Aspray House

Aspray House is a residential care home providing personal and nursing care to younger and older adults in one adapted building. Care is provided over four separate units across four floors. At the time of this inspection there were 63 people using the service including people living with dementia.

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

The provider carried out building and equipment safety checks to keep people, visitors and staff safe from harm. People had risk assessments to mitigate the risk of harm they may face. Staff were recruited safely and there were enough staff on duty to meet people’s needs. People were protected from the risks associated with the spread of infection and their medicines were managed safely. Staff knew how to report safeguarding concerns. The provider had a system in place to learn lessons from accidents, incidents and complaints.

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. Staff asked for people’s consent before delivering care. People had their care needs assessed prior to admission. Staff were supported with regular supervision and training opportunities. People were supported to access healthcare and to meet their nutritional and hydration needs. The building was adapted to meet people’s mobility needs. The service was undergoing a redecoration and refurbishment programme.

Staff were observed to interact with people in a caring manner. People’s cultural and religious needs were met. People and relatives were involved in decision making about the care. Staff promoted people’s privacy and dignity and encouraged them to maintain their independence.

Care records were detailed and personalised. There were a variety of activities offered to people. People’s communication needs were met. The provider had a complaints procedure and complaints reviewed were dealt with appropriately. People’s end of life care wishes were documented.

People, relatives and staff spoke positively about the management of the service. The provider had a variety of quality audits in place to identify areas for improvement. People were able to give feedback through surveys and meetings. Relatives and staff had regular meetings where they could be updated on the service development. The provider worked jointly with healthcare professionals to improve outcomes for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 February 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we made a recommendation in relation to the deployment of staff. At this inspection we found improvements had been made and staff were deployed more efficiently.

At our last inspection we recommended the provider review their maintenance reporting procedures and risk guidelines. At this inspection we found improvements had been made and both the reporting procedures and risk guidelines were now more effective.

Why we inspected

This inspection was prompted by a review of the information we held about the service and in part due to concerns received about staffing levels, staff safety and general care people received. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from requires improvement to good based on the findings of 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 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 Aspray House on our website at www.cqc.org.uk.

Follow up

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

Aspray House is a residential care home providing personal and nursing care to people from the ages of 18

to over aged 65. Aspray House accommodates 64 people in one adapted building. Care is provided over four

separate units each of which have adapted facilities. Many of the people at Aspray House were living with

dementia. At the time of our inspection there were 63 people using the service.

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

Risk assessment guidelines were in place to reduce risk of harm in relation to faulty bed rails however we could not be assured they were being followed at the time of the inspection. Following the inspection, the provider confirmed these guidelines were being adhered to.

People had risk assessments in place to reduce the risk of falls. However, we could not be assured they were being followed at the time of the inspection.

We have made a recommendation about following reporting procedures and risk guidelines to ensure they are effective, and that staff understand and follow these.

Quality assurance systems to check bed rails were not effective as they did not provide information on what had been checked daily for safety purposes.

Relatives told us communication from the home and the ease in which they could contact management needed to improve.

We received mixed feedback about the work atmosphere and approachability of the registered manager. Staff told us they found it easier to speak to the deputy manager as opposed to the registered manager.

Staff told us they felt staffing numbers were low during mealtimes as people were eating their lunch late and during the night time pressures were felt by staff.

We have made a recommendation about the deployment of staff.

People and their relatives told us they felt safe at Aspray House. People told us the staff were kind and helped them.

Staff understood their safeguarding responsibilities and how to blow the whistle if they felt their concerns were not being taken seriously by the service.

People received their medicines safely and medicine audits were performed to check people received them on time and that recording was accurate.

The home was clean and free from malodour. Staff were provided with enough personal protective equipment (PPE) to use within the home. We have signposted the service to review guidance on how all staff should correctly wear PPE.

Staff were recruited to the service safely.

The home worked well with external organisations for continuous improvement.

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 2 May 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about pressure care, bed rails, staffing numbers, medicines and management support for staff. A decision was made for us to inspect and examine those risks.

As a result of concerns with bed rails we widened the scope of the inspection to become a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified one breach in relation to good 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aspray House is a residential care home providing personal and nursing care to people from the ages of 18 to over aged 65. Aspray House accommodates 64 people in one adapted building. Care is provided over four separate units each of which have adapted facilities. Many of the people at Aspray House were living with dementia. At the time of our inspection there were 62 people using the service.

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

People us told us they felt safe. Risks were managed and reviewed to ensure people were safe from the risk of avoidable harm.

Medicines were managed safely, and staff were trained and had their competency checked to ensure they were able to do this safely. There were enough staff to work at the home and recruitment checks were in place to ensure staff were suitable and safe to work at the home.

People and their relatives were happy with the cleanliness of the home. The service was clean and free from malodour. The risk of infection was reduced as staff followed safe hygiene practices and used personal protective equipment.

People and their relatives told us staff were good at their jobs. Staff received regular training to make them effective in their role and regular support from the registered manager and senior management.

People's health and well-being were monitored and managed well. Staff were seen by health professionals and appropriate referrals were made to health services to keep them safe and well.

People told us they liked the food and were provided with a varied and healthy diet to meet their needs. People were encouraged to make healthy food and drink choices.

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.

Staff were kind and compassionate. People had good relationships with the staff and relatives told us staff at the home were patient and kind. Staff were non-discriminatory towards people in the home and treated them with dignity and respect.

People were supported by a registered manager and staff who knew people's preferences well. Relatives told us the care was personalised for their family member. People's communication needs were met.

End of life wishes were documented. Complaints and compliments were recorded and used to help improve the service.

Staff told us they had good support from the registered manager and provider. Quality assurance systems were effective and helped the registered manager and provider monitor the quality of care people received and make improvements where needed.

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

Rating at last inspection and (update): The last rating for this service was requires improvement (published 23 March 2019) and they were in breach of one regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection on 10 November 2017 we found five breaches of the regulations in relation to person centred care, consent, safe care and treatment, good governance and staffing.

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, effective, responsive and well led to at least good. We found the service had made improvements in the key questions of safe, effective, caring and responsive. However, the service was still in breach of the regulations for the key question well led. This is the third time the service has been rated as overall requires improvement.

Aspray House 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.

Aspray House accommodates 64 people in one adapted building. Care is spread over four separate units each of which have adapted facilities. Many of the people at Aspray House were living with dementia. At the time of our inspection there were 63 people using the service.

The service had 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.

People had risk assessments in place and in the majority of the files we looked at information on mitigation of identified risks was present. However, where this information was not clear this put people at risk of unsafe care. Information was sent after the inspection to show how this had been rectified but this indicated quality assurance systems needed to be further embedded to improve the quality of risk assessments.

Medicines at the service were managed safely. The service had systems in place to respond to and manage accidents and incidents.

Staff were recruited safely at the service and there was a robust checking process to ensure new staff and current staff were safe to work with vulnerable people.

Staff understood their safeguarding responsibilities and how to raise concerns. All staff knew how to whistleblow if they thought their initial concerns had not been acted upon by the service.

People at the home told us they felt safe and that staff attended to their needs. Relatives felt there were not enough staff in particular at weekends. We viewed records which showed staffing levels were maintained during the weekend and that the use of agency staff had reduced.

The service was very clean and there was no malodour throughout the home. Staff minimised the risk of infection and contamination by following good hand hygiene and by wearing appropriate protective equipment.

Effective care was given to people from staff who had been well trained. Staff received regular supervision and training specific to their role which was up to date. People and their relatives commented on how well staff had been trained and noticed if a new member of staff was currently being trained.

People received an assessment of need before they moved into the service which involved the person and their families where appropriate.

People were offered a varied menu and able to choose alternatives if they wanted something different to eat. We observed positive dining experiences and where people were supported to eat this was done in a calm and dignified way. We received mixed feedback on the food. People expressed that the food was not warm by the time it reached them and there were issues around the consistency of the food.

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 had good access to healthcare services and staff ensured people were referred promptly.

People were cared for by kind and compassionate staff who took the time to get to know people.

People’s privacy, dignity and confidentiality was respected.

The service still had not fully incorporated how to ensure people who may identify as lesbian, gay, bi-sexual or transgender would feel welcome at the home through their assessment process but had commenced work in this area to achieve this. Staff showed an awareness of the need to respect people’s individuality and to not discriminate against them.

Care plans were more personalised and contained people’s preferences, life histories and their goals for care. Care plans were reviewed and relatives and health professionals were involved in reviewing care.

People were supported to attend a number of different activities which were enjoyed.

People and their relatives knew how to make a complaint about the service and had their concerns acknowledged and responded to in a timely manner.

People’s end of life wishes were respected and the service supported people and their relatives during this time.

Feedback was sought informally from people when staff spoke to them and formally from staff and relatives.

Quality assurance systems were in place to drive improvement. However, they had not addressed issues identified during the inspection in relation to ensuring care records were fully completed as required, which included food, fluid and repositioning charts. There were also issues regarding the accuracy of paperwork such as incorrect date of births and the legibility of paperwork. The provider took action to remind staff of their responsibilities regarding accurate paperwork.

We have made two recommendations which we will follow up at our next inspection and found one breach of the regulations relating to good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Aspray House is a care home with nursing for up to 64 people. 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.

Aspray house is divided into four units providing nursing care to older adults. It is a large purpose built care home that is fully accessible to people with mobility needs. At the time of our inspection 61 people were living in the home. Many of the people living in the home were living with dementia.

The home did not have a registered manager. The last registered manager had left recently, and the new home manager was in the process of applying to register with us. 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 in January 2017 we asked the provider to take action to make improvements in relation to choking risk assessments and staff training in relation to choking. The provider had taken action to address these concerns.

At this inspection we found that needs assessments, care plans and risk assessments lacked detail and were not personalised to each individual. They lacked detail regarding care preferences including personal care, dietary needs and end of life wishes. Records of care did not show people were supported to have their needs met.

The home had high agency use and this affected people’s experience of care and views on the attitude and number of care staff.

Staff had not received the training and support they needed to perform their roles. Staff were using physical intervention when supporting people with personal care and had not had training on how to do this in a safe way.

The home had not always sought consent in an appropriate way, and some care files contained conflicting information about people’s capacity to consent to care. Staff did not demonstrate a sound working knowledge of the Mental Capacity Act 2005.

The governance arrangements in place had identified issues with the quality and safety of the service, but actions in place had not been effective in improving the experience of people living in the home.

Staff were knowledgeable about safeguarding adults from harm, and the provider took appropriate action to investigate and respond to allegations of abuse and other concerns raised. Some people told us the previous manager had not responded to their concerns, and the new manager addressed this immediately.

The home was clean and well maintained. The home was coming to the end of a programme of refurbishment which included replacing flooring which had previously been malodourous.

People living in the home had complex healthcare needs. They received support to access healthcare services and the home worked appropriately with healthcare professionals to ensure people’s needs were met. People were supported by qualified staff to take their medicines as prescribed.

Staff demonstrated they understood how to provide compassionate care, and how to promote people’s dignity. Staff demonstrated they understood the impact people’s sexual orientation might have on their experience of care. However, sexual orientation was not included as part of the care assessment and planning process. We have made a recommendation about supporting people who identify as lesbian, gay, bisexual or transgender.

The provider had a clear complaints policy and the new manager had introduced systems to ensure people and relatives were able to provide feedback about their experience of the home. Some people said their previous complaints had not been responded to.

Activities were delivered with enthusiasm but lacked purpose and focus. The manager had plans in place to develop the activities provision within the home.

The manager engaged with us, and external agencies provided feedback about the service. The service was developing a plan to address concerns in the home.

We found breaches of five regulations relating to person centred care, consent, safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

The last inspection, completed in January 2017 was a focussed inspection. That inspection rated the key questions Safe and Effective as requires improvement and changed the overall rating to Requires Improvement. This inspection found the service continued to be Requires Improvement.

The focused inspection of Aspray House was carried out on 19 January 2017. Focused inspections do not look at all five key questions of safe, responsive, caring, effective and well-led, they focus on the areas indicated by the information that triggered the concerns. During this inspection we looked at the key questions of 'safe' and 'effective’.

We last inspected Aspray House on 8 & 10 August 2016. At the time the service was rated as ‘Good’.

Aspray House is a nursing and residential home that provides care for up to 64 older people some of whom may be living with dementia. There were 63 people using the service when we visited.

There was a registered manager at the service at the time of our inspection. 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.

Risk assessments did not always consider associated signs and symptoms, specific to the person that could indicate potential or actual risk of choking. Care staff were not always confident what to do in an emergency medical situation.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when supporting them. People were provided with a choice of food and drink and supported to eat healthily. However some staff were not sure of the food they were feeding people.

People had access to health care professionals and were supported to lead healthy lifestyles.

The registered manager had put some safety measures in place to minimise the risks for people at risk of choking.

On the 20 & 21 October 2015 we carried out an unannounced follow up inspection of the service. We found concerns on the following; risk assessments were not always comprehensive, staff were not always supported with supervision and appraisals, and care plans were not always up to date. We issued two requirement actions. The local authority also had concerns about the service and have been monitoring and working with the service provider to improve the quality of care provided. At this inspection we found improvements had been made.

Aspray House is a nursing and residential home that provides care for up to 64 older people some of whom may be living with dementia. There were 63 people using the service when we visited.

There was a registered manager at the service at the time of our inspection. 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 quality and consistency of the risk assessments and the care planning process had improved since our last inspection. People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans in place to monitor and reduce risks.

The home environment was clean and we saw domestic staff throughout the inspection using personal protective equipment such as gloves and disposable aprons. However there was a strong malodour on the ground floor. We have made a recommendation about the management of odour at the home.

We found people were cared for by suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. There were sufficient staff deployed to provide care and staff were supported in their roles with training, supervision and appraisals. Staff understood their responsibility to provide care in the way people wished and worked well as a team. They were encouraged to maintain and develop their skills through relevant training.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when supporting them. Staff knew how to respect people’s privacy and dignity. People and their relatives were supported to attend meetings where they could express their views about the service. There was a range of activities on offer throughout the week. Most activities took place within the home, such as singing, puzzles and quiz games.

People were able to make choices about most aspects of their daily lives. People were provided with a choice of food and drink and supported to eat healthily. People had access to health care professionals and were supported to lead healthy lifestyles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood this legislation and had submitted DoLS applications for some people living at the home. Staff were aware of their responsibilities under this legislation and under the Mental Capacity Act (2005).

The home had a registered manager in place and a management structure with clear lines of accountability. Staff told us the service had an open and inclusive atmosphere and senior staff were approachable and accessible. The service had various quality assurance and monitoring mechanisms in place. These included surveys, audits and staff and resident meetings.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had undertaken recent fire safety and basic life support training. Although there were arrangements in place to deal with foreseeable emergencies, we found that care staff had limited information about the evacuation procedure in the event of a fire.

At this inspection we looked at medicines storage, medicines and records about medicines for people using the service and reviewed documents supplied by the service.

As part of this inspection we looked at the medicine administration records for 39 people. We saw appropriate arrangements were in place for recording the administration of medicines. These records were clear and fully completed .The records showed people were getting their medicines when they needed them, there were no gaps on the administration records and any reasons for not giving people their medicines were recorded. If people were allergic to any medicines this was recorded on their medication administration record chart. This meant people were receiving their medicines as prescribed.

We found that people were cared for in premises that were adequately maintained. Equipment was readily available, regularly checked and in a good state of repair.

We observed a medication administration round and found that there were procedures in place to ensure that medicines were stored, administered and discarded in an appropriate manner. Staff told us that only staff who were assessed competent were allowed to administer medication.

Staff told us that they had regular supervision, staff meetings and attended training sessions. Staff told us that they felt supported by their manager.

We reviewed care plans and found them to be individualised and reflecting the individuals current condition. Appropriate risk assessments were completed and staff were aware of these. However, people were not always aware of the contents of their care plans or if they were updated.

People told us that they had no concerns about the care they received. Staff, people, and relatives were aware of the complaints procedure and were able to express their concerns when the need arose. One person felt it might impact on them negatively if they spoke to us about concerns. However, a relative spoke on their behalf.

We found that adequate checks were done before recruiting staff and an induction programme was completed by all staff. For staff who had committed proven offences we saw documentary evidence that the home's disciplinary policy was followed. Risk assessments and care plans were up to date and person centred. We observed that call bells were answered in a timely manner. However on the first floor most people did not have their call bell in reach. We challenged this and were told that some people who stayed in their rooms were unable to use the bell appropriately.

Staff had been trained on how to use equipment and manuals were readily available. However there were gaps in service records for equipment used to take temperature blood pressure and blood glucose monitoring. This left people vulnerable to the potential of faulty equipment being used to deliver their care.