All inspections: Aspire - Care Quality Commission

We rated it as good because:

The service provided safe care. Clinical premises where patients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and staff engaged in clinical audit to evaluate the quality of care they provided.
The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
The service was easy to access. Staff assessed and treated people who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment.The service did not exclude people who would have benefitted from care.

The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

We rated Aspire as good because :

Following our inspection in May 2016 we rated the services as good for effective, caring and responsive. Since that inspection we have received no information that would cause us to re-inspect these key questions or change the ratings.
During this most recent inspection, we found that the services had addressed the issues that had caused us to rate safe and well led as requires improvement following the May 2016 inspection.
The service had modified the patient environment to ensure the safety of staff and patients. They did this by implementing hand washing facilities in the clinic room and window restrictors across the floor the service occupied. Staff had improved the quality of their risk assessments, we found risk assessments to be comprehensive and detailed. Medication storage was appropriate and well maintained. Staff were checking temperatures on a daily basis and this was audited by management. Mandatory training had high levels of completion and now included duty of candour and basic life support. Staff welcomed the addition of basic life support training and felt it was necessary to their role.
The service had updated some of their policies including their safeguarding policy and whistleblowing policy in line with concerns identified in our last inspection. The service had implemented a duty of candour policy which was not present during our last inspection in May 2016. The risk register was regularly updated and identified all the current risks within the service .There were clear communication methods between the service and the board. The service was able to demonstrate they had robust governance arrangements in place which provided higher level oversight.
Aspire were now meeting Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. They were also meeting Regulation 18 Health and Social Care Act (Registration) Regulations 2014.

However,

The service could not calibrate any of their clinic equipment.
Management did not regularly review the usage of the lone working “alert a buddy” system to see if staff were using it. This meant the service managers could not always ensure staff were using it on a regular basis

We rated Aspire as requires improvement because :

We found the provider did not always have adequate provisions in place to ensure safe care and treatment of patients at their base. Facilities in the therapy rooms were not appropriate to use as depot clinics. They compromised hygiene and increased the risk of infection because adequate washing facilities were not easily accessible.

Risk assessments had not been completed to identify whether suitable alterations to the buildings needed to be made. For example, towards the window restrictors. This meant the provider had unknown risks which they could not mitigate. We found patient risk assessments did not always reflect patients current risk profile. Staff identified risk within case notes, however, did not always update them on the risk assessment templates.

The provider was not compliant with its medication management policy. The service had no way of ensuring medication was being kept below 25 degrees Celsius as recommended by their policy. Medications that do not need refrigeration should be kept below 25 degrees as it protects the medication from deteriorating. There was no thermometer to monitor temperatures.

The providers’ governance structures did not always recognise its responsibilities it had to undertake towards the regulator. The safeguarding policy did not indicate staff at Aspire had to inform the Care Quality Commission of any safeguarding concerns or alerts they made. The service did not have a duty of candour policy in place even though they operated in a transparent, honest and open way.

We observed many good practises during our inspection. We had overwhelmingly positive feedback from patients, families and carers about the provider. We were told how responsive, caring, and supportive staff at Aspire were. Patients detailed how the provider had supported them in all aspects of their lives as well as with their mental health. We observed compassionate care; staff were dynamic, had developed positive rapport with patients and listened to them. Carers fed back on how well they were supported and how responsive the provider was to their needs. They felt comfortable in knowing what to do in a mental health crisis as the service had prepared them effectively.

The provider was meeting national targets in assessing a patient within two weeks of referral. There was evidence to show patients had developed their cognitive abilities over the three years, tests averaging 40% in the first year to 70% in the final year. Aspire were discharging over 70% of their patients back to the community and into primary care after three years. They were offering services which were in line with the National Institute of Health and Care Excellence.

Staff had good morale and everyone was complimentary about the team ethic. Staff felt supported amongst their peers and of management. Staff had regular supervision and all had been appraised within the last year.

We observed multi-faceted activity sessions. They not only supported patients with their mental health, but provided life skills, confidence, chances to network and improved physical

People expressed their views and were involved in making decisions about their care.

One person we spoke with told us they were involved in their care and support. Comments included, "The staff from Aspire are very supportive, friendly and considerate.".

There was clear and respectful communication between staff and people used the service. Staff addressed people by their first names and treated people in a kind manner. Staff interactions with people were relaxed and unrushed and were focussed on people's needs.

We spoke with staff who told us the care plans contained relevant and sufficient information to know what the care needs were for each person and how to meet them. One member of staff told us, 'We always talk through the care plan with people and their next of kin before it is signed.'

Regular health and safety checks were carried out throughout the building and we saw a record kept of these.

Training records showed that appropriate training was being delivered. One member of staff said, 'We get good training and also gain experience and learn from each other.' Another member of staff said, 'We get loads of support and training.'

Staff we spoke with said everyone worked well together and they had received enough training to equip them with the right skills to do their job well. All staff we spoke to said they felt valued as member of the team.

The Registered Manager identified, monitored and managed risks appropriately. Regular monthly audits were carried which looked at areas such as the medication procedures, FACE (Functional Analysis of Care Environments) risk assessments (The FACE risk profile is part of the toolkits for calculating risks for people with mental health problems, learning disabilities, substance misuse problems, young and older people) and discharges

During our visit, we had the opportunity to talk with three people who used the service. People told us they were happy with the care and support they received.

One person told us, 'They were very friendly and supportive, they try and get me to be busy and I feel very safe.' Another person said, 'I think they do a great job and help build up my self esteem.' One person said, 'I like going, it's a good group and builds up my confidence.'

People told us that there were always plenty of staff on duty and they felt able to approach staff when they wanted to. People who we spoke with told us that they felt that staff listened to them. They told us that they felt involved in decisions regarding their care and that they were able to contribute to care planning meetings.

People we spoke with said they understood their care and support plans and that staff had explained things well to them.

People who used the service were very complimentary about the staff. One person told us, 'They are very supportive and help me each day; there is always someone available for me to talk to.'

They also told us they were able to discuss changes and contribute to their care plans if they wished. One person told us, "I have been through the care plan with the staff and no changes are made unless we are involved.'

Archived: Aspire

All Inspections

13/11/2018 - 14/11/2018

During a routine inspection

18/01/2017

During an inspection looking at part of the service

16 May 2016

During a routine inspection

23 December 2013

During a routine inspection

11 January 2013

During a routine inspection