Aspen Place

Aspen Place is a residential care home providing personal and nursing care to up to 52 people. The service provides support to younger and older adults who live with physical disabilities and people living with dementia or learning disabilities. At the time of our inspection there were 50 people using the service.

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

People and relatives told us there was not always enough staff. One person told us, “They tell you to ring the bell. The wait times varies.” Relatives gave examples of their concerns about staff responses to call bells. Their comments included, “I did press the buzzer in an area out of the room and no one came for quite a while.” And “There are normally enough staff but at weekends it seems lower.” The provider was in the process of monitoring staffing levels to ensure people received timely support.

People’s care was not always person-centred. Some people had limited opportunities to take part in activities and were reliant on staff to facilitate this.

We have made a recommendation about expanding the adaptions within the environment to support people living with dementia.

People had their health care needs met. Some healthcare professionals spoke positively about how the staff had engaged with them but in some situations, visiting professionals spoke of potential delays in contacting community healthcare professionals.

Monitoring audits had not always identified concerns about person centred care or the feedback from some healthcare professionals.

People and their relatives told us they felt safe and were cared for by staff who knew them well. One relative told us, “I do know who to report to if we felt that my [loved one] was unsafe.”

People received their medicines as prescribed and medicines were managed safely. Accidents, incidents and safeguarding concerns were reported and investigated as required and actions taken to prevent reoccurrence. People were protected from the risk of abuse and staff were aware of their safeguarding duties and how to report concerns.

People were supported by staff who had completed training in line with people’s needs. Staff were recruited safely and received supervision where opportunities to develop and feedback about their practice were discussed. 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.

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 good (published 09 May 2019)

Why we inspected

The inspection was prompted in part due to concerns received about the experiences of people living in the dementia unit and pressure area care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led section of this full report.

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.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect

Aspen Place was previously known as Greenways Nursing Home. The service has undergone extensive remodelling and refurbishment which included extending the service to accommodate more people. Aspen Place is registered to provide nursing and personal care and support for up to 52 older persons living with dementia or nursing needs. The service provides long term and respite care. At the time of our inspection there were 39 people living at the service.

People’s experience of using this service:

We spent time with people during our visits and without exception feedback received from people living in the service was extremely positive. People and their relatives said that the service was of a high standard. People were cared for by genuinely kind and compassionate staff who were dedicated and committed to ensuring that people received the care they needed and wanted.

The remodelling and refurbishment of the service was of a high standard. The service had embraced the use of technology to enhance people’s quality of life. Feedback received included, “The open plan kitchen is a fabulous idea. The residents really benefit from it. They can see what’s going on and ask for a snack whenever they want. It has more of a restaurant / hotel vibe”, and, “There’s always someone about. It feels safe. The hustle and bustle is like normal life. The kitchen is great, they like to watch the chef and chat.”

People's wishes for their end of life were clearly documented and the care and support provided was exceptional. Staff demonstrated a depth of compassion and empathy and genuinely cared for people they supported.

The management and staff created a warm and relaxed environment and we observed a strong caring relationship between people and all grades of staff. Relationships were professional, but two way and people knew about the registered managers and staff families and interests which helped maintain these relationships.

People received care from a dedicated staff team who were very kind, caring and compassionate. Staff had built very strong relationships with people.

There were quality assurance systems in place to help monitor the quality of the service, and identify any areas which might require improvement. The provider and registered managers listened to feedback and reflected on how the service could be further improved.

The service was well led. The provider's values and vision were embedded into the service, staff and culture. The provider and registered managers were passionate and committed to developing a service where people received genuinely person-centred care. This was evident throughout our visit.

The service was safe, with systems and processes which ensured that any concerns were reported to appropriate authorities without delay.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection we rated the service good. The last inspection report was published 13 June 2016. At the inspection we found that the lack of outside space was an area in need of improvement, this was due to the building work at the time of the inspection. Following the completion of the building work this shortfall has been met.

Why we inspected:

We completed a planned inspection based on the previous rating of Good.

Follow up:

We will review the service in line with our methodology for 'Good' services.

The service had 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 registered manager was not available on the day of inspection but the provider was on site supporting the service and was present throughout the inspection.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We looked at this and other information we held about the service. This included previous inspection reports and notifications. Notifications are changes, events or incidents that the service must inform us about. We contacted stakeholders, including health and social care professionals involved in the service for their feedback.

Greenways Nursing Home has been undergoing extensive building work over the past 12 months. There were appropriate risk assessment and arrangements in place to reduce the impact of the building work such as noise, however people did not have access to an outside space and we identified this as an area that required immediate improvement. There were plans in place for a temporary outside space for people and the provider agreed to have this area completed by the end of April.

There was a system in place to monitor reported accidents and incidents. However, reporting of accidents and incidents was not consistent which meant that the risk of recurrence was not always managed appropriately and this was identified as an area which needs improvement.

Lifting equipment such as hoists and slings were stored in the dining room. This represented an infection control risk and the provider agreed to find an alternative place to store these items.

People were protected from harm. Staff had received safeguarding training, knew how to recognise the signs of abuse and understood their responsibilities to report any concerns or poor practice.

Individual risk assessments were in place to ensure that people’s health needs were appropriately managed and these were updated regularly and in accordance with any guidance from health care professionals. Planned care accurately reflected care delivered. Environmental risks were managed through regular checks and servicing and there were emergency plans in place for the service and individuals.

There were sufficient numbers of skilled staff on duty to support people’s needs. Safe recruitment practices and the use of regular temporary staff through an agency ensured continuity and maintained the quality of support offered to people.

The management of medicines was safe. People received their medicines from nurses correctly and on time. The nurses were knowledgeable and experienced and knew people well.

Staff received induction when joining the service. Staff felt supported and encouraged. They received regular supervision and appraisal and there were individual staff development plans in place.

The service acted in accordance with the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the support they receive. Consent was sought from people with regard to the care that was planned and delivered. Where people were unable to make decisions for themselves staff had considered the person’s capacity under the Mental Capacity Act 2005 and applied for DoLS authorisations where appropriate.

Meal times were an enjoyable experience for people who were supported by staff and the chef to make their own meal choices. Food was described by relatives as, “Very tasty whatever, “and “Very good.” People were assisted at their own pace to eat and drink and those with difficulties eating and drinking or who required a special diet were appropriately supported according to the advice of health care professionals involved in their care.

Peoples’ health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into peoples’ support plans.

People were assisted in a caring and respectful manner. Staff and relatives worked together to create a warm and inclusive environment and people were cared for with dignity. Staff supported people at their own pace and encouraged people to make day to day choices whenever possible. A member of staff told us that their colleagues, “Talk to residents calmly with respect. If down in the dumps they try to cheer them up.”

Care was person centred. A social care professional commented, “They are doing well on care.” A new member of staff told us, “All I have seen is good care.” There was a purposeful activities programme in place and people were included in their local community through volunteers and other community organisations involved with the service.

There was a complaints policy and procedure in place and any complaints were dealt with appropriately and within reasonable time scales. Relatives and health care professionals told us that any concerns raised were dealt with promptly by the registered manager. Relatives were consulted at relatives meetings and through surveys and spoke positively about the service.

There was a robust quality assurance programme and data management system in place and records were easily accessible and well organised.

Staff, relatives and health care professionals had confidence in the registered manager who they described as visible and accessible. A member of staff described the registered manager as, “Right on it.” Another member of staff explained to us that the registered manager and the provider were considered part of the team by staff and that the team worked hard to make the lives of people living at the service as good as they could be.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well led?

This is a summary of what we found-

Is the service safe?

We found people experienced care and support that was planned and delivered in a way that was intended to ensure their safety and welfare. There was a system in place to monitor how many accidents or incidents had taken place over a given period. The head of care was able to demonstrate how they had been analysed to make sure that the manager and staff learned from such events. There were enough staff on duty to meet the needs of the people living at the home and a member of the team was available on call in case of emergencies. Staff personnel records contained all the information required by the Health and Social Care Act. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Before people received any care they were asked for their consent and the staff acted in accordance with their wishes. Staff took time to explain what was happening and made sure they agreed with any changes. Staff demonstrated an understanding and showed consideration when providing care to people with dementia. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Observations we made on the day of our inspection showed staff were experienced and had the skills they needed to support the people living at the home. Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions and their own responsibilities under the requirements of the Mental Capacity Act 2005.

Is the service caring?

During our visit all interactions we saw between the staff and the people who lived at the home were respectful. Support was offered and provided in a way that ensured people's rights to privacy and dignity. People were spoken with in a sensitive, respectful and professional manner. We saw that personal care was carried out in private and staff always knocked and awaited permission before entering people's private rooms. In our observations of interactions between staff and people who lived at the home, we saw people were respected. People's care plans were clearly written and person centred. Staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

We saw that people were asked their opinion during the day where a choice was available. Staff gave examples of how they had made changes to peoples care in response to people's requests. We were told that one person was not happy with having a pureed diet on admission to the home. The service arranged for the person to have another speech and language assessment. Following the assessment the service were able to make the requested changes. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. Staff were able to give examples of activities they had introduced in response to requests from people, this included decorating cupcakes, posting their own letters and, 'Enjoying a beer in the garden'.

Is the service well-led?

Staff we spoke with were clear about their roles and responsibilities. All said they received the advice and support they needed from their managers and colleagues. Since our last inspection we found that improvements had been made in relation to the incident and accident reporting system. The provider had an effective system to regularly assess and monitor the quality of service that people receive against the requirements of the essential standards. An action plan had been drawn up to identify any actions that needed to be taken. We saw that shortfalls identified had been addressed promptly. We saw the manager's assessment of the outcomes we assessed during this inspection matched our own findings of compliance.

When we spent time observing the interactions between staff and people who used the service we found this to be positive, friendly and caring.

People also told us that they were happy with the environment that they lived in and the levels of cleanliness at the service.

We found that when people who lived at the service sustained an unexplained injury or bruising sufficient steps had not been taken to identify the cause of harm and protect them from further injury. We also found that recruitment practices did not always provide protection to people who lived at the service.

People using the service had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

We also spoke with the home's administrator, a nurse, four care staff and a cleaner

We were concerned that people's care was not always planned and delivered in a way that promoted their safety and welfare.

We were concerned that the environment and equipment was not clean and hygienic to minimise the risk of infection.

All of the people that we spoke with were complimentary about the service that they received at Greenways.

People told us that they were well cared for and that the staff were kind and respectful.

One person described the home as having a lovely atmosphere. They said, 'We are all friends here'.

Another person said, 'I am very happy to spend the rest of my days here."

On the day we visited we found the home had a calm and relaxed atmosphere, and saw staff interacting with people in a respectful and polite manner.