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Aspen House Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 4 July 2019

The inspection took place on 3 and 4 January 2019, the first day was unannounced and the second day was announced.

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 t

Inspection areas

Safe

Requires improvement

Updated 4 July 2019

The service was not consistently safe

Risks to people had been identified and assessed, although we found that they were not always managed safely or consistently, and records had not always been updated following a change of need.

Improvements were still needed in the management of people’s medicines. Administration practices were found to be good but the management of guidance and information for staff needed to improve.

There were sufficient staff to meet people's needs.

The provider did not always learn from mistakes and make improvements when things went wrong.

People were protected by the preventions and control of infection.

Effective

Requires improvement

Updated 4 July 2019

The service was not always effective

The needs of people living with dementia were not always met by the design and adaption of the service.

People’s needs had not always been appropriately assessed or updated to ensure that effective support could be given.

People were cared for by staff that had received appropriate training, although we identified where the assessment of people ongoing competencies needed to improve.

People were asked for their consent before being supported and the service worked within the principles of the Mental Capacity Act.

Staff worked effectively together and across organisations. People had access to healthcare services to maintain their health and wellbeing.

Caring

Good

Updated 4 July 2019

The service was caring

People were cared for by staff that were kind and caring

People's differences and diversity were respected and staff would adjust their approach to meet their needs.

People had access to advocacy services so that they could be actively involved in decisions they made

Responsive

Requires improvement

Updated 4 July 2019

The service was not consistently responsive

There continued to be a lack of consideration, care planning and guidance on how to best support people living with dementia.

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

Not all people had been assessed to ensure that their communication and information needs had been identified in accordance with Accessible Information Standards.

Complaints were well managed and people and their relatives knew how to formally raise any issues should they need to.

People received compassionate end of life support.

Well-led

Requires improvement

Updated 4 July 2019

The service was not consistently well-led

This is the fourth inspection where the service has been rated as requires improvement. The service has failed to continuously learn to improve and ensure sustainability.

Systems or processes in place were not consistently effective. There was a failure to assess and monitor and to improve the quality and safety of the services provided.

People, their relatives and staff told us that the management team promoted an open culture at the service where feedback and comments were welcomed.

Staff worked well together, and with other organisations to co-ordinate support for people.