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Inspection carried out on 23 April 2019

During a routine inspection

About the service: Aston House Care Home is a care home providing accommodation with nursing care for up to 48 older people. There were 41 people living at the service at the time of our inspection. Aston House Care Home is a purpose-built building which accommodated people over two floors. People who used the service were older people with nursing needs and/or living with the experience of dementia.

People’s experience of using this service:

¿ The provider had systems in place to help ensure people who used the service were safe from avoidable harm and these were effective.

¿ Where there were risks to people who used the service, these had been assessed and management plans included clear guidelines to help ensure people were safe from harm.

¿ People’s nutritional and healthcare needs were met and we saw that staff took appropriate action when concerns were identified.

¿ The provider had robust systems in place to monitor the quality of the service and put action plans in place where concerns were identified. People’s care records were reviewed and updated monthly or more often if their needs changed.

¿ People received their medicines safely and as prescribed. Staff received training in the administration of medicines and had their competency at managing medicines safely checked.

¿ Care plans were developed from pre-admission assessments and contained relevant and up to date information about people’s needs and preferences, so staff knew how to care for and support them.

¿ People were supported by staff who were suitably trained, supervised and appraised.

¿ Where possible, people had an end of life care plan in place which stated their individual wishes when they reached the end of their lives.

¿ Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

¿ People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean, tidy and well maintained throughout.

¿ The environment was tailored to the individual needs of people who used the service, including those living with the experience of dementia.

¿ The provider acted in accordance with the Mental Capacity Act 2005. People had their mental capacity assessed before they moved into the home. Where necessary, people were being deprived of their liberty lawfully.

¿ The provider had processes for recording and investigating incidents and accidents. We saw that these included information about the actions which had been taken and lessons learned.

¿ People were engaged in a wide range of meaningful activities. People were consulted about what they wanted to do and were listened to. People reported they were very happy with the activities on offer.

¿ Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual.

¿ The manager led a caring and dedicated team. Together, they met people’s individual needs and improved their quality of life.

Rating at last inspection: At the last inspection on 3 and 4 October 2016 the service was rated good.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection program. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at

Inspection carried out on 3 October 2016

During a routine inspection

We undertook an unannounced inspection of Aston House on the 3 and 4 October 2016.

Aston House is a purpose built home providing accommodation for up to 48 people with mental health and/or dementia care needs. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 39 people using the service.

We previously inspected Aston House on 29 May 2014 and 6 August 2014 and the provider had met all the regulations that were inspected.

At the time of the inspection there was a registered manager in place. 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.

There was a policy and procedure in place for the administration of medicines. We noted an issue with the storage of controlled medicines but this was resolved during the inspection.

The provider had processes in place in relation to infection control and cleaning but we noted the footplates of two hoists had not been cleaned appropriately. This was resolved during the inspection and a refurbishment programme for communal bathrooms and toilets was underway.

People told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

The provider had processes in place for the recording and investigation of incidents and accidents. A range of risk assessments were in place in the support folders in relation to the care being provided.

The provider had an effective recruitment process in place. Care workers and nurses told us they felt supported by their line manager.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

People gave mixed feedback in relation to the food provided and a menu based upon photographs of each meal option was in development.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

A range of activities were arranged at the home which included trips to the pub and local garden centres but alternative activities were not always organised for the people not participating in the trip. We have made a recommendation for the provider to review guidance on providing activities in care homes.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided. The registered manager introduced guidance for staff on providing more detail about the person’s daily experiences in these records during the inspection.

People using the service and their relatives had a range of ways to provide feedback on the way care was provided and the quality of the service.

The majority of records we looked at were up to date but some records of personal care had not been completed accurately. The registered manager took action during the inspection and resolved the issue by providing additional guidance to care workers and nurses.

The provider had systems in place to monitor the quality of the care provided and these provided appropriate information to identify issues with the quality of the service.

Inspection carried out on 6 August 2014

During an inspection in response to concerns

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess what the provider had done in response to concerns raised with us about the service. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines. Improvements had been made to the arrangements for medicines handling and to the checks that were carried out to make sure safe processes were followed. Staff had received additional training to support the safe management of medicines in the home.

People in the home were unable to talk to us about their medicines, so we looked at records and watched how medicines were given to people to find out about their experiences.

Inspection carried out on 29 May 2014

During a routine inspection

We spoke with one person using the service, two relatives, four visitors, two members of staff and the registered manager. At the time of the inspection there were 32 people using the service.

The inspection was carried out by an inspector during one day. This helped answer our five questions;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessment related to the care and support being provided and were regularly reviewed to ensure people's individual needs were being met safely.

The medicines prescribed to people using the service were stored in a secure appropriate manner. We saw that the Medicines Administration Records (MAR) charts for all the people using the service were correct and information was clearly recorded. We saw that the stock of five medicines recorded on the MAR chart was not the same as the actual stock. The manager confirmed additional checks would be carried out.

Relatives we spoke with said they felt their family member using the service was safe and they understood what to do if they had any concerns about the care being provided.

Staff members and relatives we spoke with felt there were enough staff to provide the levels of care required by people using the service.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.

The building was maintained and plans had been put in place to resolve any issues identified including replacing the carpet and upgrading the call bell system.

Is the service effective?

People using the service and their relatives were involved in the development and review of care plans so they understood and agreed to the care planned for them.

The home had a good relationship with the six General Practitioners (GP�s) to provide medical assessment and support for the people using the service.

Is the service caring?

We saw that people were supported by kind, attentive staff who treated them with respect and dignity. We saw people were supported and encouraged to be actively involved in their daily care and activities. Relatives we spoke with said they felt the person using the service was safe and they were treated with respect.

Is the service responsive?

The manager ran a surgery session every Thursday when relatives or visitors could meet with her to discuss any issues or concerns relation to care. We saw these sessions advertised in the reception area.

Is the service well led?

At the time of our inspection the manager of the home was in the process of registering with the CQC.

The service had a quality assurance system in place. Records seen by us showed that any issues identified in relation to the quality of the care provided. As a result the quality of the service was continuingly improving.

Regular audits of the care plans and risk assessments were carried out and any identified actions had a completion date. This enabled people to be involved in the decisions regarding the support they received and for staff to identify if the care provided met the needs of each individual using the service.

The manager explained that a questionnaire had not been sent out to people using the service and their relatives during the previous year but they planned to send one out in the next couple of months. They told us that people could complete a feedback card with their comments.

Inspection carried out on 26, 28 June 2013

During a routine inspection

We spoke with four people using the service, two relatives and twelve staff. We spoke with the registered manager and with a member of the ambulance service. At the time of inspection there were thirty people using the service.

People and their relatives confirmed they could make choices and that the people using the service were being well cared for. Comments received from relatives included, �the staff are all very caring and nice people.� and a person using the service told us, �it is very sociable here.�

People said they liked the food and staff were available to provide the support and assistance people needed to meet their nutritional needs.

Procedures for the management of medicines were in place but were not always being followed, putting people at risk of not receiving their medicines as prescribed.

Staff said they had undertaken induction training when they started working at the home, plus they received training and updates to keep their knowledge and skills up to date. The manager was aware of individual staff training needs and work was on-going to bring all staff up to date with training.

Procedures were in place for quality assurance, and where shortfalls had been identified, action plans had been drawn up and action taken to address them.

A complaints procedure was in place and staff knew to report to their senior or the manager if anyone looked unhappy or voiced a concern, so these could be addressed.

Inspection carried out on 11 February 2013

During an inspection looking at part of the service

During our inspection on 18 October 2012 shortfalls were identified which showed that people were at risk of receiving unsafe and inappropriate care. We asked the provider to improve and they submitted an action plan to address the two areas where the service was not complying with essential standards of quality and safety.

At this inspection we found that the areas we had previously identified as requiring improvement, had been improved or were in the process of being improved. As a result we judged that the provider was compliant with the essential standards of quality and safety where we had previously identified shortfalls. The improvements included the management of the lunchtime meal on the first floor, wound identification and care and the maintaining and updating of care records.

Inspection carried out on 18 October 2012

During a routine inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with four people using the service, two visitors and eight staff.

People were encouraged to make choices about their care and said staff listened to them. The majority of the care provision was good and people looked well cared for, however some shortfalls were identified with mealtimes, wound and falls management. One person said �if you want anything you can always ask� and another said �this is a lovely home�. Visitors told us they were happy with the care being provided and that a variety of entertainments and activities took place.

Staff demonstrated an understanding of safeguarding and whistle blowing procedures and were clear that all safeguarding concerns must be reported to the manager and to the local authority. People said if they had any concerns they would be able to speak with staff about them.

The home was being staffed to meet the needs of the people using the service. Staffing levels were monitored in line with the number of people using the service and changing dependencies.

Systems were in place for monitoring the quality of service people received. While some of the care plan records viewed were comprehensive, there were shortfalls identified and action was needed to ensure people�s records accurately reflected their current care needs.