Aspen House Care Home

Aspen House is a 'care home' providing accommodation and personal care to up to 15 people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. At the time of the inspection there were 12 people living at the home.

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

People and their relatives described a homely atmosphere at Aspen House where they felt safe and secure. Staff demonstrated a good understanding of how to safeguard people from abuse and systems for managing risks to people ensured that staff had the information they needed to provide care safely. A relative told us, “The home is small and homely enough to be just right. People are very safe and well cared for there.”

People were supported by staff who were receiving the support and training they needed to be effective in their roles. People’s needs were assessed, and records reflected the care provided. Staff supported people to access health care service when they needed them. People spoke highly of the food and staff supported people to have enough to eat and drink. 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.

People had developed positive relationships with staff who knew them well and had a good understanding of their needs. Staff were responsive to changes in people’s needs and people were receiving a personalised service. One person said, “The staff are very kind and caring and they do spend time with us.” Staff were mindful of supporting people’s dignity and maintaining their privacy.

Systems for monitoring quality were effective and the registered manager had good oversight of the service. People, relatives and staff spoke highly of the management of the service. They described an open and positive culture at the home where people and staff were able to express their views and felt listened too.

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 requires improvement (published 5 November 2020). At this inspection the rating had improved to good.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aspen House is a 'care home' providing accommodation and personal care to up to 15 people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. At the time of the inspection there were 11 people living at the home.

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

People and their relatives told us they were happy with the support provided by staff. One person said, “I’m very happy. They are good to me. Well, good for everybody.” Although the provider had put in place necessary visiting restrictions during the COVID-19 pandemic, family members told us that they had seen improvements in the home in the past year. One relative said, “There has been a genuine attempt to make change.”

Despite the need to keep people safe taking priority during the COVID-19 pandemic, the registered manager had consistently worked to address the areas identified for improvement following the last inspection. For example, the management of risks to people’s safety was more robust, and the information staff needed to deliver safe and effective care was consistent and accurate. People had enough staff to support them. Staff understood people’s individual care needs well and how to support them safely. One person said, “Staff sort it out for you.”

Quality systems were more robust and consistent in identifying when changes needed to be made to people’s care. The register manager had recognised their need for support and direction in this area and had sought guidance from an external quality advisor and the local authority’s quality commissioning team. The registered manager had become more confident in their oversight of people’s care and support and had a system in place to consistently review people’s support.

The registered manager and staff had worked to ensure the appropriate infection control procedures for the pandemic were in place to keep people safe. People were living in a clean environment where staff were diligently following enhanced procedures to ensure that they, and the people at the home, were as protected as possible. One relative said, “I’ve always found it clean and tidy.”

Rating at last inspection and update

The last rating for this service was Requires Improvement, report published 4 July 2019. The home had been rated 'Requires Improvement' on four consecutive occasions. They were in breach of regulation 12 and 17. At this inspection, enough improvement had been made and the provider was no longer in breach of regulations.

Following the last inspection, we met with the provider and formally requested specific information and documentation under regulation 17 of the Health and Social Care Act 2008. From 1 July 2019, the provider needed to complete, and send to CQC, an ongoing monthly action plan to demonstrate how they would make the necessary improvements.

Why we inspected

We undertook this announced, focused inspection to confirm that the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

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 assurances that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aspen House Care Home on our website at www.cqc.org.uk.

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.

Aspen House 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. The care home can provide accommodation and personal care for 15 older people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. There were 12 people living at the home at the time of our inspection.

The home had a registered manager who was also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection in November 2017, we found the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They were in breach of regulation 12 for not ensuring people were provided with safe care and treatment by assessing and mitigating risk to service users, and regulation 17 for not ensuring that adequate systems and processes were in place to enable them to fully assess and identify where safety was compromised. The service was rated as ‘requires improvement’.

We asked the provider to complete an action plan to show what they would do, and by when to improve the key questions of safe, effective, responsive and well-led. We also asked them what they would do to meet the legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that improvements had not been made and that the provider remained in breach of regulations 12 and 17.

At this inspection improvements had been made in some areas, for example people’s medicines were now being stored and monitored safely. The provider was no longer in breach of regulation 13 and had ensured that they were taking steps to safeguard people from abuse. However, further improvements were identified and required, including the breaches of regulation in relation to providing safe care and treatment and good governance.

The provider remained in breach of regulation 12 as people were not always protected from the risk of harm as risks to safety and incidents were not always identified or effectively managed.

The provider remained in breach of regulation 17 as quality assurance systems and audits to monitor and oversee care were ineffective. Care plans, risk assessments and guidance had failed to be updated despite records showing that quality assurance checks and audits had taken place.

Information relating to some people’s as and when medication was incorrect. This had not been identified despite medicines audits being completed.

Appropriate actions had not been taken to learn or improve from mistakes and changes when they had occurred.

There continued to be a lack of consideration, care planning and guidance on how to best support people living with dementia. The provider could further explore guidance on ensuring a more dementia friendly environment.

Care plans and risk assessments were not always detailed and personalised and did not always reflect the changing needs of the person.

Staff received ongoing training to meet the needs of people at the service, although improvements were needed in the management of ongoing competencies for the administration of medicines.

People’s communication and information needs had not been fully addressed across the service. We have continued to make recommendations in relation to the sourcing of information to inform compliance with the Accessible Information Standard.

Improvements in supporting people’s food choices had been sustained and people’s nutrition and hydration needs were being met.

The provider had systems in place to monitor the health and safety, to prevent and control infection and to assess and lesson mitigate environmental risks to the service.

Systems were in place to ensure that people were safeguarded from abuse. The provider had demonstrated improvements in its reporting structure and staff demonstrated a good understanding of the indicators of abuse and how to report any safeguarding concerns.

Complaints were recorded and people and relatives knew how to complain if they needed to.

Staff we spoke with understood the requirements of the MCA and people had access to advocacy services to promote their choice and rights in line with legislation. People were supported in line with the principles of the Mental Capacity Act (MCA) 2005.

People and their relatives told us that the staff were caring. We observed people and staff interacting in a happy comfortable manner. People’s privacy and dignity was respected, and people were supported to express their views and be involved in decisions about their care. There were sufficient number of staff to support people to stay safe and meet their needs.

People were supported with compassionate care at the end of their lives.

Staff worked well together within and across organisations and supported people to access healthcare services and lead healthier lives. The provider worked in partnership with other agencies.

Aspen House 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. The care home can provide accommodation and personal care for 15 older people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. There were 12 people living at the home at the time of our inspection.

The home had a manager who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. At the time of the inspection the registered manager was on planned absence and had notified the CQC of this as is legally required. They had made provision for the deputy manager to be supported by a consultant during this time and were also available if the deputy needed guidance.

At the last inspection on the 19 July 2016, we found one breach of the regulations and that the provider had met previous breaches of regulation. The home was rated as ‘Requires Improvement’ and we asked the provider to provide us with a report on the actions they planned to take in response to the breach. The provider wrote to us to say what they had done to meet the legal requirements in relation to failing to display performance assessment ratings. We undertook a comprehensive inspection on 18 and 19 December 2017 in response to information of concern we had received about the home, and to check whether the required action had been taken to address the breach previously identified. This report discusses our findings in relation to this.

At this inspection improvements had been made in some areas, for example the ratings of the home were now clearly displayed, so there was no longer a breach of this regulation. People had more choice in relation to their food choices and overall meal time experience. However, further areas of improvement were identified, including breaches of regulation in relation to safeguarding people from abuse, providing safe care and treatment and notifying us of significant incidents.

People were not always protected from the risk of abuse or potential abuse. Staff could tell us about different types of abuse and how they should report it. However, in at least three incidences, peoples’ wellbeing was not promoted as the registered manager did not effectively identify, or act on evidence that abuse may have occurred. They also failed to notify the CQC of these incidents and the local safeguarding bodies, or do so in a timely way.

People were not always protected from the risk of harm as risks to safety and incidents were not always identified or effectively managed. Where accident and incidents had been identified and records completed, action had been taken to reduce the risk of reoccurrence. However, one person’s care records contained body maps detailing three separate potential injuries relating to skin integrity. On each occasion, although the staff took action to ensure medical advice and treatment was accessed, the cause of the injuries were noted as ‘unknown’ and not investigated or analysed to effectively mitigate the risk of further injuries.

Practice around the administration and storage of medicines was not consistently safe. People’s prescribed medicines were not always available or given in a timely way. Staff did not always ensure that medicines were securely stored, monitored, and available or kept at a suitable temperature.

Communication at the home was not consistently effective. Staff and relatives told us the registered manager and deputy manager were always very accessible at the home. They were also confident that they could discuss concerns with them and they would be heard. However, we had some feedback from relatives that the provider had not always been open to feedback or communicated in a timely way in relation to a change in needs or wellbeing.

People living with dementia and additional complex needs, such as reducing mobility did not always receive personalised care and support. The changing needs of people living with dementia and additional mobility issues were not always considered and consistently supported by detailed care plans. We have made recommendations in relation to the sourcing of information about the design of homes for people with living with dementia.

The provider had systems in place to monitor medicines, health and safety and environmental risks through audits and checks of accidents and incidents. However these systems did not always identify risks where individual’s needs changed or identified poor practice. For example ‘as required’ medicines being available.

People told us that the staff caring and nice. We observed people and staff interacting in a happy comfortable manner.

Complaints were recorded and people and relatives knew how to complain if they needed to. However, the provider did not always identify or act suitably to concerns that needed to be addressed through the local authorities safeguarding procedures. Therefore people’s rights to be safe from the risk of potential abuse and harm were not always protected.

Improvements in supporting people’s food choices had been made. People were involved using pictures to help them decide what meals they wanted. People told us they liked the food, and had more food options to choose from. People’s dietary and nutritional needs were met. We have made recommendations in relation to the sourcing of information and training to inform compliance with the Accessible Information Standard.

Relatives and visitors told us that overall the care was good. People’s initial preferences and choices for care and support were considered. Relatives told us that staff were knowledgeable and encouraged choices and recognised that the needs and capacity of people living with dementia changed. One relative told us, “On the whole I am happy with the way they are being looked after.”

People’s practical needs were met by sufficient numbers of staff and safe recruitment processes were followed. Staff were very positive about how the home was managed. Staff told us that they felt well supported and that regular supervisions and team meetings took place. Staff received support and guidance and had good access to training that ensured they had the skills required for their role in care.

People received support from healthcare professionals when required. GP’s, district nurses, opticians, and chiropodists regularly visited to support people to maintain good health. A relative told us that their relative was visited regularly by health professionals and that, “I like the fact that others are there to look out for them”. Records demonstrated that people regularly had appointments with health professionals.

Staff we spoke with understood the requirements of the MCA and people had access to advocacy services to promote their choice and rights in line with legislation. People were supported in line with the principles of the Mental Capacity Act (MCA) 2005. People felt that they could make some choices and relative felt they were treated as individuals and that their privacy was respected. One relative told us, “They treat my relative as an individual; they talk to her, rather than at her”.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Aspen House provides accommodation for up to fifteen older people. On the day of our inspection there were twelve people living at the home. The home provides support for people living with varying stages of dementia along with healthcare needs such as diabetes and epilepsy. Accommodation was arranged over two floors with stairs and a stair lift connecting both levels. There was a communal lounge, a quiet lounge, dining room and gardens. The home is situated in Hove, East Sussex.

The home had a manager who was also the registered provider A registered provider is a ‘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 carried out an unannounced comprehensive inspection on 6 and 8 May 2015. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. At the inspection on 19 July 2016 we found that significant improvements had been made, however, we found a breach of legal requirements in relation to the failure to display performance assessment ratings. Further areas that needed improvement related to peoples’ dining experience and the lack of choice in relation to food, as well as the lack of signage and adaptation of the building to assist people, who were living with dementia, to orientate around the building.

Part of the requirements of the provider’s registration is to ensure that when their service is inspected by CQC, that they display their performance assessment rating to provide members of the public with an awareness of the rating of the service. The provider had not displayed the rating of the previous CQC inspection and therefore this was an area of concern.

People had sufficient quantities to eat and drink and were happy with the food. However, people told us that they didn’t get enough choice in relation to the food that was provided. One person told us “There’s a bit of choice at breakfast but you can’t have a cooked breakfast or anything like that and at lunchtime it’s a main meal in the dining room. You never know what it is unless it’s Friday and you know it’ll be fish then”. People were able to choose where they ate their meals, most deciding to eat in the main dining area. Independence, with regard to eating and drinking, was not consistently promoted. Although people were observed to be independently eating their food, observations showed a member of staff moving from person to person mixing their food and putting spoonful’s to people’s mouths. People appeared not to welcome this support, which did not promote people’s dignity or independence. This is an area of practice in need of improvement.

All of the people living in the home were living with dementia. Although the home provided a homely and relaxed atmosphere there were no adaptations or clear signage for people to orientate and know where their rooms, or other parts of the building were. Some people’s rooms had been furnished with their possessions and items that were important to them, whereas others were bare and stark and did not create a homely atmosphere. This is an area of practice in need of improvement.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments were personalised and ensured that risks were managed and people were able to maintain their independence. There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

Sufficient numbers of staff ensured that people’s needs were met and that they received support promptly. People told us that they felt safe. When a visiting healthcare professional was asked about the staffing levels, they told us “Definitely enough staff, they chat with them, they’re not left”. Another healthcare professional told us “There are always lots of staff around and on hand”. Staff were suitably qualified, skilled and experienced to ensure that they understood people’s needs and conditions and plans were in place to provide training for newer members of staff. Essential training, as well as additional training to meet people’s specific needs, had been undertaken or was planned. People told us that they felt comfortable with the support provided by staff. One person told us “I only have to ask and they help me or get it done”.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. Staff were aware of the legislative requirements in relation to gaining consent for people who lacked capacity and worked in accordance with this. People confirmed that they were asked for their consent before being supported and our observations confirmed this.

People’s healthcare needs were met. People were able to have access to healthcare professionals and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services. One person told us “I had the chiropodist just the other day so my toe nails are quite alright”.

Positive relationships between people and staff had been developed. There was a friendly, caring and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People were complimentary about the caring nature of staff, one person told us “I find they are very kind to me”.

People’s privacy and dignity was respected and their right to confidentiality was maintained. People were involved in their care and decisions that related to this. Care plan reviews, as well as residents meetings, enabled people to make their thoughts and suggestions known. People’s right to make a complaint was also acknowledged, however, people told us they were happy and had no complaints. One person told us “I don’t worry about anything in here, no complaints”. Another person told us “I can’t complain about anything, but I would if necessary”.

People received personalised and individualised care that was tailored to their needs and preferences. Person-centred care plans informed staff of people’s preferences, needs and abilities and ensured that each person was treated as an individual. Staff had a good understanding of people’s needs and preferences and supported people in accordance with these.

People, staff and healthcare professionals were complimentary about the leadership and management of the home and of the approachable nature of the management team. One member of staff told us “I love being here, it is a friendly, happy place, a lovely home”. Another member of staff told us “I feel privileged to work here”. There were quality assurance processes in place to ensure that the systems and processes within the home were effective and ensured that people’s needs were being met and people were receiving the quality of service they had a right to expect.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt settled and at home at the service.

Systems were in place to make sure that all staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Feedback was sought from people and their relatives which helped the service develop and learn.

The service was clean and tidy. We found that shortfalls highlighted at the last inspection of the service had been addressed and people from safeguarded from the risk of cross infection.

Staff handled medicines safely. We found that shortfalls highlighted at the last inspection of the service had been addressed. Recording of medicines administered was now accurate and up to date.

Is the service effective?

People had their care needs assessed and staff understood what people's care needs were. Care records were accurate and fit for purpose and had been reviewed regularly to reflect any change in care needs.

People's health needs were monitored and the service worked well with outside healthcare professionals including General Practitioners (GP) and district nurses.

Staff received mandatory training and felt confident in providing care and support to people.

Is the service caring?

People were supported by kind and attentive staff. Observations reflected that people looked content in the service and care workers knew their care needs. People told us, 'I'm very happy here, it has a general nice atmosphere and I get on with everyone.' Another person told us, 'I'm settled down here.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive to people's needs?

People completed a range of activities. The service employed a dedicated activities co-ordinator who provided arts and crafts, music and exercise stimulation.

Resident and staff meetings were held to explore how positive changes could be made.

There was a complaints policy and procedure in place if people were unhappy, which was monitored by the provider. Since our last inspection, the provider had received one complaint which was acted upon immediately. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

During our inspection, we spoke with four members of staff, these included the deputy manager, two care workers and a member of housekeeping. We also spoke with two people who used the service and a visiting relative. A significant number of people were unable to express their views verbally, so we carried out structured and other observations to better understand their experience.

People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Staff we observed had an understanding of the support needs of people who used the service and were confident about meeting those needs. A relative told us, 'Care staff treat the people with dignity and respect. They do activities such as painting and a singer who comes in and I think my loved one is very happy here.'

People we spoke with told us they thought the service was kept clean. However, we saw that there was not an effective system in place to reduce the risk and spread of infection.

Medicines were stored safely however shortfalls were identified in relation to ordering, administration and recording of medicines, which placed people at risk of unsafe medication practices.

People who used the service were protected against the risks of unsafe premises.

Records were stored safely but shortfalls were identified in relation to records. Not all care records were accurate and fit for purpose.

This told us people or their representatives had been able to express their views about the care provided, and where possible people who used the service had been involved in making decisions about their care and treatment.

People's care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

People's care had been provided by care workers who understood their care needs. One person who used the service commented, 'I am very comfortable here, with three meals a day.'

People knew who to talk with if they had any concerns about the care provided.