence or information, from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were kept safe. Risks were identified, managed and reduced. Staff were recruited safely and they were trained and supported to meet people’s needs effectively. People’s medicines were managed safely and they received these as prescribed. The environment was kept clean and well maintained.

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 home supported this practice. People’s nutritional wellbeing had been maintained and they continued to have access to health care professionals when needed.

People’s needs were assessed, care plans were developed and care was delivered in a way which met their needs and preferences. People were treated equally and their individual preferences and wishes were respected. Relatives were provided with opportunities to speak on behalf of their relative and to visit when they chose to.

Staff were kind, caring and compassionate. There were arrangements in place to help people feel included and to take part in social activities. Staff had the skills and knowledge to support people’s end of life needs. No-one at the home was receiving end of life care. However the registered manager explained that they had plans to slowly and informatively speak to people individually about their end of life care and wishes and document their views

The home was well managed and the registered manager ensured people’s needs and wishes were the primary focus. Effective and appropriate systems, processes and practices ensured the home ran smoothly and that necessary regulations were met. Complaints could be raised and these were investigated and addressed. All feedback was welcomed and used to improve the service further.

Further information is in the detailed findings below.

Aaron house provides residential accommodation to a maximum of six people with learning disabilities. An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report. This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe. There were enough staff on duty to meet the needs of the people living at the home and the manager was always available in emergencies. Staff had been trained to administer medicines. This included the administration of a specialist medicine which required additional training. Staff had been trained in caring for people with epilepsy.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs. They knew each person who used the service very well. One person told us 'the staff are always there to help me when I need it'. One relative told us 'I can't fault it, my daughter gets very good care here'.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and encouraged the people who used the service. The people who used the service told us that there were not rushed by the staff. Our observations confirmed this.

Is the service responsive?

People's needs had been assessed . Records confirmed people's preferences, interests, aspirations and diverse needs had been considered and acted on. Care had been provided to meet their needs. People had access to activities that were important to them and had been supported to maintain relationships with their family.

Is the service well-led?

Staff had a good understanding of the home and the people who used the service. The people who used the service told us that they felt comfortable approaching any member of staff if there was any problems. Staff and people who used the service were involved in day to day decisions affecting the home.

We found that people looked well cared for and that staff were very supportive and attentive to people's needs. Staff said they were fully supported by the home to develop and retain the required skills and knowledge to support people appropriately and safely.

Although people took part in different activities, we did find that people did not have enough opportunities to take part in a one to one activity of their choice and interest.

We found that care records were person centred and detailed which gave guidance to staff on people's care needs. People told us that they knew how to make a complaint and we saw that the format of the complaints procedure was in an appropriate format and that the home followed its policy and procedures when investigating and resolving complaints.

We found that the home was spacious and airy with appropriate furnishings and decor. One person told us they "Loved their bedroom and everyone was friends".

People led active lifestyles with the appropriate support of staff as required. On the day of our visit three people were out for the morning attending college another person had gone out shopping in preparation for short break to Weymouth. One person told us 'I really enjoy college, I meet my friends, and drama group is my favourite'.

People were aware that if they were unhappy about the service they received they could make a compliant to the manger. One person told us "if I had to make a complaint I am sure they would listen to me and do something about it", another person told us 'I have been to the office and a problem that I had was dealt with immediately'.

We spoke with two support workers during our visit. Staff were very motivated, caring and positive about working in the home and praised the teamwork and supportive atmosphere.

Appropriate recruitment checks had been undertaken before staff began working at Aaron House. Staff had received training in order to support people that lived at the home.