Aspen Court Nursing Home

Aspen Court Nursing Home is a residential care home providing nursing and personal care for up to 72 adults. At the time of the inspection 69 people were living at the service, including older people, people with physical health conditions and those living with dementia. The second floor can accommodate up to 26 people with nursing care needs.

Aspen Court Nursing Home accommodates people in one building across three floors, with each person having their own bedroom and en-suite bathroom. There were also communal living and dining rooms, a main kitchen, smaller kitchenettes on each floor and access to a secure garden.

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

Improvements were still needed with people's care plans and risk assessments as inconsistencies were seen across the records we reviewed. Records were not always clear about levels of risk or guidance for staff to follow to keep people safe.

People and their relatives were positive about the kind and caring attitudes of the staff team. One relative said, “The staff are very friendly and they show respect. [Family member] is very sociable and they have a good rapport, get on well together and have a good sense of humour together. They thrive on this.”

People were supported by staff who were dedicated in their role to ensure they received the care they needed. We observed a range of positive interactions between people and the staff team throughout the inspection. Staff responded appropriately, with patience, compassion and in a timely manner.

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.

People and their relatives told us they had been well supported throughout the COVID-19 pandemic and were updated if there had been any changes to government guidance or changes with visiting restrictions. One relative said, “They have been very good with this and ensured staff were wearing masks. They were providing tests and helping to keep us all safe.”

The manager had a visible presence and people and their relatives felt comfortable approaching them to discuss any issues or concerns. One relative said, “The new manager called me the other day to let me know her door is always open. I feel she has fallen into the job in a very caring way.”

People were supported to access healthcare services and had input from health and social care professionals if their needs changed. Health and social care professionals were positive with the improvements that were being made since the new manager had started.

Although feedback was positive about the changes that had been made by the new manager, not all staff felt supported or appreciated for their work. Some staff told us this impacted on the working environment.

Improvements had been made since the previous inspection and the provider’s monitoring processes had identified areas to be improved. The manager held daily meetings and carried out regular walkarounds to check on the care and support people received.

Incidents that occurred across the service were regularly notified to the CQC. However, safer recruitment practices were not always followed.

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 inspected but not rated (published 21 July 2022). This is because it was a targeted inspection to look at a specific concern. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The last rating for a comprehensive inspection was requires improvement (published 21 April 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on the action we told the provider to take at the last comprehensive 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 COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified a continued breach in relation to safe care and treatment. We have identified a breach in relation to recruitment practices. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aspen Court Nursing Home is a residential care home providing nursing and personal care for up to 72 adults. At the time of the inspection 65 people were living at the service, including older people, people with physical health conditions and those living with dementia. The second floor can accommodate up to 26 people with nursing care needs.

Aspen Court Nursing Home accommodates people in one building across three floors, with each person having their own bedroom and en-suite bathroom. There were also communal living and dining rooms, a main kitchen, smaller kitchenettes on each floor and access to a secure garden.

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

There were systems in place for safeguarding procedures across the home to ensure people were protected from the risk of abuse.

Staff were positive about the training and discussions they had around safeguarding and were regularly reminded about their responsibilities. Staff were confident in the management team dealing with any concerns they raised.

The management team were open and transparent when we discussed the concerns with them and the reason for the unannounced inspection. They were continuing to work with the local authority in response to an incident that led to this inspection.

We did not speak with any people who used the service as part of this inspection.

Rating at last inspection

The last rating for this service was requires improvement (published 18 April 2020) and there were two breaches of regulations. The provider completed an action plan to show what they would do and by when to improve.

Why we inspected

The inspection was prompted by a notification of a serious incident and information from the local authority safeguarding team. Following which a person using the service was alleged to have been subjected to a serious assault. At the time of the inspection this incident was 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 possible concerns about the safeguarding systems in place at the service. This targeted inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Aspen Court Nursing Home on our website at www.cqc.org.uk.

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, which will help inform when we next inspect.

Aspen Court Nursing Home is a residential care home providing nursing and personal care for up to 72 adults. At the time of the inspection 68 people were living at the service, including older people, people with physical health conditions and those living with dementia. The second floor can accommodate up to 26 people with nursing care needs.

Aspen Court Nursing Home accommodates people in one building across three floors, with each person having their own bedroom and en-suite bathroom. There were also communal living and dining rooms, a main kitchen, smaller kitchenettes on each floor and access to a secure garden.

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

People and their relatives were positive about the kind and compassionate attitude of the staff team. People and their relatives told us they had settled in well since they had moved in and were made to feel welcome by a friendly staff team.

We observed positive interactions between people and staff throughout the inspection, with staff responding appropriately to changes in people’s needs, including when they became distressed or upset.

People's care plans and risk assessments were not always clear about the level of risk or what actions were required to mitigate risks to their safety, with inconsistencies seen across the records we reviewed.

Positive feedback was seen in how people were supported at the end of their life, with numerous compliments received from relatives on how they had been cared for at this sensitive time.

Two dedicated wellbeing coordinators encouraged people to be involved in a range of activities and events within the home and in the local community.

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.

People were supported to access healthcare services and appropriate referrals were made to the necessary health and social care professionals if people’s health changed. Health and social care professionals visiting during the inspection were positive about the care and support people received and felt staff had a good understanding of people’s needs.

People were cared for by a motivated staff team who felt appreciated in their role. Staff were positive about the support they received and the working environment, which helped to create a warm and welcoming home. Some staff described the home as their ‘second family.’

The management team had a visible presence and staff said they made themselves available when needed. The registered manager had daily meetings and walkarounds to check on the care and support people received.

Although we saw some improvements had been made since the previous inspection, the provider had failed to notify us about all the incidents that had occurred across 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 17 December 2018) and there were two breaches of regulations. 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to safe care and treatment and notifiable incidents. 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 alongside the provider and 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.

The previous comprehensive inspection of this service took place on 10, 11 and 15 February 2016. The service was rated overall as Good. Safe was rated as Requires Improvement, and effective, caring, responsive and Well-Led were rated as Good. There were no breaches of Regulation and one recommendation was made for the service to seek guidance from a reputable source about measures to prevent and control the spread of infection. This recommendation had been made as we had observed that a sluice room was not clean and staff had not always worn gloves and aprons as appropriate, which had placed people at the risk of infection.

We subsequently carried out an unannounced focussed inspection of this service in September 2017. This inspection was conducted in response to information of concern received by CQC from different sources in relation to how the provider ensured that people were provided with safe and appropriate care to meet their identified health and social care needs. We had spoken with the provider about the concerns at the service, which were being investigated through safeguarding protocols by the local social services. The provider had developed and begun to implement an action plan to address areas for improvement, as identified by the provider’s own monitoring system and feedback from external authorities. Although the sluice rooms were hygienically maintained and staff appropriately wore personal protective equipment to protect people who used the service from the risk of infection, other safety practices at the premises were not sufficiently rigorous. We had observed that two unlocked bathrooms were being used for storage of equipment such as wheelchairs, which placed people at risk of trips and/or other accidents. A linen chute was also unlocked and incorrect cleaning apparatus was being used by a member of staff. These issues were addressed by the provider at the time of the inspection.

At the time of the inspection there was a registered manager in post, who was present on all three days of our visit. A registered manager is a person who has registered with the CQC 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 commenced in her management role after the previous inspection.

The systems for managing and monitoring the administration of people’s medicines were not sufficiently robust to identify an incident where staff had failed to follow medicine instructions from a person’s GP to promote the person’s physical and emotional comfort, and other occasions when medicine was not signed for to evidence that it had been administered.

People told us they felt safe with staff, who had received safeguarding adults training and understood how to protect people from abuse. Safeguarding notifications were appropriately sent to CQC, in line with the law. Risk assessments had been developed to identify and mitigate risks to people's safety and welfare. However, some of the risk assessments were generic and did not address people’s individual needs and circumstances. The provider had implemented systems to enable staff to assess people's capacity to make decisions and support people to make their own choices, where possible.

Staff received training and support to undertake their roles and responsibilities. Aspects of the mandatory training were not up to date, however the provider had identified this and had scheduled training in place to rectify this. The training programme had a useful course for care staff to develop their knowledge of health care issues that impacted on the health of older people, but end of life care training was limited.

People were supported to eat a nutritious diet that took into account their preferences, and any cultural and/or health care needs. The catering staff met with people who used the service to check if they had any comments and suggestions about the food service.

Staff supported people to meet their health care needs and we received some positive comments from relatives in relation to how staff had escorted their family member to a hospital appointment or supported a family member to appropriately gain weight by adhering to a clinically advised diet. We also received negative comments from relatives about staff failing to provide adequate support to people, including a person was receiving end of life care.

Interactions between staff and people were positive. We received some mixed views from relatives in relation to whether their family member were treated in a respectful way that upheld their entitlement to dignity and privacy.

The care plans explained how to provide people’s care and support in practical terms so that new staff could follow the plan to provide safe care. However, there was limited information within the care plans to demonstrate that people’s preferences were taken into account so that their care reflected their unique and individual likes and wishes.

People were supported to take part in activities and entertainments. This included visits from key members of the local community, for example staff from the local fire brigade and a city farm within the borough had engaged with people who used the service as part of ongoing connections. The wellbeing coordinators were developing their knowledge and skills for working with people who were living with dementia.

People who used the service and their representatives were provided with information about how to make a complaint. We saw that the registered manager responded to complaints, however one relative had to try on several occasions to get an acceptable response to their complaint.

There were shortfalls with the quality of end of life care. Although the people we met during the inspection were comfortable, the complaint from a relative identified issues in relation to staff training and the ability of staff to communicate with relatives in a professional and sincere manner.

People who used the service and relatives were mainly positive about the registered manager's welcoming approach and leadership skills. Staff were unanimous in their comments about the registered manager's supportive management style. The provider had systems in place to monitor the quality of the service, support and advise the registered manager and listen to the views of people and staff. However, the quality monitoring was not rigorous enough to swiftly identify a range of concerns in relation to the ability of the service to provide consistently valued and reliable end of life care.

Our previous inspection of this service was undertaken on 10, 11 and 15 February 2016. This was a comprehensive inspection and the service was rated overall as Good. Safe was rated as Requires Improvement, and Effective, Caring, Responsive and Well-Led were rated as Good. There were no breaches of Regulation and one recommendation was made for the service to seek guidance from a reputable source about measures to prevent and control the spread of infection. This recommendation had been made as we had observed that a sluice room was not clean and staff had not always worn gloves and aprons as appropriate, which had placed people at risk of the spread of infection.

We carried out this focussed inspection as the Care Quality Commission had received information of concern from different sources in relation to how the provider ensured that people were provided with safe and appropriate care to meet their identified health and social care needs. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Aspen Court Nursing Home on our website at www.cqc.org.uk.

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. The registered manager commenced their position in June 2017 and was present on both days of the inspection.

Care and treatment was delivered in a way that was intended to ensure people’s safety and welfare. People reported that they felt safe with staff, who were described as being kind and caring. Staff understood their responsibilities to keep people safe and free from harm. Systems were in place to identify and manage any risks to people’s safety, and records showed that people received the daily care they needed to promote their health and wellbeing. People were provided with a clean and hygienic home.

People, and their relatives where applicable, were supported to participate in the planning and reviewing of their care plans. People’s views were sought through a range of approaches including annual review meetings, the ‘resident of the day’ system, residents’ meetings and formal surveys.

Information about how to make a complaint was readily available for people and their representatives, and complaints were fully investigated. However, not all of the complaints investigations satisfactorily evidenced that agreed actions for improvement had been fully implemented.

Positive views were voiced by people who use the service and relatives about the leadership style of the registered manager. We found examples of how the service needed to improve on the quality of its documentation for the reporting of accidents and incidents. There were clear processes in place to monitor and audit the quality of care and ensure that staff received appropriate guidance, training and supervision to satisfactorily meet people’s needs.

Our last inspection was completed on 14, 15, and 17 April 2015 and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to medicines management, staffing, risk management, infection control, good governance and consent. We checked whether the provider had followed their plan during this inspection to confirm that they now meet legal requirements.

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.

A new registered manager had been appointed since our last inspection and driven forward a series of improvements at the service. Robust monitoring procedures had been developed to ensure the care was of high quality. The team morale had improved and there was a positive and open culture at the service.

The provider had not done all that was reasonable to prevent the spread of infection because a sluice we observed was not clean and staff did not always wear gloves and aprons as appropriate.

People were protected from other risks related to their health and well-being because risk assessments were adequately detailed and updated to provide effective guidance to staff about how to mitigate such risks. People were kept safe from the risk of abuse by well trained staff who felt confident to raise concerns about poor practice.

The provider had used a robust recruitment procedure to employ staff suitable to work in the caring profession. The provider had appointed staff to newly created roles and had assured there were enough staff to meet people’s needs.

Staff developed caring relationships with people who used the service. People were supported to raise any concerns they held.

Medicines were stored, administered and disposed of safely. Medicines that were administered covertly or on an as required basis were well managed. People were supported to get enough to eat and drink and people had access to healthcare professionals as required.

The provider followed the latest guidance and legal developments about obtaining consent to care. Staff used a range of communication methods to support people to express their views about their care. There was evidence that people and their relatives were involved in planning their care and care records included information about people’s likes and dislikes. Records were updated in response to people’s changing needs.

We have made two recommendations about infection control and communicating with people for whom English is not their first language.

People using the service told us the staff treated them with respect and dignity. One person told us, "the staff respect my privacy." A visiting professional told us, "they treat people here with compassion, respect and dignity."

We looked at staff files and saw that the service followed recruitment procedures and checked that new staff were suitable to work in a care home.

People using the service said they could talk with staff or the manager if they had any concerns or complaints. They also felt confident that staff members would resolve their problem. One person said, "I would complain to the manager. She would look at it."

We spoke with four people who were using the service. Each person told us they liked living at Aspen Court Nursing Home. People told us staff were "kind" and "caring." One person told us, "Mary [the registered manager] looks after us very well. Staff are very nice. I am happy here." We spoke with a relative of a person, who felt the staff understood her family member's personality. They also commented the home was "very nice."

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. There was a good care planning system in place and staff working in the home were aware of each person's individual needs. This included each person's cultural and spiritual needs.

There were effective systems in place to reduce the risk and spread of infection. The premises were clean and hygienic. Staff were aware of infection control issues and they received the relevant training.

Staff told us they felt very well supported by the management team. They were offered a wide range of training and regular supervision and appraisal meetings.

People who use the service, their representatives and staff were asked for their views about their care and treatment and their views were acted on. The provider took account of complaints and comments to improve the service.