This unannounced inspection took place on 8, 13 and 22 November 2017. This meant the provider, registered manager, staff and people using the service did not know that we would be carrying out an inspection of the service. The service was registered on 27 June 2017 and this was the first inspection of the service. This service had been rated 'Inadequate' under the previous provider and we needed to check that improvements had been made.
Aster care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Aster care is purpose built and can provide nursing and personal care for up to 102 people across three separate units for people living with a dementia and people who have nursing needs. The service also provides support for working age adults who have a physical health condition, live with a mental health condition, learning disability or autism. At the time of inspection there were 39 people using the service who had nursing needs, were living with a dementia, had a physical disability or had a mental health condition.
The registered manager has been registered with the Care Quality Commission since 27 June 2017. 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.
The registered manager had not always informed CQC of significant events by submitting the required notifications. This meant we could not always check that appropriate action had been taken.
Quality assurance procedures had not identified that staff were not following the correct procedures for monitoring people at risk of dehydration and for turning percutaneous endoscopic gastrostomy (PEG) feeding tubes to stop them embedding into the wall of the skin.
Some aspect of medicines management needed to be improved. This included medicines audits and policies to make sure they were specific to the service.
The provider had not carried out quality assurance visits to monitor the service. The registered manager was carrying out some audits. Formal supervision sessions had not been carried out.
People's privacy and dignity was not always maintained. Doors were not always closed during personal care.
People and staff were aware of how to raise concerns about bullying, abuse and inappropriate behaviour. There was evidence that lessons had been learned, such as when safeguarding incidents had occurred, as measures were put in place to prevent repeat events.
Systems were in place to monitor the safety of the building. Staff participated in regular fire drills. Accidents and incidents had been reviewed and actions taken to review risks. Risk assessments were in place to keep people safe. They had been reviewed and were in-line with people’s needs.
Complete recruitment records were in place and also staff had Disclosure and Barring Service (DBS) checks in place. The DBS carry out criminal records checks and also ensure that people are not barred from working with vulnerable children and adults. This helps employers make safer recruitment decisions.
There were sufficient staff on duty, however break times were not managed well. The registered manager told us they would take immediate action to address this.
There was sufficient personal protective equipment available for staff. An infection prevention and control champion was identified within the service who provided staff with up to date information and training for all staff was on-going.
Staff were supported through an induction programme. Informal supervisions had taken place but not been recorded. Training was in place for staff.
People told us they enjoyed the food provided but wanted to be involved in menu planning. People were given choice and had been given enough to eat and drink.
Care records reflected recommendations and guidance made by health professionals to support people’s health and wellbeing. People were supported to access whatever healthcare services they needed to in order to remain healthy.
Mental Capacity Act assessments had been carried out when needed. The registered manager had followed the requirements of Deprivation of Liberty Safeguards (DoLS) and applications had been submitted when needed so that assessments could be made about whether people needed to be lawfully deprived of their liberty to maintain their safety. CQC had been informed when applications had been approved. Staff were complying with conditions applied to authorisations.
People were supported to make decisions about their own care; however this was not always reflected in people’s care records. This is because staff had not completed the records fully. The registered manager was aware that this was a training issue.
The service was clean and tidy and rooms were personalised. Some adaptations were in use at the service, such as handrails in communal areas and bathrooms. Further improvements were needed to create a dementia friendly environment.
A small number of assistive technologies were in place for people. These included wheelchairs, walking aids, mobile phones, Wi-Fi and a computer with voice recognition. Communication passports were not in place for people when they went into hospital. We have made a recommendation about this.
Staff provided safe care and support to people and knew people's needs well. Care plans were detailed and contained relevant information about people’s needs, wishes and preferences.
People told us staff were kind and respectful to them and staff encouraged them to remain independent. People spoke highly of staff. We saw people and staff laughing and joking during inspection. Staff responded quickly when people were anxious and upset. Staff supported people to maintain relationships with people important to them.
Staff took quick action when people became unwell and followed recommendations and guidance from health professionals.
People and staff gave mixed reviews about the quality of activities provided at the service. People had developed their own activities committee to improve the quality of activities for everyone.
People and staff spoke positively about the registered manager. Staff worked together as a team and they told us the morale within the team was good.
Meetings for staff and people using the service had taken place. Both parties had been kept up to date on the work being carried out by the provider and plans for the future. Feedback had been sought in both of these meetings. The registered manager told us that surveys were due to be carried out shortly.
The service worked in partnership with health and social care professionals involved in people’s care, with the clinical commissioning group, local authority contracts and commissioning and safeguarding teams.
People and relatives were aware of how to make a complaint, though none had done so. People told us they felt listened to when they had raised concerns.
The registered manager told us they provided end of life care to people when needed, however they were not providing this at the time of inspection.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Good governance. We also identified a further breach of the Care Quality Commission (Registration) Regulations 2009 by way of failure to make statutory notifications in relation to the abuse or allegation of abuse of people. You can see what action we told the provider to take at the back of the full version of the report.