Aarons Specialist Unit

Aarons Specialist Unit is a residential care home providing personal and nursing care to up to 22 people living with dementia and other neurological conditions. At the time of our inspection there were 22 people using the service.

Aarons Specialist Unit accommodates people across 4 separate wings, each of which has separate purpose built facilities.

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

People were not always safe. This was because risks assessments were not always completed to manage known risks associated with people’s care and support. The protocols for managing medicines were not always in line with best practice. Lessons were not always learnt from incidents that occurred at the service to minimise the risk of reoccurrence.

The systems used by the provider for monitoring the quality of care and support people received, identified areas of improvement. However, there was no evidence of actions taken to make the required improvements. The provider did not take required actions to meet the conditions of people’s deprivation of liberty safeguards authorisations.

People were not supported to have maximum choice and control of their lives and staff did not 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. The environment did not always promote people's dignity, privacy and their individual needs.

People were supported to manage their health conditions. They had prompt access to health and care professionals.

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 good (published 09 April 2020).

Why we inspected

The inspection was prompted in part due to concerns we received concerns in relation to the management of medicines and management of people’s behaviour support needs. As a result, we undertook a focused inspection to review the key questions of safe, and well-led only. We returned for a second site visit to extend the inspection to include the key question effective as we found concerns related to this.

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 requires improvement based on the findings of this inspection. 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 Aarons Specialist Unit on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care, need for consent and good governance at this inspection.

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.

Aarons Specialist Unit is a residential and nursing home providing personal and nursing care to 14 people with dementia at the time of the inspection. The service can support up to 22 people.

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

People received safe and kind care from enough suitably skilled staff who knew them well. Staff supported people with complex needs in a dignified and compassionate way.

Safe recruitment procedures were in place to ensure only people with the right character and experience were employed.

People received their medicines when they needed them. The environment was well maintained and free from infection.

People received personalised care. People's consent to care was gained before being provided.

Risk assessments were in place to manage people’s risks, and the service worked well with healthcare agencies to ensure their health and well-being was maintained.

People’s nutritional needs were met, they enjoyed their meals, and were given a choice of what they liked.

People gave positive feedback about the service and were listened to if they had cause for concern. Lessons were learnt when things went wrong and changes to practice were made when needed.

The service had an open culture. They had good knowledge and understanding of people’s needs and were supportive of staff.

Effective systems were in place to monitor the quality of the service and drive improvements.

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.

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 requires improvement (published 15 March 2019) and there was one breach of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. 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 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.

- The service is in a residential area of Loughborough.

- The service provides accommodation and personal care for people with a brain injury or with a dementia type illness or similar conditions. The care home can accommodate 22 people in one building. At the time of our inspection there were 11 people using the service.

People's experience of using this service:

• The service was not comprehensively safe. Staffing levels did not always keep people and staff safe. There were insufficient numbers of staff deployed to meet people's care and support in a safe or timely way and to comprehensively protect the safety of staff.

• There were audits in place to see whether the service provided high quality, safe care. However they had not comprehensively ensured quality care, as not all issues of concern or areas requiring improvement had been identified.

• People were not always protected against abuse, neglect and discrimination. Although staff were aware of ensuring people's individual safety risks and acting to prevent harm coming to them, three incidents had not been reported to us so we were not able to evaluate whether an earlier inspection was needed.

• Complaints made had not always supplied a comprehensive response to concerns made.

• There was a homely atmosphere and the home was kept warm.

• Questionnaires had been supplied to people’s representatives for their views of the service. These were generally positive about people’s satisfaction with the service.

• People were treated with a friendly and caring manner by staff.

• Staff members knew people well and people appeared to enjoy the attention from staff.

• People were assisted to have choice and control of their lives.

• Peoples representatives had a say in how the service was operated and managed.

• People's care was personalised to meet their individual needs.

• A registered manager was in place to ensure governance of the service.

• The service met the characteristics for a rating of "good" in caring and effective but not in safe, responsive and well led where the rating was Requires Improvement.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "Good". Our last report was published on 19 July 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will follow up the breach in regulation and require the provider to outline necessary improvements in an action plan and continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

Aarons specialist unit provides accommodation, nursing and personal care for a maximum of 30 people with a brain injury or similar conditions. There were 23 people using the service on the day of our inspection.

There was 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.

People were protected from harm. People told us they felt safe and that there were enough staff available to meet their needs. There was a recruitment policy in place which the registered manager followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

Risks associated with people’s care were assessed and managed to protect people from harm. Staff had received training to meet the needs of the people who used the service. People received their medicines as required and medicines were administered safely.

People’s independence was promoted and staff treated people with dignity and respect. Some people were supported to follow their interests and engage in activities. We observed times of inactivity for some people. Records did not make clear if activities were consistently being offered to people.

People were supported to make decisions about the care they received. The provider had considered their responsibility to meet the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was clear of their role in ensuring decisions were made in people’s best interest.

The registered manager had assessed the care needs of people using the service. Staff had a clear understanding of their role and how to support people who used the service as individuals.

People enjoyed the meals provided and where they had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff felt supported by the registered manager. The registered manager supervised staff and regularly checked their competency to carry out their role. People who used the service felt they could talk to the registered manager and were confident that they would address issues if required. Relatives found the registered manager to be approachable.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made.

We spoke with a senior manager, the deputy manager for the service, members of the multidisciplinary team that consisted of an occupational therapist, physiotherapist, speech and language therapist and a psychologist. We also spoke with a senior nurse and two support workers.

We looked at some of the records held in the service, including the care files for eight people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

People spoke about their individual needs and how staff supported them to keep them safe and well. This included support with personal care, social interests and weekly activities with the physiotherapist and occupational therapist.

Staff showed a good understood of each person's needs and how they wished to be supported. We saw people had care plans and risk assessments that instructed staff of what they were required to do to keep people safe.

People could be assured that they received their medicines appropriately and as prescribed. The provider had safe systems and procedures for the administration, ordering and storage of medicines.

We found there were sufficient staffing levels available during all times of the day and night to keep people safe. We looked at the staff rota that showed how staff were deployed appropriately dependent on their experience, skills and qualifications.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw examples that DoLS applications had been made, and found the provider had adhered to the legislation that protected people's human rights.

Is the service effective?

Whilst we found the service effective, the lack of structured and meaningful activities could have a negative impact on people's mood and behaviour.

We found people had their care plans and risk assessments reviewed on a regular basis. The multidisciplinary approach to the delivery of care and treatment, meant people had their needs monitored by a team of health professionals who worked together.

Is the service caring?

We observed staff involved and treated people with compassion, kindness, dignity and respect. We observed staff to be sensitive, caring and attentive to people's needs.

We observed staff intervene to support one person who was becoming upset and agitated. This was done in a calm and respectful manner, and without bringing undue attention for others in the lounge. One person who used the service was asking the same question repeatedly. A staff member replied each time in an appropriate and respectful way. This was done without discrimination.

During the morning of our visit we observed staff supported people with a hand massage. Another person was supported to attend the gym and lunchtime was found to be relaxed and calm. Staff were observed to anticipate people's needs, and we found staff to be knowledgeable about the needs of people including their routines and preferences.

Is the service responsive?

We saw the provider had a complaints policy and procedure that informed people how to make a complaint and what their rights were.

We found some examples that showed the service was responsive to people's assessed needs. For example, people were supported with their routines and activities that were important to them. However, it was difficult to ascertain if people were supported to achieve their therapeutic goals and outcomes or aspirations as records did not clearly document this.

Is the service well-led?

People who used the service were able to share their views about the service. The provider supported people to have 'house meetings' to discuss and share their views about the service provided.

The provider carried out internal audits that monitored service delivery. Staff meetings were regular and staff were enabled to share their views and experiences that contributed towards the running of the service.

There was not a registered manager in place but staff told us that they felt there had been improvements since our last inspection. They described the leadership as good and that they felt supported.

People received medicines on time and knew what they took. The system for receiving, dispensing and recording medicines were not safe. The medication audits were ineffective because although they identified actions needed to be taken it was not always clear if this had been done.

People using the service were supported by trained staff. Staff did not receive adequate or timely support for their job role and development, and there were not enough suitably qualified and experienced staff were available to meet people's needs safely.

The provider did not effectively assess and monitor the quality of service. People's views were not sought and audits were not carried out regularly to ensure the health, welfare and safety of people using the service was protected.

During our inspection visit the registered manager informed us they had resigned. The provider had appointed an interim manager and the service was not taking new admissions until improvements were made.

People told us they were treated with respect and their independence was promoted. People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people's health and care needs were monitored and reviewed regularly by staff and health care professionals. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People were protected because there was effective staff recruitment and selection processes in place. Records showed appropriate checks were undertaken before staff began work. Staff received training which enabled them to meet people's care needs safely.

Information about how to make a complaint was available to people using the service. People told us they were confident to raise concerns with the manager. One person said 'I've got no complaints but I'm sure I could tell the staff if there was a problem.'