Aspray House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People experienced care that was not always safe. Mixed feedback from relatives and healthcare professionals confirmed this. Whilst some relatives were happy with the care provided to their loved ones, others believed the service needed to improve. The service was not always proactive in addressing people’s health needs in a timely manner. Mixed feedback about staffing levels meant we were not assured that staffing levels were always sufficient to meet people’s needs. Risks to people were not always well managed. People were cared for by staff who had been recruited safely and received mandatory training to carry out their role. There was a management presence at the home. However, changes in management over the past 12 months had an impact on how the service had been managed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from relatives about the care provided. One relative told us staff had contacted them after an incident, although they had discussed this with a staff member, they felt some safety measures needed to improve. Another relative told us they didn’t always feel their relative was safe, because the communication device used to speak to their relative had been disconnected on a number of occasions. They said they were having to point out issues, rather than staff being proactive in identifying them. The provider told us that the device had been accidently disconnected by

The deputy operations manager told us referrals are received via email. An initial assessment is conducted by phone and a visit carried out if more information is needed. Before someone is accepted by the service, the provider told us they would need to be sure they could meet their needs. For example, where someone required the use of oxygen, the hospital must book, deliver and set up everything in the room and appropriate yellow warning sign used to show a cylinder is in use. The operations manager told us, “If someone is at risk of a pressure sore or high risk, we must ensure we can meet the needs.” Staff told us they worked closely with the nurse on duty to ensure people’s health needs were met. A staff member told us, “The management team or the nurse on shift typically follows up on reported issues and concerns promptly and effectively.” Another staff member said, “Generally the issues and concerns reported are followed up in a timely and responsive manner by the management team or nurse on shift.” A third staff member told us, “If there any changes to residents’ health, food and wellbeing I do inform the nurse on duty and the concerns are followed up in a responsive manner. The changes are made on resident’s care plan too.” Another staff member responded, “No” to the question whether they felt management or the nurse on shift followed up issues and concerns in a responsive manner.

Although processes were in place to encourage learning from incidents and accidents, some improvements were required to ensure these were robust and effective to ensure staff understood the impact of these changes. For example, we observed one person being given spaghetti by care staff but we were informed by the relative who regularly visited their loved one, they were at risk of choking. The relative said to the staff member “They could choke on that [spaghetti].” We asked the operations manager about this; they told us the person was not at risk of choking and consumed a normal diet. Although records confirmed this, we noted the relative’s opinion had not been considered. Given previous concerns about people at risk of choking, we were not assured that lessons were always learnt. Records showed staff received training in basic life support and were able to tell us what they would do should someone suffer a choking episode. One staff member told us, “Yes, I have done training on practical basic life support, moving and handling, first aid. Also, e-learning training. In case of choking, I would press emergency button for help, I have to encourage the person to cough, 5 back blows then 5 abdominal thrusts.” Staff were aware of changes made to the people’s care based on lessons learnt and told us these were discussed, usually at hand over or staff meetings. There was a tracker kept for accidents and incidents and safeguarding. We saw this was not always up to date. The service understood their responsibilities under duty of candour. Notifications were submitted by the service. Delays and quality of reporting were not always in line with requirements. At the time, these were addressed by the deputy operations manager. The home manager understood their role in reporting, however, some notifications required further clarifications and detail.

Relatives told us the service was not always proactive in addressing their relative’s health needs. For example, one relative talked about having to raise issues before any action was taken. Another relative told us, People and relatives were involved in the initial assessment process. A relative told us they were involved in the initial assessment process with healthcare professionals and the service. For those people moving into the service, there was a process in place which involved gathering pre-assessment information regarding the individual. Healthcare partners involved in this process reported staff followed the appropriate procedures to ensure the smooth transition of people into the service.

The deputy operations manager told us referrals are received via email. An initial assessment is conducted by phone and a visit carried out if more information is needed. Before someone is accepted by the service, the provider told us they would need to be sure they could meet their needs. For example, where someone required the use of oxygen, the hospital must book, deliver and set up everything in the room and appropriate yellow warning sign used to show a cylinder is in use. The operations manager told us, “If someone is at risk of a pressure sore or high risk, we must ensure we can meet the needs.”

Staff told us they worked closely with the nurse on duty to ensure people’s health needs were met. A staff member told us, “The management team or the nurse on shift typically follows up on reported issues and concerns promptly and effectively.” Another staff member said, “Generally the issues and concerns reported are followed up in a timely and responsive manner by the management team or nurse on shift.” A third staff member told us, “If there any changes to residents’ health, food and wellbeing I do inform the nurse on duty and the concerns are followed up in a responsive manner. The changes are made on resident’s care plan too.” Another staff member responded, “No” to the question whether they felt management or the nurse on shift followed up issues and concerns in a responsive manner.

Healthcare professionals we spoke with provided mixed feedback. One healthcare professional told us referrals were made in a timely manner, they said, “I think they are sending in referrals in a timely manner.” Another healthcare professional said reporting is not always good, it was sometimes difficult to get a full picture of incidents. They told us at times, “It was difficult to obtain information on what happened and the learning.”

A third healthcare professional told us, staff were aware of risk, but sometimes capacity affected the way staff were able to respond. For example, people with continence needs required regular changes, sometimes evidence showed this was not done as quickly as possible. However, when issues were raised with floor staff they responded quickly.

People were referred to the service and an assessment of needs carried out. Relatives confirmed they were involved in assessments prior to their relative joining the service. We saw evidence of referrals to healthcare professionals and medical appointments to help staff to meet people’s health needs. For example, referrals to speech and language team for people at risk of choking and referrals to the falls clinic for people at risk of falls. However, feedback from health professionals showed these were not always completed in a timely manner.

Whilst some relatives believe their loved ones was safe others felt safety could improve. We received mixed feedback from relatives and healthcare professionals. Although relatives spoke positively about the care provided to their loved ones, not all felt the service was always safe. A relative told us they felt their relative was safe because, “I don’t feel [relative] is unsafe. They have good security, a pin number to gain access to the building.” Another relative told us their relative was not always kept safe despite their risk of absconding. This meant people were not always kept safe. A healthcare professional who regularly visited the service said there was a shortage of staff. They have 2 hours and try to accommodate this, but there is a lack of staff availability, particularly where assistance is needed where people required repositioning, they told us, it is difficult to find a staff member to assist. Safeguarding alerts were raised by the service and the local authority, however, we found risks were not always managed in line with peoples identified risks. This meant the provider did not always manage risk to people using the service. The provider’s response to safeguarding incidents was not always timely and important lessons to be learnt were not always acted on immediately, placing people at potential risk of further harm.

Staff and records showed they completed safeguarding training and most knew what to do should they suspect or witness abuse. This was confirmed by a staff member who said they had completed training, they told us their responsibilities included, “Staying alert to signs of abuse or neglect, knowing how to report any concerns, and taking necessary actions to protect individuals from harm.” Another staff member told us, “I had training in safeguarding vulnerable adults. Safeguarding means to protect people from harm and abuses.” Staff gave examples of the types of abuse and the actions they would take should they suspect or witness abuse. A staff member told us, “I know the kinds of abuses such as physical abuse, emotional abuse and mental abuse. If I find anyone being abused or neglected, I should tell someone who can help about this. It could be a social worker, a doctor or a healthcare professional or a police officer.” Staff confirmed their understanding of whistleblowing procedures. One staff member told us, “We have discussed whistleblowing at work. I know how to raise concerns through the appropriate channels, such as reporting to a supervisor or using a designated whistleblowing hotline.” Another staff member said, “Whistleblowing means making a disclosure or blowing the whistle. The term used when worker passes on information concerning wrongdoing. I know how to raise concerns if I find any concern, I have to raise my concerns with my line manager or someone equivalent.” The home manager told us, “They [staff] have the policy they know where it is. I always remind them, it’s their duty about the care of the residents.” They are free to speak with me. If not, comfortable they know they can speak with somebody else.”

We observed some good examples of care provided by staff to keep people safe. For example, we saw a staff member was able to care for the person who required 24-hour supervision to keep them safe. We observed the person knew the staff member well and responded to them in a comfortable manner, by touching and using eye contact. The staff member showed compassion and care throughout their communication with the person.

Safeguarding procedures were in place to report, record and investigate concerns. The provider maintained a safeguarding tracker to ensure they were able to keep up to date with concerns raised. Records showed this required updating as gaps were noted. We informed management about this.

Risk to people were assessed and covered areas such as, risk of falls, choking, pressure sores and malnutrition. However, risks to people were not always managed well. For example, feedback from a relative concerned that their relative was at risk of choking had not been reassured with health professionals. When we asked, the relative told us their loved one choked on rice and spaghetti, on this day staff served spaghetti bolognaise. The staff member told us they were on a normal diet; however, this was in contrast with what the relative observed when regularly assisting their relative at mealtimes. We notified the management team during our inspection visit; they told us the person was on a normal diet and previously known to speech and language therapist but had been discharged. Records reviewed confirmed this was approximately 2 years ago. This presented a risk as the provider had not followed up to ensure choking was no longer a risk.

Staff told us they knew people well and were able to explain the risks to people and how they supported them safely to manage those risks. A staff member told us as well as using aids such as wheelchairs and regularly monitoring people, “The support plans and risk assessments are thorough and informative. For instance, I managed a resident's fall risk by ensuring their environment was free of obstacles. These details are clearly outlined in their care plans, allowing me to apply them effectively.” We spoke with the home manager about involving people using the service in risk, they provided an example of how they would manage risks, this included involving the GP to help manage the person's health needs. The deputy operations manager told us they worked closely with the GP and dietitian to mitigate risk where they can.

We observed staff managing risk to people. Where people received one to one care, we saw they had staff nearby. Staff we spoke with understood the person’s risk and was able to tell us why the person required one to one care. We saw a staff member who had been working with one person for some time, was assisting the person during lunch time. They explained the risks whilst involving the person in our discussion. The person was responding well and was comfortable in the staff members presence. However, risk to people required further improvement to ensure all risks were identified and managed.

Where people lacked capacity to make decisions about their care and treatment, Deprivation of Liberty Safeguards (DoLS) were either in place or in the process of being renewed. The home manager told us, “I would try to act in their [people using the service] best interest, use less restrictive practice, ask the family for background information, what they used to like, choose from family, what is healthy. DoLS must be in place. I always ask [deputy operations manager] and [operations manager] because I am still learning.”

A healthcare professional told us they felt the service managed risk fairly well. For example, when a person using the service attempts to leave, the service applies for DoLS assessment to keep them safe. For people unsteady on their feet and having falls, the service applied for funding for one -to -one supervision, they also refer to the multi-disciplinary team for support.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from relatives about staffing levels. Relatives spoke positively about the treatment people received. A relative told us their family member was well cared for and always looked well presented. They said, “I think there is [enough staff]. However, another relative said they had noticed a change in staffing levels, there did not appear to be many around at times and call bells were constantly buzzing. They told us, “Managers seem to just disappear. There has been a change in staff, reduction in staff. It feels like not as many staff on the floor, I struggle to find anybody, whereas before staff seem to be everywhere. Sometimes alarm [call bell], they seem to go on for ages sometimes never know if it’s an emergency. Irritating goes on and on, even with door closed, spoils the peace.” Healthcare professionals who visited the home provided mixed feedback regarding staffing levels. One healthcare professional told us the home needs. “More registered nurses on the floor, they could up their quota” Especially where they want a nurse with them as they did their rounds. Another healthcare professional told us staffing levels were, “Quite adequate, no issues when I’ve been there [visiting the home].” We were not assured staffing levels met people's needs at all times.

Feedback from staff about staffing levels was mixed. Some told us they thought the home was sufficiently staffed. Staff comments included, “There is enough staff on duty to support residents safely and meet their needs.” And “There is not enough staff on the duty and many times this has been raised to the management regarding the problems everyone is facing.” Another staff member described some units as being understaffed at night, at times they reported only 1 carer on duty to care for 19 residents, most requiring 2 care staff for personal care. This had an impact on staff and people using the service. We were not assured staffing levels always met people’s needs, this put people at risk of poor care or harm. We shared feedback about staffing levels with the management team who told us staffing levels were assessed using a tool based on people’s level of need, occupancy and staff to people ratio. The operations manager explained the formula used to determine staffing levels. Both the operations manager and deputy operations manager were registered nurses and could assist staff where this was required.

We observed some good interactions between people and staff providing one to one care where this was required. Staffing levels during our visit showed numbers expected on the rota were present during our visits. A healthcare professional told us, staffing levels were quite adequate, there had been no issues when they had visited the service, but mentioned there was quite a high turnover of care staff. The healthcare professional observed improvements were required for staff to develop a better understanding of caring for people with dementia.

However, we received mixed feedback during our inspection about staffing levels from relatives, staff and other health professionals. We were not always assured staffing levels and skills mix of staff met people's individual needs.

The provider operated safe recruitment processes. This included undertaking appropriate checks with the Disclosure and Barring Service (DBS), obtaining suitable references and meeting visa sponsorship requirements. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Newly appointed staff completed an induction and shadowed experienced staff. Staff confirmed they had completed mandatory training in various subjects and most staff had completed recent supervision.

We were not assured staffing levels always met people’s needs, this put people at risk of poor care or harm. The home manager told us staffing numbers met people's needs, “If staff are unwell or a family emergency we have to book an agency staff. Our first priority is to ask permanent staff, we never run under numbers, it is not safe. I have to look after staff and ensure the safety of people using the service and staff

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.