Aarondale is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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. Aarondale is registered to provide personal and residential care for up to 48 people. At the time of the inspection 35 people were living at the home.

We undertook an unannounced focused inspection of Aarondale Care Home, Chorley on 27 November, 3 December and 11 December 2018. This inspection was undertaken due to concerns raised with us about the safety of people using the service. We wanted to be sure people were safe and concerns raised were being managed. We inspected the service against two of the five questions we ask about services; is the service safe and is the service well led.

No other risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity between 27 November 2018 and 11 December 2018 so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At the time of the inspection the service did not 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.

The former registered manager had resigned their position in September 2018 and the provider was in the process of recruiting a home manager at the time of the inspection. In the absence of a registered manager, the CQC had spoken with the provider prior to the inspection around concerns in the management of the home. As a result of this, the provider had put an area manager in place who was managing the home. This person was present at the time of the inspection.

We initially became concerned about safety at the home when we were alerted about a significant medications error on the evening of 19 November 2018. We entered into dialogue with the registered provider around the measures that were to be put in place to avoid a repeat of the concerns. Thereafter, we received information from people's relatives and the provider that supported that there had been further failings in the delivery of safe, quality care. As a result, we conducted a unannounced inspection on 27 November 2018. This part of the inspection process resumed on 3 December 2018 when we were assured by the provider around the implementation of robust systems to avoid any further concerns and the recruitment of a new home manager who was to apply for registration with the CQC.

We were further alerted around a repeat of the 19 November 2018 medications issue on 7 December 2018. Immediate steps were put in place to ensure that people received their medicines as prescribed by health care professionals and we received documentation from the provider that supported a robust set of systems and the temporary recruitment of qualified nurses to supervise the medicines' administration processes. The unannounced resumption of the inspection process on the evening of 11 December 2018, was to check that the assurances that we had been provided were in place and effective. On that occasion, we noted that two registered nurses were involved in the administration of medicines and that the processes that we had been assured about were working effectively.

During the course of these concerns, the registered provider had kept in regular contact with the CQC and had made notifications to the authorities and CQC consistent with their legal obligations. However, during this inspection we found that the service was in breach of regulations in re

This unannounced inspection took place on 6 and 7 February 2017.

At our comprehensive inspection on 18 and 25 October 2016, we found several breaches of legal requirements. Some medicines’ administration practices were unsafe and infection control measures were not robust.

In addition, people’s dietary requirements were not always catered for, the service was not conducting effective mental capacity assessments and was not seeking consent from some people in relation to 'do not attempt cardio-pulmonary resuscitation’ (DNACPR) forms.

There were also issues with auditing and checking on the provision of care and failure to spot the issues that we found during the inspection.

In addition to the breaches of the regulations, we made recommendations around areas involving potential fire hazards with soft toys, staffing levels, complaints’ processes, areas of the home that required updating and that the service should look at ways of engaging people who use the service and provide activities.

We rated the home as 'Requires Improvement' and asked the provider to make improvements in all of these areas. They kept CQC informed of the changes that had been made.

At this inspection in February 2018 we found that significant improvements had been made in all these areas but have made a continuing recommendation around the need to provide variation in the provision of activities. We have now rated the home as 'Good'.

Aarondale Care Home is a ‘care home’ located in the Coppull in the county of Lancashire. The service does not provide nursing care. People in care homes receive accommodation and personal care as a 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 care home accommodates 48 people. At the time of the visit there were 39 people who received support with personal care.

The service was managed by 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.

We found that people were not being deprived of their liberty inappropriately, DoLS applications were being made and the registered manager and staff were aware of the need to seek consent in line with the MCA.

Proper assessments were being made around ways of protecting people and people were being supported by well-trained staff.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported.

There was a whistle-blowing procedure available and staff said they would use it if they needed to report poor practice. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. Although improvement could still be made, there was a range of appropriate activities available for people to enjoy.

People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The registered manager and provider conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and acti

Aarondale Care Home provides accommodation and assistance with personal care for up to 48 adults, some of whom live with dementia. The home does not provide nursing care. People who live at the home have varying needs and specialist support is provided where necessary. The home is arranged over three floors, each having lounge, bathing and dining facilities. A car park is available and on road parking is permitted in the surrounding area. A range of amenities are close by and public transport links are within easy reach.

The last inspection of this location was conducted on 4 September 2013, when all outcome areas assessed at that time were being met. This inspection was conducted on 18 October 2016 and 25 October 2016. The first day was unannounced, which meant that people did not know we were going to visit the home. The registered manager was given short notice of the second day of our inspection.

A registered manager was in post at the time of our inspection. However, she was not on duty on the first day of our inspection, but she was present on the second. 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager was in charge of the home on the first day of our inspection.

The care planning system was, in general person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed regularly.

Risks to the health, safety and wellbeing of people who used the service had, in general been assessed. However, where risks were identified these were not consistently incorporated into the care planning system.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided good information about how people needed to be assisted from the building, should the need arise.

A range of internal checks were regularly conducted and environmental risk assessments were in place, showing that actions taken to protect people from harm had been recorded. However, we found that several fire doors did not fully close into the door frames. This created a potential fire hazard. We observed that in one person’s bedroom there was a very large stuffed toy and an abundance of smaller soft toys. None of those we looked at were labelled as being fire retardant. We have made a recommendation about this.

Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer’s recommendations. This helped to protect people from harm. Infection control practices could have been better in some areas.

Records showed that Mental Capacity Assessments had been conducted in some cases, in order to determine capacity levels. However, there was a ‘Do Not Attempt Cardio-Pulmonary Resuscitation’ record on one care file, which was not fully completed or signed by a medical practitioner.

The rights of people were not always protected as applications to deprive someone of their liberty for their own safety had not always been obtained for restrictive practices. People's privacy and dignity was consistently respected.

The service had reported any safeguarding concerns to the relevant authorities and suitable arrangements were in place to ensure that staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. A range of training for staff was provided. However, staff on duty appeared to be rushed during busier periods of the day, such as meal times. We have made a recommendation about this.

Recruitment practices adopted by the home were robust. Appropriate background checks had been conducted, which meant that the safety and well-bei

People who lived at Aarondale Care Home were positive about their experiences and the comments received reflected this One person living at the home stated, "I'm well looked after here. It's alright here. Everybody's friendly". Another person using the service told us, "I like the girls who look after me".

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

Staffing levels were found to be sufficient to ensure the safety of residents at all times throughout the day and night. A suitable system was in place to ensure that residents' needs were catered for with extra staff being introduced if needed.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We talked with three staff and nine people who live at the home as well as family members.

We looked at the care plans for three people who lived at the home to see how their needs should be met.

We found that all the people who lived at the home were supported and encouraged to maintain their independence and family contacts.

People living at the home told us that they were satisfied with the food provided by the home and if they didn't like something they could ask for an alternative and this would be provided.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

People living at the home told us that they felt safe at the home. They told us they had no concerns or complaints about their care but would speak with the owner, manager or the staff if they needed to.