Aden Mount Care Home

Aden Mount is a residential care home providing personal and nursing care for up to 45 people aged 65 and over. At the time of inspection there were 31 people living at the service. Care is provided across three floors.

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

Medicines were managed safely. Staff were appropriately trained to ensure safe medication management.

Risks to people were safely managed. Care was individualised and staff were knowledgeable about people’s needs.

People were safeguarded from the risk of abuse. The service worked in partnership with relevant authorities to keep people safe. Safe recruitment procedures were in place.

Infection prevention and control (IPC) practices were safe, minimising the risk of cross infection.

Systems in place to monitor the service were effective in identifying and addressing areas that required improvement. There was a positive culture at the service and people were involved in their care. People and relatives were involved in making changes to the service.

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 requires improvement (published 11 June 2019) and there was a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 regulation.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of pressure care. This inspection examined those risks.

We undertook a focussed inspection to review the key questions of safe and well-led only. 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 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 changed from requires improvement to good. 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 Aden Mount Care Home 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

Aden Mount is a purpose-built home situated in Primrose Hill, a residential area of Huddersfield. Aden Mount offers personal and nursing care and accommodation for up to 27 older people and care for up to 18 people aged between 18 and 65 years with a physical disability.

The inspection took place on 14 May 2019 and was unannounced which meant the people living at Aden Mount and the staff working there didn’t know we were visiting.

The service was previously inspected in August 2018, when we identified four breaches of regulations. The registered provider did not ensure there were sufficient staff to meet people’s needs, care plans did not contain sufficient information to ensure person-centred care, risks were not managed including medication and there was not an effective quality monitoring system in place and no provider oversight or governance. The provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found the service had improved although new systems still required embedding into practice.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Aden Mount’ on our website at www.cqc.org.uk.

People’s experience of using this service:

We completed a tour of the home with the registered manager, we found the décor and furnishing in some areas were worn and tired. The registered manager explained that there was a maintenance and renewal programme in progress and all the areas we had found were included in the programme.

Medication systems were in pace, however, we found these were not always followed. Care plans had improved since our last inspection and were more person-centred and people were involved in developing their plans. The registered manager told us they were continuing to improve the plans of care. Risks associated with people's care, including moving and handling had been identified and were detailed in the plans of care. However, we found there could be more detail to guide staff to ensure people were moved safely.

The new registered manager and provider had introduced new quality monitoring and audit systems. These had identified most of the areas for improvement and most were very thorough and effective. However, we found continued issues with medication administration that staff were still not following procedures. The new systems still required embedding into practice.

People told us they generally felt safe. The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in safeguarding and confirmed that they would take appropriate action if they suspected abuse

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

Peoples nutritional needs were met. People who required support with their diet had their needs met by staff that understood their dietary requirements. We observed the lunch time meal the food served was well presented, appetising and special dietary needs were met. However, we found the experience for people on one unit where they stayed in their rooms could be improved.

Staff told us they had received the training and support they needed to carry out their roles well. They said they had been supported by the new registered manager. People had confidence in the staff and told us they were happy with the care they received form the care workers. All people we spoke with spoke highly of the care workers and the registered manager.

Staff were respectful of people’s privacy and dignity. We observed staff interactions with people they supported were caring and kind. Staff we spoke with knew people well and understood their needs.

There was a complaints procedure available which enabled people to raise concerns or complaints. People we spoke with told us they were listened to and any concerns raised were dealt with promptly and resolved.

There was a varied and appropriate activity programme and people had regular access to the community.

The registered manager and the provider, had implemented a new audit system and quality monitoring system, which we looked at. This had identified many issues and had an action plan in place. However, the audits had not always been effective as we identified continued issues with medication administration. The new systems needed embedding into practice.

Rating at last inspection:

At the last inspection the service was rated requires improvement with the key question ‘is the service safe’ rated inadequate. (last report published 24 November 2018).

Why we inspected:

This was a scheduled inspection based on the previous ratings.

Follow up:

We will continue to monitor the service through the information we receive. We also requested some further information form the provider to reassure us people are safe, which we have received including the providers action plan.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

When we completed our previous inspection on 8 and 11 May 2017 we found concerns relating to a continuous breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we issued a warning notice to the provider.

Following the last inspection we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions of the need for consent, effective management of people’s nutrition and hydration, and staffing. At this inspection we found that people’s consent to care and treatment was not effectively managed, nutrition and hydration needs were monitored effectively, and we were not assured staffing levels were deployed appropriately to ensure people’s safety and needs were met.

Aden Mount is registered to provide accommodation and personal and nursing care for up to 45 people. There were 44 people living at the home on each day of our inspection. Aden Mount is a purpose-built home offering accommodation across three floors, accessed by stairs and a passenger lift. One floor is designated for people receiving nursing care. At the time of the inspection there were two communal lounges available for people to use on the middle floor and one dining room. There was a separate activity room on the lower floor. Communal bathrooms were available on all floors, each room had an en-suite.

Aden Mount is a ‘care home’. People in care homes receive accommodation and 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 home had a registered manager who was available throughout our inspection. 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 told us they felt safe living at Aden Mount Care Home and staff were knowledgeable about safeguarding processes.

There was little evidence people received care personalised to them. People’s care plans and risk assessments associated with their care were not always regularly reviewed. Some people did not have appropriately recorded risks to their safety and these were not monitored effectively. There was little evidence of people being supported and engaged in meaningful activity. This meant people’s individual needs were not captured or being met nor were risks to people’s safety.

Medicines and topical creams were not always administered safely. This meant there was a risk people would not receive the appropriate dose of medicines or receive medicines not as prescribed.

People, relatives and staff told us staffing levels were not sufficient and we observed the impact of this from staff’s response to call bells. Training records showed not all staff had been adequately trained. This meant people were at risk from insufficient staffing levels and from staff not being adequately trained to support people safely.

Records did not accurately document people’s needs and choices, and these did not show current guidance had always been followed. Documents did not always show whether people had consented to care and treatment.

There was a little choice for people in terms of what they would like to eat. People’s nutrition and hydration was not always monitored. People’s specialised fluid needs were not administered safely.

There was no record of manager checks on the day to day running of the home. Governance and audit processes were not robust and had not identified discrepancies in documents. Systems were not in place to effectively implement lessons learnt.

People, relatives and staff said waiting times for call bells to be answered were lengthy. Staff training was not up-to-date. Staff did not receive regular supervision or appraisals and there was little evidence staff’s competencies were checked regularly.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Aden Mount is a purpose-built home which offers personal and nursing care and accommodation for up to 45 adults. There were 44 people living at the home at the time of our inspection. All bedrooms, which are over three floors, are en-suite and all floors are accessible via a passenger lift or stairs.

The home did not have a registered manager in place at the time of our inspection. We had been made aware by the registered provider the person who was the registered manager during the last inspection had since left the service and a new manager had been appointed and had been in post for three months. They were in the process of applying to register as manager. 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 told us they felt safe living at Aden Mount. The manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Risks to people had been assessed and measures put into place to reduce risk. The building was well maintained and regular safety checks took place.

Medicines were managed, stored and administered safely by staff who had been trained to do so, although appropriate records were not always kept in relation to topical creams.

Appropriate safe recruitment procedures were followed. However, sufficient numbers of staff were not always deployed effectively in order to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received appropriate induction and training, although staff lacked formal one to one supervision.

Appropriate referrals were made for additional support in order for people’s health care needs to be met. However, professional advice was not always followed which meant people’s nutritional and hydration needs were not always met.

Staff asked people for consent prior to providing care and support. Formal consent was not consistent and the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were not always followed. People were not always supported to have maximum choice and control of their lives.

People and their relatives told us staff were caring and we observed staff to be kind and supportive. We observed people’s privacy and dignity was respected. People told us staff encouraged them to maintain their independence.

Care records were person centred and reviewed regularly. However, not all care and support staff were aware of the content of care plans. The manager was aware of this and this was currently being addressed. The service was responsive to people’s needs.

Staff told us they felt supported by the manager and people and their relatives spoke positively about the new manager. Meetings such as staff meetings and residents’ and relatives’ meetings were held. Regular audits and quality assurance checks took place, although these were not sufficiently robust and did not identify some areas found during our inspection which required action.

The manager was visible throughout the service during our inspection and they knew people’s needs well.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 11 and 12 January 2016 and was unannounced. The service was last inspected 20 May 2013 and was found to be compliant in all areas.

Aden Mount is a purpose-built home situated in Primrose Hill, a residential area of Huddersfield. It offers personal and nursing care and accommodation for up to 45 people aged between 18 and 65 years. All bedrooms, which are over three floors, are single en-suite and all floors are accessed via a passenger lift or stairs.

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.

People who lived at Aden Mount told us they enjoyed living there. They felt staff had the skills and knowledge to support them in a safe and caring way.

Staff we spoke with had received training in safeguarding vulnerable adults and had a good understanding of what constituted abuse. They were able to tell us what they would do if they had any concerns about the way people who used the service were being treated.

Medicines were administered by staff that had the training to do so. People we spoke with told us they received their medicines on time. However, we observed staff did not always stay with people to ensure they had taken their medicines.

We observed two mealtime experiences. At lunchtime people had a lighter meal with the main meal served at tea time. We saw people had a choice of food and drinks. The food looked nutritious and people were offered a choice of vegetables with the tea time meal. Drinks and snacks were available for people during the day. If people had issues with weight loss, we saw evidence the service referred them to the appropriate services, such as the dietician or the general Practitioner.

Staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They understood the need to ask for consent before they carried out any personal care. The registered manager was aware their responsibilities in protecting the rights of people who do not have the capacity to make their own decisions.

We looked at the training matrix for the staff team and saw all training was up to date. Staff we spoke with told us they felt the training helped them to carry out their role effectively. People and relatives we spoke with felt staff had the right skills and knowledge.

The home was spacious with rooms for people to meet their visitors privately. However, there were no signs on the doors to the bathrooms and the communal areas. The bedroom doors did have people’s name on them but did not have any other form of identification. Sometimes people living with dementia have difficulty recognising their name when it is written and use pictures to help them identify their own rooms.

We observed the interactions between staff and people who used the service. We saw it was warm and respectful. People who lived at Aden Mount told us they thought the staff were lovely and very caring. Visitors we spoke with also felt staff were very approachable and their relative was cared for.

The service carried out an annual survey which asked people who used the service to say what they think of the care and support they receive. It showed us people were being asked their opinion of the service.

In the care records we looked at we saw people had been asked how they wanted to be supported toward the end of their life.

The care records we looked at were centred on the support needs of the individual. People told us staff talked to them about their care records and we saw people had signed their consent to care. People’s bedrooms were decorated in a way which reflected their own personal tastes.

Food and fluid charts were not being completed on a consistent basis and it was difficult to establish how much people, who were at risk of malnutrition and dehydration, had to eat and drink.

Activities took place on a daily basis and each person had a copy of the weekly activity sheet. Activities were varied and included arts and crafts and quizzes. People who were unable to take part in group activities were offered one to one activities.

The visitors and people who used the service told us they knew what they would do if they were not happy with any aspect of their care. In people’s bedrooms we saw a copy of ‘How to complain’ which meant people had the information they needed when they wanted to make a complaint.

Staff felt supported by the registered manager. They had an understanding of the vision of the home and what it was trying to achieve. People who used the service knew who the registered manager was and felt able to talk to them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can what action we have asked the provider to take at the end of the full version of this report.

At the time of our visit there were 43 people living in the home; we talked with five people who used the service and six staff, including the managers.

The atmosphere was relaxed as people were seen to be going about their daily routines and had free access to the communal areas of the building.

The staff were seen to speak with people in a respectful manner. People living at the home told us that where they had experienced concerns the manager had acted appropriately and had addressed the issues to their satisfaction.

Comments from individual people who used the service included:

'The cleaner keeps my room tidy. I love my room. I have my own computer and fridge. I have a new carpet and chose it myself. I am going on holiday soon.'

'I just buzz when I need the staff. Sometimes they are slow to answer but they always come.'

'I am happy living here.'