About the service:

Ayresome Court is a residential care home that was providing accommodation and personal and nursing care to 36 people aged 65 and over at the time of the inspection.

People’s experience of using this service: People told us they received a good service and they felt safe and secure living at the home. Staff knew how to keep people safe and were trained in safeguarding and how to reduce the risks of harm from occurring.

Robust recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Medicines were managed, stored and administered safely by staff trained for this role.

Staff received appropriate training and support to meet people’s individual needs and to use equipment safely.

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.

People were supported to have enough to eat and drink.

Appropriate healthcare professionals were effectively engaged in peoples care and support as and when this was needed.

People spoke positively about the deputy manager and the wider management team. There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

There were systems in place for communicating with staff, people who used the service and their relatives to ensure they were fully informed via team meetings, newsletters and relative and resident meetings.

People had strong links to the local community through regular access to the local facilities and from the management building relationships with local services.

Rating at last inspection:

The rating at the last inspection was good (28 April 2018) www.cqc.org.uk

Why we inspected:

This inspection was brought forward as a result of concerns raised to us regarding care for people at risk of pressure sores and a safeguarding incident.

Follow up:

We will continue to monitor information we receive about the service. If any concerning information is received, we may re inspect sooner.

This inspection took place on 20 March 2018 and was unannounced. This meant the registered provider did not know we would be visiting.

Ayresome Court Nursing Home was last inspected by the Care Quality Commission (CQC) on 18 January 2017 and was rated Requires Improvement overall and in two areas, Safe and Well led. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments and regulation 17 regarding governance and monitoring of medicines and risk assessments.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider had completed actions necessary to meeting the above regulations.

Ayresome Court Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ayresome Court Nursing Home provides nursing and personal care for up to 43 people. At the time of our inspection there were 37 people living at the home.

There was 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.

At the last inspection we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. This was in regard to the preparation of medicines for administration and also incorrect administration of covert medicines (medicines are given disguised in food)

At the last inspection we found risk assessments were not managed or monitored appropriately. At this inspection we found that risks to people were assessed and monitoring had improved. Risk assessments were up to date and individualised. These were in place to ensure people could take risks as part of everyday life and minimise any potential harm by mitigating risks.

Accidents and incidents were monitored by the registered manager to highlight any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

The premises and people’s rooms were exceptionally clean and tidy and throughout the inspection we saw staff cleaning communal areas. Staff had access to plenty of personal protective equipment.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

Staff were regularly supported to maintain and develop their skills through a range of training and development opportunities.

Staff were encouraged to become ‘champions’ in selected areas to increase their knowledge in a subject area and also share learning with the rest of the team.

We found the registered manager had completed regular supervisions and appraisals with staff, which gave them the opportunity to discuss their care practice and identify further training needs.

People’s health was monitored and referrals were made to other health care professionals where necessary, for example, their GP.

People’s rights were valued and people were treated with equality, dig

This inspection took place on 18 January 2017. The service was last inspected in February 2015 and at that time required improvement in the effective domain due to the lack of detail in the records for people who had a Deprivation of Liberty Safeguards authorisation. At this inspection we found that improvements had been made.

Ayresome Court is a 43 bedded purpose built care home providing both nursing and personal care primarily to older people. It is situated on the outskirts of Yarm and in close proximity to public amenities.

There was a registered manager in place who had been registered with the Care Quality Commission since 2014. 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 systems were not always in place to ensure that people received their medication as prescribed. One person who was having their medicines crushed had no record from the pharmacist or GP giving permission to do this, and no record was in place in the person’s care plan. Another person self-administered their medication but there was no record of a risk assessment or a check to make sure this person was, and continued to be, competent to self-administer their medicines.

Risk assessments relating to peoples’ health and support needs needed more detail and updating to ensure they reflected the individual’s current needs. Risks were still in people’s care plans when they were no longer relevant. The service used a form called ‘recent daily records,’ which staff used to document fluid input and output, however these were not always completed. When people took their food and fluid via a Percutaneous Endoscopic Gastrostomy (PEG) feed, the records did not always match with the dieticians feeding regime.

Risks to people arising from the premises were assessed, and plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.. Staff were given effective supervision and a yearly appraisal.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The registered manager understood their responsibilities in relation to the DoLS that were in place.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food at the service, and that they enjoyed it.

The service worked with external professionals to support and maintain people’s health. Staff knew how to make referrals to external professionals where additional support was needed. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

We found the interactions between people and staff were cheerful and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. People and their relatives spoke highly of the care they received. People had access to a wide range of activities, which they enjoyed.

Procedures were in place to support people to access advocacy services shoul

We carried out an unannounced focused inspection of this service on 21 July 2015. The inspection team consisted of one adult social care inspector.

At the last unannounced, comprehensive inspection on 4 February 2015, we identified breaches of the Care Quality Commission Registration Regulations 2009. We asked the provider to take action to make improvements. We asked the provider to ensure they notified CQC without delay of the incidents specified in paragraph 4A of Regulation 18 Care Quality Commission Registration Regulations 2009 in relation to a request to a supervisory body for standard authorisation under the 2005 Mental Capacity Act. We also asked the provider to ensure they had 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 under Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 - Consent to care and treatment. The provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this focussed inspection to check that the registered provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the previously identified breaches of regulation.

Ayresome Court provides nursing and personal care for up to 43 people, close to Yarm and Stockton.

The service had 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.

We saw that appropriate mental capacity assessments had been undertaken and submitted to the authorising body as appropriate, although work was still required to make sure these assessments were consistently completed. The service had also sought help, advice and training from the local authorising body, which they said had helped them complete assessments and understand the process and implications of the Deprivation of Liberty Safeguards (DoLS) better.

Since the last inspection the service had submitted notifications about all notifiable incidents and DoLS authorisations to the Care Quality Commission as required and these had been done in a timely manner.

We looked at the care plans for four people who were currently subject to a Deprivation of Liberty Safeguard authorisation. Although all relevant paperwork was completed and in place in relation to the authorisation process, further information was not consistently recorded regarding best interests’ decisions or whether lasting power of attorney was in place for some individuals.

Whilst it was recognised the service had significantly improved in ensuring appropriate DoLS and mental capacity assessments were in place since the last inspection in February 2015, further work was still required to ensure the service fully meets the requirements of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 - Consent to care and treatment.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ayresome Court on our website at www.cqc.org.uk

This inspection took place on 4 February 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Ayresome Court provides care and accommodation for up to 43 people. It is situated on the outskirts of Yarm and in close proximity to public amenities. The home provides personal and nursing care. On the day of our inspection there were 34 people using the service.

The home did not have a registered manager in place. The manager had applied to become registered with CQC and was going through the process to be registered at the time of our visit. A registered manager is a person who has registered with the Care Quality Commission (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.

Ayresome Court was last inspected by CQC on 6 August 2013 and was compliant.

People, who used the service, and family members, were complimentary about the standard of care at Ayresome Court.

People told us they felt safe at the service. We saw that staff were recruited safely and were given appropriate training before they commenced employment. There were sufficient staff on duty to meet the needs of the people. The staff team were very supportive of each other.

Medicines were stored in a safe manner. We witnessed staff administering medication in a safe and correct way. Staff ensured people were given time to take their medicines at their own pace.

There was a programme of staff supervision in place that the new manager had established since joining the service at the end of 2014. Staff told us they had received training in mandatory subjects such as moving and handling and health and safety. Records of staff training were not well maintained although the new manager had a clear picture of people’s training needs and training was planned imminently.

We saw people’s care plans had been well assessed. Staff told us they referred to care plans regularly and they showed regular review that involved. We saw people being given choices and encouraged to take part in all aspects of day to day life at the service.

The service encouraged people to maintain their independence and the activities co-ordinator ran a full programme of events, which included accessing the community with people and helping people keep in touch with their families.

The service undertook regular questionnaires not only with people who lived at the home and their family but also with visiting professionals. We also saw a regular programme of staff and resident meetings where issues where shared and raised. The service had an accessible complaints procedure and people told us they knew how to raise a complaint. This showed the service listened to the views of people.

Nursing staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but not every staff member knew about the requirements of the Act. Records were inconsistent and did not show that staff had always appropriately completed capacity assessments. Some were of good quality and involved the person whilst they were not in place for other people or partially completed in others. The manager stated they would address this straight away. This was a breach of Regulation 18 (Consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have asked the provider to take at the end of this report.

During the inspection we spent time observing the interactions with staff and people who used the service. We spoke with 15 people and five relatives. We also spoke with the manager and a number of staff of different grades and roles.

All of the people we spoke with were very satisfied with the care they are receiving. One person said, “The carers are angels.” Another said, "The staff are marvellous. They make this place like a home from home”. Another commented, "The carers are excellent. They do the extra little things we need”.

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for help. We saw that staff communicated well with people and explanations of care were given.

We found that people had nursing and care plans in place that were up to date and reflected their nursing and care needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that people lived in an environment that was homely, clean, well maintained and safe. Although, some upgrading was needed to areas, which we found the provider had planned to complete.

We found that people’s needs were generally met by sufficient staff, although additional recruitment was underway for registered nurses and bank care workers.

We spoke with three people who lived at Ayresome Court and had informal discussions with two others. We spoke with the manager and four staff and spent time observing life within the home. We observed staff interacting with people, giving appropriate support and explanations. We saw staff engaging in a positive way with people, they were kind, sensitive and respectful. We observed people being offered a range of choices, such as options to remain in their own rooms, to have their meals in their rooms or spend time in the communal lounge.

People spoken with were confident that their nursing and care needs had been met. They said, "They know you as a person, not just a number and we know each other well enough so we can tease each other." A relative said, "They are so kind to the residents, always stop and chat, they show respect and are kind."

People had their nursing and care needs assessed, however we found that records were not always detailed enough, appropriate or available, which meant that there was the potential for people not to have their needs met.

From the records we looked at, we saw that there were good systems in place for ensuring effective recruitment of staff and that the environment was safe.