Archived: Aston Grange Care Home

Aston Grange Care Home provides accommodation for people who require nursing or personal care to a maximum of 45 people. At the time of our inspection 30 people were living at the home. The home is a purpose built care home and arranged across three floors. During the inspection only two floors were in use.

There was a registered manager in post although they were not available during the 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.

Care plans did not contain details of people’s preferences and lacked the detail required to provide good quality care. Risk assessments were not robust and did not contain measures designed to mitigate risks faced by people. Records showed that care plans and advice from professionals were not always followed.

The provider had not implemented sufficient measures to ensure that people’s nutrition and hydration needs were met. People told us they did not like the food, which looked unappetising and was undercooked.

The provision of activities had improved, but remained limited and were not dementia friendly. People told us they were bored and observations showed task focussed support and a lack of engagement with people living in the home. Working practices within the home meant that people were not consistently treated with dignity and respect.

The improvements in the management of medicines had not been sustained. Medicines were not managed in a safe way and people were not always getting their medicines as prescribed.

The service had taken appropriate action to address the concerns regarding the building. Improvements had been made to the physical environment. The service was now clean and had appropriate infection control practices in place.

The service had enough staff on duty and staff had been recruited in a safe way which ensured they were suitable to work in a care environment. Staff received the training they needed to perform their roles. Not all staff had received supervision and support to develop in their roles.

The leadership and governance of the service was ineffective. Audits and action plans had not improved the quality of care plans or risk assessments and people continued to receive support that was poor quality.

The provider was not consistently working within the principles of the Mental Capacity Act 2005. Records showed the service did not understand Best Interests principles.

Staff were knowledgeable about safeguarding adults and records showed the service escalated concerns appropriately.

The service had a robust complaints procedure and records showed this had been followed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Aston Grange Care Home provides accommodation for people who require nursing or personal care to a maximum of 45 people. At the time of our inspection 35 people were living at the service. The home is purpose built and arranged across three floors.

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.

The service was unclean and there were significant risks that people were not protected against the risk of the spread of infection. Measures in place to prevent people accessing areas of the home that presented health and safety risks were not implemented. Risk assessments were not robust and did not contain sufficient measures to mitigate against the risk of harm.

There were insufficient staff to ensure that people's needs were met. This meant that the care provided was task focussed and was not personalised. People were not always supported in a way that respected and promoted their dignity. The training provided to staff was not sufficient to ensure they had the skills required to perform their roles.

The provider had not implemented sufficient measures to ensure that people's nutritional, hydration and healthcare needs were consistently met. People told us they did not like the food and observations showed that people were not finishing their meals. There were insufficient staff to facilitate a positive dining experience. Records of care and updates on people's health were captured through shared systems meaning that people's care plans did not always reflect their current needs.

Care plans did not contain details of people's preferences and lacked detail. People told us there were no activities that appealed to them. The only activities were group activities and there were no activities designed to be suitable for people living with dementia.

The leadership and governance of the service was ineffective. Audits were not robust and failed to identify multiple issues of safety and quality.

The management of medicines had improved since our last inspection.

The service's external recruitment processes were robust and ensured that new staff were recruited safely. It was unclear if internal recruitment ensured that people had the skills and knowledge required to perform their roles.

The provider had followed the principles of the Mental Capacity Act 2005 in relation to seeking authorisations to deprive people of their liberty. However, practice in terms of best interests decision making for specific decisions was poor.

People and relatives told us the staff were kind.

Staff were knowledgeable about safeguarding adults and whistleblowing and records showed the service had improved practice in this area.

The service had a robust complaints procedure and records showed this had been followed. People and relatives told us they knew how to make complaints, and where they had done so, the response had been satisfactory.

Staff told us they felt supported by the registered manager. Staff received regular supervisions and appraisals.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service remains 'Inadequate' and the service therefore remains in 'Special measures.'

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Care plans were detailed and updated regularly. People had a varied activities programme which they could participate in if they wished. People received visitors at the home which we saw made people happy. One family friend said "X is doing very well here the staff are very good."

The home worked well with other providers and kept a clear audit of who was involved in people's care at any one time. We observed how the home coordinated the GP visits and how this meant all providers and people involved knew the purpose of the visit and the outcome.

Medication was administered appropriately and we saw that staff had completed relevant medication training. Staff were proactive in raising concerns identified with the medication to ensure the safety of people.

The home had a clear complaints procedure that people and their relatives knew how to follow.