Aspen House

Aspen House is a residential care home providing personal care for up to 10 people. The service provides support to people with learning disabilities and autism. At the time of our inspection there were 8 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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.

People received care and support to maintain an environment that suited their needs and preferences.

Staff supported people to make decisions following best practice in decision-making. People were

supported to carry out their daily living activities and pursue their hobbies and interests.

Staff supported people to access health and social care services. Staff supported people with their

medicines safely and in their preferred way.

Right Care:

People received care that was person-centred, and dignity, privacy and human rights were promoted.

Staff communicated with people in ways that met their individual needs.

People received kind and compassionate care. Staff understood and responded to people's individual needs. They protected and respected people's privacy and dignity.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service employed skilled staff to meet people's needs and keep them safe.

People's care plans reflected their needs and wishes and promoted their wellbeing. Risks that people may face were appropriately managed.

Right Culture: The ethos, values, attitudes and behaviours of the registered manager and staff team ensured people lead confident, inclusive and empowered lives.

People received good quality care and support because trained staff and specialists could meet their needs and wishes.

People and those important to them, including social care professionals, were involved in planning their care. The registered manager and the staff team ensured people received support based on best practice, respect and inclusivity.

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 requires improvement, published 10 March 2022.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Aspen 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.

Aspen House is a residential care home providing personal care to eight people at the time of the inspection. The service can support up to ten people and specialises in providing care to people with a learning disability and autistic people.

The service is delivered on two floors and two separate wings with a communal kitchen, lounge and dining room in each wing. Some rooms have en-suite facilities. Where this is not available, there are suitable communal facilities.

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

There had been a number of improvements in the safety and quality of the service since the last inspection. People were protected from the risk of abuse. Staff were knowledgeable around the signs of abuse, how and where to report it. The provider supported staff with whistleblowing and provided support and information to support staff with this. Whistleblowing is the term used when a worker passes on information concerning wrongdoing to an official body such as the police or social care, when they believe it has not been acted on by the internal management.

Risks to people were now fully assessed, planned into care and reviewed regularly. Risks in the environment were better managed. The provider was in the process of improving the environment, and though most areas were clean and odour free, staff did not fully understand good infection control practices and how to keep people safe. There were storage issues for mops and buckets and where documentation was required, some areas were incorrectly recorded as satisfactory. Further improvement had been made by the time we returned for the second day of the inspection and storage issues had improved.

Staff were recruited safely and there were enough staff available to meet people’s needs. Medicines were managed safely with only suitably trained staff administering people’s medicines.

There was evidence of learning lessons when things had gone wrong. The provider and interim manager were open and transparent, reporting appropriately to the local authority and Care Quality Commission and ensuring families were updated with any concerns.

The provider and management team worked in partnership with other professionals to ensure good outcomes for people. People were considered as partners in their care and were encouraged to be independent and involved, decision making was supported. Easy read and pictorial information for people supported them with this.

The provider had improved audits which now reflected an oversight of the service and the interim manager was open to suggestions and keen to improve the service and develop the staff.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

People were encouraged and supported to be independent and make their own decisions. Easy read and pictorial records were used to ensure people were involved in their care.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

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 inadequate (published 22 September 2021) and there were breaches 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.

Why we inspected

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 the service can respond to coronavirus and other infection outbreaks effectively.

We received concerns in relation to how people were being tested for COVID-19 and staffing numbers. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 improved to requires improvement. This is based on the findings at this inspection.

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

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.

Aspen House is a residential care home registered to provide personal care to people with Learning disabilities, autistic people and people with mental Health needs or Physical Disability. At the time of the inspection 8 people were living in the home. The service can support up to 10 people.

The home is separated into two wings, “The House” and “The Lodge”. Both wings have a kitchen, dining area and a communal lounge. People’s rooms have private en-suite facilities. There is an enclosed communal garden.

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

Systems and processes in place had not been robust enough to maintain effective oversight of the safety and quality of the service. Where systems had identified issues, these were not addressed in a timely manner. The meant people had been at increased risk of harm.

There had not consistently been enough suitably trained and experienced staff deployed across shifts to ensure people’s needs could be met. There was not always a positive culture in the home and staff had not been consistently satisfied with how the home was managed this had resulted in a high turnover of staff.

Risks to people were not consistently assessed and mitigated. We identified risks to people in the environment and from health-related issues.

Lessons had not consistently been learned when things had gone wrong, risk had not been reviewed and records updated following accidents and incidents.

Medicines were not consistently managed safely; we were not assured that people were receiving their medicines as prescribed. There had been several medication errors in the service, and we identified that staff medicine competency checks had not been appropriately completed.

People were not consistently protected from the risk of infection. Measures to monitor people for symptoms of COVID-19 were inconsistent and staff and people’s test results were not recorded and monitored to protect people from the risk of infection. Staff did not follow government guidelines which required people returning to the service remain in isolation. This meant people had been exposed to increased risk of COVID-19.

The building did not represent a homely environment it was bare and uninviting with some furniture in a poor state of repair. The home was visibly unclean. Staff were responsible for cleaning but had no training in this area and did not have clear guidance to ensure good standard were achieved.

People were not consistently supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice.

People had limited access to the support of their families for decision making and care planning and relatives did not consistently feel informed or involved in their relative’s care. People were not supported with maintaining relationships and contact with their family as the provider was not following current government guidance on visiting in care homes.

People’s privacy was not consistently maintained and there was evidence of people being frequently monitored throughout the night with no rationale for this practice.

The service was not operating within the principles of the MCA and some people were being deprived of their liberty without evidence of the legal authority to do so. Best interest decision was not consistently in place and where they were there was no evidence of involvement of advocates or family members.

The provider had failed to notify the commission of a significant event via a statutory notification.

People appeared comfortable with staff during the inspection and staff were patient an understanding with people. People were making daily choices around their care.

The provider had a complaints policy and procedure in place that was available in formats to meet people’s communication needs. There was evidence of transparency with families when things had gone wrong.

People had enough to eat and drink and were supported to maintain a balanced diet. People had access to health care professionals as and when required and there was evidence of partnership working with other healthcare professionals.

New staff had been recruited safely.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Following the inspection, we received confirmation from the provider that DoLs (deprivation of liberty safeguards had been applied for). Following the inspection, we were assured that unnecessary monitoring had now stopped.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 9 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing, management of medicines and safeguarding. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to their not being suitable numbers of staff with the right knowledge and experience deployed across the service. We also identified breaches in relation to safe care and treatment, managerial oversight of the safety and quality of the service and consent.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to notify us of an incident that stopped the service from running safely and properly. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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.

Aspen House is a residential care home providing personal to eight people at the time of the inspection. The service can support up to ten people.

The service is delivered on two floors and two separate wings with communal kitchens, lounges and dining rooms in each wing. Some rooms have en-suite facilities, where this isn’t available there are suitable communal facilities.

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

Some improvements were required to the oversight of the safety and quality of the service and to ensure compliance with regulations. The provider did not have a manager registered with the care quality commission at the time of the inspection. Manager audits did not always identify gaps in record keeping or errors in people’s records. We have recommended that people’s photographic consent records are reviewed to ensure they have capacity to consent to photography.

People were protected from the risk of abuse. Staff were knowledgeable around the signs of abuse and how to report it. The provider supported staff with whistle-blowing and provided support and information to support staff with this.

Risk to people were assessed, planned into care and reviewed regularly. Risks in the environment were well managed. The home was well maintained and the provider was in the process of improving the environment at the time of the inspection. The home was clean and odour free, staff had a good understanding of good infection control practices and how to keep people safe.

Staff were recruited safely and there were enough staff available to meet people’s needs. Medicines were managed safely with only suitably trained staff administering people’s medicines.

There was evidence of learning lessons when things had gone wrong. The provider and manager were open and transparent, reporting appropriately to the local authority and Care Quality Commission and ensuring families were updated with any concerns.

The provider and management team worked in partnership with other professionals to ensure good outcomes for people. People were considered as partners in their care and were encouraged to be independent and involved, decision making was supported. Easy read and pictorial information for people supported them with this.

The provider completed audits to maintain oversight of the service and the new manager was open to suggestions and keen to improve the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

People were encouraged and supported to be independent and make their own decisions. Easy read and pictorial records were used to ensure people were involved in their care.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people

using services lead confident, inclusive and empowered lives

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 6 January 2018).

Why we inspected

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 received concerns in relation to how people were being tested for Covid-19 and staffing numbers. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained good. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well-led section of this report.

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

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 the last comprehensive inspection in November 2015 the service was rated overall Good.

A focused inspection took place in January 2017 due to an increased amount of statutory notifications detailing medication errors. The inspection specifically focused on those areas. The rating for the service remained Good overall; however the rating for the safe domain was changed to Requires Improvement.

At this inspection we found the provider had made the necessary improvements. The medicines storage arrangements had been reviewed and all people using the service had been provided with a lockable medicines cabinet within their bedrooms.

Aspen House is a residential care home that provides care for up to 10 people with complex learning disabilities, autistic spectrum disorder and mental health needs. At the time of the inspection nine people were using the service.

At the time of the inspection an acting manager was in post. They had submitted a registered manager’s application to the Care Quality Commission (CQC) and the application was in progress. 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 continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risks to people were assessed and monitored regularly. The premises were maintained to support people to stay safe.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place. Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service.

Systems were in place to ensure the premises were kept clean and hygienic so people were protected by the prevention and control of infection. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

People were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and reviews of their care.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

The provider understood the need for people, and their family, friends and other carers to be involved in planning, managing and making decisions about end of life care.

The service had a positive ethos and open culture and people were involved in decisions about changes. People, their relatives and staff felt confident to approach the registered manager and felt they would be listened to. Quality assurance systems were in place to monitor and review the quality of the service which was provided to drive continuous improvement.

At the last inspection the service was rated as Good. At this inspection we found although the service remained Good overall, that the rating for the safe domain had changed to Requires Improvement.

This inspection was prompted by an increased amount of statutory notifications detailing medication errors and system breakdowns. The information shared with CQC about these errors indicated potential concerns about the safe administration and management of medication. This inspection specifically focused on those areas.

People were provided with their medication in accordance with prescribed guidance, however we found that there was an issue in respect of the storage, disposal and recording of some medication. Systems were in place to ensure people’s daily medicines were managed in a safe way, but these had not always been followed adequately. Although we found that these aspects had been identified by the provider prior to our inspection, and some action taken to make improvements, more time and further work was needed to fully implement and embed required improvements.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People's needs had been assessed before they were admitted to Aspen House. After admission to the home we saw that people's needs were reassessed on a regular basis, to ensure they received the safe care they needed. This meant that staff had the information they needed to minimize identified risks to people.

We found that the provider had effective infection control processes in place. This meant that people were cared for in an environment that was clean and hygienic.

When we inspected there were sufficient numbers of experienced and competent staff on duty to safely meet people's care needs. Records showed that staff had been appropriately trained and received the support they needed to do their job. This meant that people were protected from the risk of neglect or unsafe care.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager who demonstrated appropriate knowledge of the procedures to follow. We saw evidence that applications had been submitted following correct procedures and proper policies relating to DoLS were in place.

We saw evidence that staff had been trained in DoLS, in the Mental Capacity Act 2005 and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found associated risk assessments; with clear action plans were in place to ensure people remained safe.

Is the service effective?

People told us they were happy with the quality of care that had been delivered. One person told us they were going on holiday and we were told that the activities they would engage in were detailed in their care records. We confirmed this to be the case and that the delivery of care was in line with people's care plans and assessed needs.

We spoke with staff and observed their engagement with people and we determined that they had a robust knowledge of each person's care needs and preferences.

We found that the staff had received training to meet the needs of people living at the home. Staff received additional training when needed and when they requested it. Training courses included challenging behaviour, mental health and infection control.

Is the service caring?

We saw that staff were able to communicate effectively with people with limited verbal communication and to meet their needs with respect and dignity.

We found that people who lived in Aspen House were supported by friendly, respectful and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw staff helped people with their care and support, with patience and kindness.

Is the service responsive to people's needs?

People's needs had been assessed before they moved into the home and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included people's history, wishes and preferences and goals to be achieved. People and/or their representatives were involved with reviews of care plans and were kept informed of any changes. People had frequent access to daily activities that included outings, life skills (including cooking) and holidays.

We observed that staff responded very promptly to people's needs, both physical and social. We saw that care plans and risk assessments had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and supported them to access a variety of activities.

We saw that there was enough staff on duty to meet people's needs, in a timely manner,

Is the service well-led?

There was a registered manager in post on the day of our inspection that had support from a wide range of staff. This meant that the support systems in place facilitated staff to provide an effective level of care for people.

We found comprehensive policies and procedures that addressed every aspect of the service were in place. The registered manager operated a system of quality assurance and completed audits to identify how to improve the service. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent and analysed.

Staff told us they were able and encouraged to express their views and concerns they may have and were listened to. Complaints, incidents and accidents were appropriately recorded and audited. Staff's practice was regularly observed and supervised by the registered manager to identify whether additional training or refresher courses were needed.

We looked at outcome areas covering people's consent to receiving care in the home and how the staff are organised to assist in delivering people's care. We looked at the composition of care plans and how people are assisted with their diet and medication. We also looked at the general safety around the home and staff support. We found all these areas to be well detailed and compliant.

We looked at the quality assurance questionnaires that were put out in August 2012, both to people using the service and their relatives. People were asked to comment if they were satisfied with the services provided in the home and could add comments or return these anonymously if they wished. We looked at the feedback compiled from the 16 returned forms. We noted comments such as '(My relative) is happy being at Aspen House so it must be ok' another relative stated 'I am very happy with the physical aspects of the home i.e. furnishings, appearance and upkeep on my visits and the staff always come across as helpful and friendly.' Another person stated 'Need more flowers in the garden. Like to have a relaxation room.'

On our tour around the home we saw people in a relaxed state, though those we spoke with did not make specific comments about their home or the staff.

When we spoke with staff they were aware how to support people and this reflected the support plans we viewed at the time.