Archived: Aspen Court Care Home

The last inspection took place in November 2016 before BUPA (the provider) changed their legal identity to BUPA Care Homes Limited. This was the first inspection of the service since the legal entity changed on 31 January 2017.

A registered manager was 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.

People did not always receive their prescribed medicines at the right time. We found gaps in the records that showed the systems to manage and store medicines, was not safe.

The provider was mostly meeting their regulatory responsibilities. The provider’s governance system was not used effectively. A range of quality audits were carried out. Shortfalls were not always identified and any improvements made were not always sustained. System to support and manage staff was fragmented. Opportunities to make comment about the service were limited. The registered manager acted on complaints and feedback from surveys. We found the registered manager was responsive and had acted on some of our feedback immediately. That showed they were committed to improving all aspects of Aspen Court Care Home.

People had a choice of food, drinks and snack which were available throughout the day and night. Catering staff were knowledgeable about people’s dietary requirements and planned menus that were nutritious and balanced. Despite this, some people’s nutritional needs were not always met due to inconsistences found in the records used to monitor the nutritional needs.

People had access to a range of health care services but recommendations made by health care professionals were not followed and not always included in the care plans. The registered manager was responsive and took action to ensure people’s health needs were met.

Comments from people, their relatives and staff; and our observations found that staffing levels were not always sufficient to consistently meet the needs of people who used the service. We identified this was an area of improvement as to how staffing levels were determined in the detailed findings within this report.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. People’s safety was promoted and protected from avoidable harm. Risks were assessed, managed and reviewed regularly. Measures were put in place including the use of equipment to support people safely and promote their independence.

People lived in a clean environment. Regular checks were carried out on the premises and equipment used in the delivery of care.

Staff recruitment procedures were robust. Staff received appropriate induction and training for their role. Staff felt confident to approach the registered manager when required.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People developed positive relationships with the staff. They found staff to be kind and caring. Staff knew people who used the service well and respected their wishes with regards to their care and support needs. People’s dignity and privacy was promoted and maintained by staff. Records showed that people and in some instances, their relatives, had been involved in the development and review of their care plan. This enabled staff to provide care and support that respected people’s preferences.

People mostly received personalised and responsive care when they needed it. Care plans contained information about people’s preferences and how staff should support them to meet their individual needs. Care plans were reviewed regularly.

People maintained contact with family and friends. People’s religious needs were met. People had opportunity to take part in a range of social events, activities and accessed the wider community. This enhanced people’s health and wellbeing and protected them from the risk of social isolation and loneliness.

People knew how to make a complaint and were mostly confident that action would be taken. A complaints process was in place and records showed complaints were handled appropriately. Advocacy information was made available to people.

We found 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.

The service is registered to care for 40 people living at Aspen Court. On the day of inspection there were 30 people living there.

There was 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.

We found the service was not always safe. Medicines were not consistently well managed and people were at risk of not receiving their medicines as prescribed. There were not enough staff available to care for people and they were not deployed effectively. Call bells were not always answered promptly and owing to a lack of staff available to supervise people in the communal lounges, relatives felt responsible for keeping people safe or alerting staff if there was a problem.

The service was not always effective. Staff did not have time to read care plans and familiarise themselves with the needs and preferences of the people they cared for. Staff did not always follow the directions given to them by specialist community health professionals. People were offered a nutritionally balanced diet and individual diets were catered for; however the meal time experience was not a particularly sociable occasion and it was not well managed.

We found the quality of care was variable and relatives told us it also depended on who was on duty. We found some staff did not care for people respectfully, did not promote their dignity and did not always put their needs first. However, we observed some good care and interaction between staff and people which was person centred.

At the last inspection in August 2015, we found the care people received was not person-centred and constituted a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found things had improved and staff were more aware and responsive to peoples individual interests, wishes, and preferences for how they wished to be cared for. People told us staff understood how they liked things done and responded to their individual needs. There was a planned programme of activities and an activity worker who spent time engaging with people and enabling them to participate in activities and maintain their interests. People and their families spoke highly of the activities worker, the activities and the events organised. Relatives meetings took place and information was fed back to the staff team via the registered manager.

At the last inspection, 15 months earlier we had identified poor governance which constituted a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found there had not been sufficient improvement to the management and governance of the service, which meant they were still in breach of Regulation 17. The service had not been consistently well led since the last inspection. There had been three managers during this period and many changes in practice. Staff were not always adequately supervised or supported to carry out the duties they were asked to do. The staff team did not consistently work well together, were not motivated and did not take responsibility for their own development. This affected the quality of care and led to a negative culture within the home. We found the systems and processes in place were not used effectively to identify and address areas for improvement within the service and had not addressed all the improvements identified at the last inspection.

We found four 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 report.

A variety of activities were available for people to participate in and these were observed on the day of our visit. People told us they enjoyed the activities available.

Relatives we spoke with said they were happy with the care and services their family member received and confirmed they were involved in their care and reviews.

Care records provided sufficient information regarding people's support needs; this information was reviewed on a regular basis to ensure it remained relevant.

People using the service confirmed they felt safe and said if they had any concerns they would speak to the staff or their relatives. Visitors told us that they were aware of the complaints procedure and said they were confident that any issues they had would be addressed.

At our last inspection we identified gaps in staff training, which meant that not all the staff were working to current practice. At this visit there was evidence to demonstrate that further training had been undertaken since the last inspection.

Some of the people who used the service were able to give us their views of the support and services they received. The comments from these people were positive, such as 'the staff are all very nice, I came initially for respite but have now decided to stay, I have no complaints.' And 'It's very nice here, I'm quite happy and the staff are a nice bunch.'

Staff were observed supporting people to make choices, for example at the lunch time meal and regarding the various activities that were being provided on the day of our visit.

People spoken with told us that they had their preferred routines, such as the time they went to bed and got up in the morning. This was also recorded within the care files seen.

Comments from visitors were generally positive regarding the care and support provided. Such as, 'staff are brilliant, I can't fault them, nothing is too much trouble for them.' And 'there's a good atmosphere here, staff always seems happy and it's always kept clean and smelling fresh.'

Throughout our visit there were occasions when the communal areas were not staffed. This meant that people were not always being supervised to ensure their safety was maintained.