This inspection was carried out on 14 and 16 August 2018 and was unannounced.

Aynsley nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 19 people were living there when we visited, some of whom were living with dementia. The accommodation is provided in single and double rooms. However, no one was sharing a room at the time of the inspection. Access to the upper floors is by way of stairs or passenger lift.

At the last inspection on 19 July 2017 we rated the service requires improvement overall and in each of the five questions we ask. This was because improvements made since the previous inspection needed to be sustained.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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.

Improvements to the service provided identified at the last inspection had been maintained. However, we identified some gaps in the completion of some records that needed to improve.

People and relatives told us they felt the service was safe. People were protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe management of medicines. People were supported to get their medicine safely when they needed them. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed. 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 supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff felt fully supported by management to undertake their roles and were given training updates, supervision and development opportunities.

People were encouraged to express their views at meetings and results of customer satisfaction surveys were positive. People and relatives felt listened to and any concerns or issues they raised had been addressed.

Staff supported people to participate in activities of their choice and trips to the local shops and tourist attractions had been organised.

People were supported to eat and drink sufficient amounts and they were given time to eat at their own pace. People’s nutritional needs were met and people had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with commented positively on the caring and respectful attitude of a consistent staff team which we observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The ratings from the previous inspection were on display in accordance with requirements.

This inspection was carried out on 19 July 2017 and was unannounced. We carried out the inspection at this time because the home had been rated inadequate and was in special measures. We needed to check that improvements had been made to the quality and safety of the service.

We last inspected the home on 7, 8 and 15 February 2017 and found breaches of regulations 9, 10, 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because: The premises were not adequately maintained or refurbished and there was unsafe equipment in use. There had been very little training for staff and there was insufficient evidence that all new staff had been recruited safely. People’s capacity to consent to care and treatment had not been assessed and care plans did not adequately describe the individual characteristics of people living at the home. People’s dignity was not always upheld. There was a poor standard of record keeping and no evidence that the provider had oversight of the service being provided at the home.

During this inspection we found that improvements had been made in all of these areas but further improvements were required. However, in response to the improvements that had been made we took the service out of special measures.

As a condition of the provider’s registration with the Care Quality Commission, the home is required to have a registered manager. A registered manager is a person who has registered with the CQC 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 home has not had a registered manager for a long time. CQC has taken enforcement action in relation to this issue and the provider has paid a fixed penalty notice. The current manager has now submitted an application to CQC which is being processed.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 21 people were living there when we visited for this inspection.

During previous inspections we saw that people were potentially at risk from inappropriately fitted bedrails and from hot radiators. We also saw that maintenance records were incomplete. During this inspection we saw that all radiators had been fitted with protective covers and people who required the use of bedrails were provided with beds that were safe and suitable to meet their needs. We also saw records to show that equipment and services had been tested and maintained.

During our last inspection we were concerned that adequate arrangements were not in place to protect people from the risk of fire and we referred these concerns to the Fire Service. At this inspection we were able to see that the provider had taken appropriate action to address this.

During previous inspections we found that the premises were not adequately maintained and the home looked ‘tired’ and was in a poor state of repair and decoration in some areas. During this inspection we saw that a programme of redecoration and refurbishment was underway to provide a more pleasant environment for people to live in.

During previous inspections we found that staff records were poorly maintained and records relating to the recruitment and employment of new staff were incomplete. During this inspection we saw that this had been addressed and records relating to two new staff contained adequate information to show that they were safe to work with vulnerable older people.

During previous inspections we found that staff had not received the training and support they needed to work safely and effectively. During this inspection we saw that a programme of staff training and supervision had been put in place and was underway.

At our last inspection we found that the manager had not followed the requirements of the Mental Cap

We carried out this inspection on 7, 8 and 15 February 2017. We had previously inspected Aynsley Nursing Home on 18 and 19 February 2015, and 21 and 25 January 2016. On both of these occasions we found that the home required improvement.

As a condition of the provider’s registration with the Care Quality Commission, the home is required to have a registered manager. A registered manager is a person who has registered with the CQC 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 home had not had a manager who was registered with the CQC since August 2014. Following our last inspection we made the provider aware that this was a breach of the Health and Social Care Act 2008. We also wrote to the provider about this in July 2016.

This is a criminal offence with respect to Schedule 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Section 86 of the Health and Social Care Act 2008.

During this inspection we also found breaches of regulations 9,10, 11, 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the premises were not adequately maintained or refurbished and there was unsafe equipment in use. There had been very little training for staff and there was insufficient evidence that all new staff had been recruited safely. People’s capacity to consent to care and treatment had not been assessed and care plans did not adequately describe the individual characteristics of people living at the home. People’s dignity was not always upheld. There was a poor standard of record keeping and no evidence that the provider had oversight of the service being provided at the home.

Areas we had identified as needing improvement at our last inspection had not been addressed by the provider and there was no development plan to show how the service would move forward.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 25 people were living there when we visited for this inspection.

During our visits we saw that there were enough staff to support people and meet their needs. People we spoke with described the staff as kind and caring and we observed warm and respectful interactions between staff and people who lived at the home. However, two people had contacted CQC to tell us that their relative had not always received the care they required at Aynsley Nursing Home.

Records relating to the recruitment and employment of new staff were incomplete so did not provide evidence that staff recruitment had always followed safe procedures to ensure that new staff were of suitable character to work with vulnerable older people.

Staff had received training about safeguarding vulnerable people from abuse in September 2016, however little other training had taken place since 2015 and there was no training plan. Some staff had attended individual and group supervisions over the last year but there were no records to identify staff who may not have had supervision.

Some people were potentially at risk from inappropriately fitted bedrails and from hot radiators. Maintenance records were incomplete. This meant that we could not be sure that all equipment and services had been tested and serviced.

The service had not followed the requirements of the Mental Capacity Act 2005 because people’s capacity to make decisions about their care and treatment had not been assessed.

People’s needs were assessed before they moved into the home and referrals were made to medical professionals as needed. Care plans recorded people’s care and support needs but were not person-centred.

The manager completed a series of monthly quality audits but these were not verified in any way and had not identified the sh

We found that people who used the service and their relatives were very satisfied with the care given to them at the home. They told us that they were involved in care and treatment options and choices, they were treated with dignity and respect and felt safe and secure in the home. People were asked for their agreement before and during care delivery, although this was not always documented.

They told us:

“I am very happy here, they look after me very well”,

“It’s wonderful, they look after me very well”,

And relatives told us:

“It’s excellent, they are really committed to what they do”,

“Mum is well looked after, she calls it her home”.

We found care was assessed, planned and delivered according to the person’s individual needs. Staff were knowledgeable in safeguarding and there was access to the local safeguarding authorities guidance, policies and procedures.

We found there were suitable numbers of staff employed at the home and they were appropriately trained. However we found that some training was out of date and that service specific training, such as dementia, had not been undertaken for some staff.

The provider had systems in place to monitor the quality of service provided.

We spoke with a range of people about the home. They included the registered manager, staff members, people who lived at the home and two family members visiting their relatives.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "This home is homely and second to none.”

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.

We visited this service on 7th September 2011. Service users and their families told us that they were very satisfied with the care and treatment given to them at the home.

They told us that they were always involved in care and treatment options and choices. They were pleased with their home and felt their bedrooms were well kept and offered privacy and dignity. They felt safe and secure in the home.

Service users commented that they were very happy at the home and said such things as:

“its is brilliant here”, “fantastic”, “I love it here”, “the staff are very caring and can't do enough to help you”

Relatives also made positive comments such as:

“Mum loves it here”, “They have brought her on so much, she was very poorly when she first came here”, “I wouldn’t have wanted her anywhere else”.

We were told by service users and their relatives that the care is individualised and that it feels like home.

We inspected Aynsley Nursing Home on 21 and 25 January 2016. The first day of the inspection was unannounced. Our last inspection of the service was on 18 and 19 February 2015 when we found two breaches of regulations. The breaches we found were that the provider did not have suitable arrangements in place to assess and monitor the quality of the service being provided, and that the provider did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them. During this inspection we found that improvements had been made in both of these areas.

The service is registered to provide accommodation with personal care or nursing care for up to 28 people and 24 people were living there when we visited. The manager informed us that some of the registered places were in shared rooms which were now rarely used as shared rooms.

The home is required to have a registered manager but had not had a manager who was registered with the Care Quality Commission for more than a year. 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.

During our visits we saw that there were enough staff to support people and meet their needs, and people we spoke with considered there were enough staff. People we spoke with described the staff as kind and caring and we observed positive and respectful interactions between staff and people who lived at the home. Staff had received training about safeguarding vulnerable people from abuse.

The home was clean and there were no unpleasant smells. Some improvements had been made to the environment since our last inspection. Medicines were stored safely and people received their medication as prescribed by their doctor.

People were registered with local GP practices and the care plans we looked at gave details of people’s health needs. People’s needs were assessed before they moved into the home and referrals were made to medical professionals as needed.

Improvements had been made to the standard of meals and this was monitored regularly. People we spoke with were satisfied with the food they received. People told us that they enjoyed the social activities provided.

Care plans recorded people’s care and support needs and were being rewritten in a more person-centred format.

Some people were potentially at risk from inappropriately fitted bedrails.

There was no staff training programme in place.