Aspen Grange Care Home

Aspen Grange Care Home is a residential care home providing personal and nursing care for up to 49 people in one purpose built home. The service provides support to older people living with dementia and complex care requirements. At the time of our inspection there were 24 people using the service.

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

People received safe care from staff who knew them well. There was a safeguarding policy in place and the registered manager, and staff knew how to identify and report concerns. There were enough staff deployed to meet the needs of people using the service. Staff had been recruited safely and pre-employment checks carried out.

Risks to people had been assessed and updated in people's care plans when their needs changed. Medicines were administered safely by trained members of staff. Staff had received an induction and training to enable them to meet people's needs. Supervisions, appraisals, and competency assessments for staff were carried out. Staff felt supported by the senior team.

There were effective infection control measures in place. Staff wore personal protective equipment (PPE) appropriately and had access to PPE.

People's nutritional needs were met and additional support was given as required. The food provided was fresh, nutritious and people ate well. Staff were kind and caring and people and their relatives confirmed this. We observed staff responding to people's needs with dignity and respect. People and relatives knew who to speak to if they had any concerns or complaints to raise.

We received positive feedback about the leadership and management of the service. There were systems in place to monitor, maintain and improve the quality of the service.

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. However, we have made a recommendation about completing mental capacity assessments for each specific decision.

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 16 November 2020)

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.

Recommendations

We have made a recommendation in relation to the completing of mental capacity assessments for people which are required to be decision specific, meaning assessing a person for 1 specific decision at a time.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aspen Grange Care Home is a residential care home providing personal and nursing care for up to 49 people in one adapted building. It is a purpose-built home arranged over two floors providing accommodation for people needing residential, nursing and dementia care. At the time of this inspection there were 29 people using the service.

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

Our previous inspection in January 2020 found Aspen Grange had been through a difficult period due to frequent changes of manager which had led to a lack of leadership, management and oversight. This had impacted on the quality of the service provided and resulted in risks to people’s safety not being identified and managed effectively. Staff had failed to recognise and report safeguarding incidents. They lacked training and guidance on how to support people with behaviours difficult to manage. Additionally, the provider's systems for assessing and monitoring the service had failed to identify, poor falls management, lack of cleanliness and poor infection control.

At this inspection we found significant improvements in the management and leadership of the service. A new manager started in post in January 2020 and registered with the Commission as the registered manager on 09 April 2020. Relatives of people using the service and staff told us the new manager had had a positive impact on the culture in the service. A successful recruitment drive had significantly reduced the use of agency staff. Having a consistent staff team, with strong leadership had led to improved staff morale and better team work, which in turn had improved outcomes for people using the service.

Systems and processes to safeguard people from the risk of harm, or abuse had improved. Improved monitoring of people assessed as having behaviour defined as challenging and swift referrals to other professionals had led to these people having a better quality of life. Staff were observed to manage situations in a positive way to ensure people had maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff recruitment and induction processes, including agency staff, had improved which ensured the required checks had been completed to ensure they were suitable to work at the service. A new system to assess the quality of training had been implemented, which assessed staff's knowledge and understanding of training delivered, and their competency to deliver safe and effective care.

Systems were in place to ensure the premises and equipment were safe to use and well maintained. People’s medicines were managed safely in accordance with relevant national best practice guidance. We were assured the service was meeting good infection prevention and control guidelines, including processes to respond to coronavirus and other infection outbreaks effectively.

Systems to assess and monitor the quality and safety of the service, had significantly improved to accurately reflect how well the service was performing, and where improvements were needed. Arrangements for reviewing and investigating incidents where things had gone wrong had improved. All incidents were being reviewed on a monthly basis, looking at what caused the incident to occur, identifying trends, and reflected actions taken to prevent reoccurrence.

Rating at last inspection and update:

The last rating for this service was inadequate (published 13 March 2020) and there were multiple 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.

This service has been in Special Measures since January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 and 17 January 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, systems and processes to safeguard people from abuse, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate 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 Grange Care Home on our website at www.cqc.org.uk.

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 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.

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 Grange Care Home is a residential care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service accommodates up to 49 people in one adapted building. At the time of the inspection 37 people were living at the service.

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

Aspen Grange has been through a difficult period since our last inspection, and whilst we found some improvements had been made to recruit new staff and work better with other professionals, frequent changes of manager have led to a lack of leadership, management and oversight of the service. This has impacted on the quality of the service provided and has resulted in risks to people’s safety not being identified and managed effectively. People’s relatives and staff told us the changes in management had impacted on the culture in the service and the quality of the care people received.

At the time of this inspection there was no registered manager in post, the service was being managed by the area manager and deputy during a transitioning period until a newly recruited manager commenced in post on 20 January 2020.

Our previous inspection in January 2019 identified the providers governance arrangements needed to improve. At this inspection we found the frequent changes in management had failed to drive the required improvements. Governance systems had not been used effectively to address previous issues regarding staffing levels and staff knowledge or identify improvements needed, such as cleanliness of the premises. Neither had they been used to analyse information to identify trends and look at ways of reducing risks to people, such as deployment of staff to manage people’s behaviours and repeated falls. This is a continued breach of regulation 17 (Good governance) Health and Social Care (Regulated Activities) Regulations 2014 from the previous inspection in January 2019.

People’s relatives and staff told us there were not enough staff to meet their family members care needs, provide meaningful engagement and keep them safe. Both days of the inspection people’s anxieties and agitation manifested in arguments whenever staff were not present, resulting in people becoming verbally aggressive towards each other.

Systems, processes and practices to safeguard people from abuse were not effective. Staff were not clear of when to raise incidents that constituted as abuse, which meant there were times when people’s safety had not been protected. Improvements were needed to ensure the environment was clean to prevent the spread of infection and free from unpleasant odours.

We have made recommendation about improving infection control and hygiene.

Although the provider had a training programme in place, this did not ensure all staff had the skills and knowledge to carry out their roles effectively and keep people safe. Additionally, not all training was up to date. Staff had completed challenging behaviour training, but this had not included techniques to keep themselves and others safe where people become physically aggressive. There were no systems in place to test staff understanding of training delivered and minimal testing of their competence to ensure they delivered safe and effective care.

The induction process for agency staff was not robust, 21 agency staff were used between December 2019 and January 2020. 16 of these agency staff had no record of induction to the service to ensure they were familiar with the premises, safety matters and had the skills and knowledge to carry out their roles. Staff recruitment checks, including agency needed to improve to ensure employees were suitable to work with people using the service.

Staff were mixed in their views about the support they received from managers. Staff supervision had not routinely taken place, with some staff not having had a supervision meeting to discuss their performance and professional development. The area manager assured us a supervision programme had been implemented for all staff in 2020.

Care plans needed to improve to ensure they accurately reflected people's needs and provided guidance to staff on how to meet those needs. Further work was needed to ensure people’s care plans contained information about their preferences at the end of their life.

We have made a recommendation about improving end of life care.

People’s personal hygiene needs were not always being met, which meant people were not always treated with dignity and respect. Complaints were not always actioned and responded to.

Systems in place ensured people received their prescribed medicines. The service was working the Clinical Commissioning Group (CCG) Medicines Management Team, the GP surgery and pharmacy to improve communication.

People’s relatives were positive about the caring attitude of staff. Staff treated people with kindness and demonstrated a caring attitude. People had developed good relationships with staff and looked comfortable in their company. A new activity organiser had been recruited. People and their relatives told us there had been an improvement in the activities provided.

People had access to enough food and drink to maintain a balanced diet. People and their relatives were complimentary about the food provided. Peoples healthcare needs were being met. 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.

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 February 2019) and they were in breach of regulation 17, good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulation 17, good governance.

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

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns received about poor falls management, safeguarding concerns not being reported and management of people’s behaviours. A decision was made for us to inspect and examine those risks.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. We have identified breaches in relation to good governance, staffing, staff recruitment, staff training and failure to safeguard people from the risk of abuse at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 with the 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.

Special Measures:

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.

People’s experience of using this service: The service had deteriorated in all domains since our last inspection. The service met the characteristics of requires improvement in all of the five key questions.

There were systems in place to monitor the quality and safety of the service provided and to manage the maintenance of the buildings and equipment. However, these systems were not always effective. They had not identified the areas of concern we found during this inspection in relation to staffing levels, staff knowledge and person centred care. We found a breach of the regulations in relation to the quality assurance processes.

We found there were not enough staff to provide person-centred care. During the inspection, there were mixed views about staffing levels. Observations and feedback indicated at times insufficient staff were deployed to meet people's needs in a timely way. Staff told us they had limited time to spend talking to people or interacting with them. At this inspection we found people were not always offered opportunities for meaningful engagement.

Overall, staff were caring and treated people with dignity and respect. Where possible staff supported people to be as independent as they wanted to be. People and relatives spoken with were complimentary about the support they received. However there were occasions where staff did not always demonstrate that their training was effective.

The service had a safeguarding procedure in place and people were protected from the risk of abuse. Staff assessed people’s risks and records of these assessments had been reviewed. The provider had systems and processes in place for the safe management of medicines. Storage was secure and stock balances were well managed.

Staff received supervision from the management team. People received support they needed to eat and drink sufficient quantities. We found in one area some aspects of the meal service required improvement in order that the mealtime was a positive experience for people using the service.

People's health needs were catered for with appropriate referrals made to external health professionals when needed.

Rating at last inspection: Good (report published July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we identified some areas which required Improvement.

Enforcement: Please see ‘the action we asked the provider to take’ section towards the end of the report.

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

The service had 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.

Staff understood what constituted abuse and the safeguarding procedures to follow to report abuse both internally and externally. People were supported to express their autonomy and make informed choices when taking risks. Medicines were safely managed and took into account people’s capabilities and preferences as to how to take their medicines.

Staff were recruited following safe and robust procedures and there were sufficient numbers of suitable staff available to meet people’s assessed needs. Staff received training to ensure they were equipped with the skills and knowledge to support people using the service. Staff supervision systems were in place to ensure they had the opportunity to reflect on their work practice and plan their learning and development needs.

People’s consent was sought before staff provided their care. People who lacked capacity to make decisions were supported following the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had a balanced and varied diet and their dietary needs were assessed and monitored. They had regular access to healthcare professionals and were supported to attend health appointments to ensure their health and well-being was maintained

Staff treated people with kindness, compassion, dignity and respect. Independence was promoted and people were enabled to make and maintain relationships. Individualised care plans were in place that reflected people’s needs and choices on how they wanted their care and support to be provided.

People and their representatives were encouraged to provide feedback on the service and suitable arrangements were in place to respond to any complaints.

The vision and values of the service were person-centred. People and their representatives were supported to be involved and in control of their care.

Quality assurance management systems were in place to monitor the safety of the environment and the quality of the service.

Aspen Grange Care Home provided a service for people with nursing needs and dementia. We looked at the care records for six people who used the service. We also looked at how their care and health needs were met, how they were safeguarded from harm and how staff were supported and supervised.

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 is a summary of what we found;

Is the service safe?

The service had ensured that staff were provided with the knowledge and skills to keep people safe and protect them from harm. Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place.

We found that the service had suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. No Deprivation of Liberty Safeguards (DoLS) authorisations were in place for anyone at the service, although applications had been made to the local authority after assessments had been completed.

The monitoring of people's care through the reviews of care plans, risk assessments and daily records ensured people were provided with nursing care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence.

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. Staff had a good knowledge of people's likes and dislikes. People told us that the staff treated them respectfully. People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by staff who were respectful and caring.

Is the service responsive?

Regular checks on the dependency levels of people who used the service were undertaken in order for people's needs to be responded to in a timely way. Staff took time with people when undertaking tasks and activities. One person said, "They are good to me, they know me inside out and come when I need them."

We saw from the records viewed that the service worked well with other agencies. A range of health, mental health and social care professionals from the community were involved in people's care. This showed that people received their care in a joined up way and prevented admission to hospital.

Is the service well-led?

Regular care reviews and discussions about people's quality of life at Aspen Grange Care Home were discussed with them and their families. This ensured that people's changing needs and preferences were always taken into account.

Staffing levels were reviewed and spot checks were completed at night to ensure there were always sufficient staff to meet people's needs.