The inspection visit was carried out on 17 December 2015 and was unannounced.
Aspen Lodge provides care for up to 25 older people some of whom may be living with dementia. On the day of the inspection there were 19 people living at the service.
The service is located in the village of Sholden. On the ground floor there is one large communal lounge, a dining room and a small conservatory. Bedrooms are located on the ground and first floor. There is a secure garden and car park at the rear of the premises.
The service had an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 time of the inspection the registered manager and the provider were in the process of updating and changing the systems on how the service was run and managed. They were changing over to a computerised system which they anticipated would be more effective and efficient. At the beginning of the inspection the registered manager stated that because they were in the process of doing this, there were going to be shortfalls in some areas of the regulations.
Potential risks to people were identified regarding moving and handling and eating but full guidance on how to safely manage the associated risks was not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible. We observed a person being moved incorrectly. When new risks had been identified the registered manager had taken immediate action to prevent them from re-occurring. They had updated risk assessments and passed the information to staff so that people would be safe.
Care plans lacked detail to show how all aspects of people’s care was being provided. Care plans did not record all the information needed to make sure staff had guidance and information to care and support people in a person centred way.
People received their medicines safely and when they needed them and they were monitored for any side effects. On occasions medicine practices were not as safe as they could be. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.
Accidents and incidents were recorded and appropriate action had been taken but the events had not been analysed to look for patterns or trends to prevent further occurrences.
Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. Checks were done to ensure the premises were safe, such as fire and health and safety checks. The checks for the fire alarms were done weekly and other fire checks were completed monthly. There was supposed to be regular fire drills at the service so that people knew how to leave the building safely. Staff told us that regular fire drills had taken place but this had not been recorded since April 2015. Safety checks on the water temperatures in people’s bedrooms and bathrooms were supposed to be carried out monthly. The last check recorded was in August 2015 and this indicated that the temperature of the water in some areas of the service was higher than recommended. No action had been taken to address this shortfall and the temperatures had not been re-checked. Equipment to support people with their mobility and skin care had been serviced to ensure that it was safe to use.
The registered manager did not have a system or tool in place to help them decide how many staff were needed to give people the care and support that they needed. On the day of the inspection staff were rushed but they did spend time with people when they could. Staff were not always deployed effectively. During the visit there was a period of time when people were left unattended in the lounge area which was a potential risk.
The staff had not received all the training and support they needed to carry out their roles effectively and safely. A system of recruitment was in place to make that the staff employed to support people were fit to do so. All the safety checks that needed to be carried out on staff to make sure they were suitable to work with people had been completed by the registered manager.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection the registered manager had applied for a DoLS authorisation and had been granted authorisations for five people who were at risk of having their liberty restricted. Not all mental capacity assessments were in place to assess if other people needed to be considered for any restrictions to their freedom. All of the people using the service needed to have their capacity assessed to make sure consideration was given to ability to consent to any possible restrictions to their freedom.
People felt safe in the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager followed clear staff disciplinary procedures when they identified unsafe practice.
On the whole respected people’s privacy and dignity. The care staff were attentive and the atmosphere in the service was calm and people appeared comfortable in their surroundings. Staff encouraged and involved people in conversation as they went about their duties, smiling and chatting to people as they went by. When people became anxious staff took time to sit and talk with them until they became settled. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. Staff were respectful, kind and caring when they were supporting people. People were comfortable and at ease with the staff.
There were quality assurance systems in place. Audits and health and safety checks were supposed to be carried out. The registered manager had not identified and taken action to make sure the systems used by the service were checked regularly and that shortfalls were identified and improvements made. The service had sought feedback from people, their relatives and other stakeholders and made improvements following their feed-back.
Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service. Staff were clear about their roles and responsibilities and felt confident to approach senior staff if they needed advice or guidance. They told us they were listened to and their opinions counted.
The service had a plan to improve the environment and the premises were regularly maintained to ensure that people lived in comfortable home. People’s rooms were personalised to their individual tastes.
People had choices from a variety of food on offer and specialist diets were catered for. The cook was knowledgeable about people’s different dietary needs, and ensured that people received food that was suitable for them. People’s nutritional needs were monitored and appropriate referrals to health care professionals, such as dieticians, were made when required. People said they enjoyed the meals. However, on one occasion during the inspection peoples’ mealtime experience was interrupted unnecessarily.
The complaints procedure was on display to show people the process of how to complain. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken. Records were stored safely and securely.
We found a number of 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 this report.