Archived: Aspen Hill Village

Aspen Hill Village is a care home that can accommodate up to 180 people who require support with nursing or personal care needs, some of whom were living with dementia. At the time of our inspection, 123 people were living at the service.

The home has six separate units and care was provided in five of the units. Each of the units was providing care to people with varying health and care needs including people living with physical disabilities, people requiring end of life care and people living with dementia.

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

People did not always receive safe care. During this inspection, we identified and reported safeguarding concerns. People's medication was not always administered safely. Risks to people's care were not always managed well or had not been properly identified and acted upon. We found concerns in relation to the safety and management of window restrictors. During our first inspection visit, we identified concerns in relation to risk of cross infection of COVID 19 in one of the units.

People and relatives told us agency staff did not always seem to be knowledgeable about people’s needs or communicated well with people. The provider had developed systems to make sure agency staff were aware of people needs. People told us call bells were not always responded to in a timely way. The provider was not monitoring call bells’ response times; this issue had been highlighted at our last inspection. We made a recommendation in relation to this area.

The provider failed to ensure people's nutritional needs were always met. Several people living at the home had lost weight and some had not been identified before our inspection. Some people living at the service told us the food was not always appetising; this feedback was known to the provider and actions were being taken to address this.

We found staff were offered varied training, but this had not always been completed.

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 in the service supported this practice. However, we found examples of inconsistent application of the policies. We saw relevant mental capacity assessments and best interest decisions had been completed in several occasions, but we also found examples where this was needed and had not been put in place. We made a recommendation for the provider to review this area.

The provider did not always ensure people received person-centred care and treatment. Some people's care plans were inaccurate and lacked information about people's needs. We found concerns in relation to the provision of people's foot care and lack of evidence around oral care. There were activities happening at the home, but the provision wasn’t always consistent or dementia friendly.

Although people and relatives told us staff were kind and we observed caring interactions between people and staff, our overall findings did not indicate the home was consistently providing a caring service that always respected and was responsive to people's needs.

We found widespread shortfalls in the way the service was managed, in particular a lack of management oversight. There was a risk of people receiving inappropriate care. Quality assurance processes had not always been effective in identifying the issues found at this inspection and in driving improvements. Records were not always accurate and complete.

The registered manager collaborated with the inspection, was receptive to the inspection findings and acted on the issues found or told us the action they would take to address the issues identified.

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 18 May 2021).

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 the provider remained in breach of regulations and we found new breaches.

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safeguarding incidents, management of medication, staffing, infection prevention control and management of the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, person centred care and good governance 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Aspen Hill Village is providing personal and nursing care to 157 people aged 65 and over at the time of the inspection. The service can support up to 180 people. Care is provided to people across six separate units. Each of the units specialises in providing care to people with varying health and care needs including people living with physical disabilities and people living with dementia.

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

Improvements had been made since the last inspection and medicines were managed safely and issues with staffing resolved. In these areas, systems and processes had been introduced to ensure the service continued to improve.

Numerous audits were regularly taking place to monitor the service. These showed an improving service. There were still some areas where audits had not identified areas to improve to ensure safety was enhanced. This included the assessment of individual risk and moving and handling assessment and recording.

People and their relatives were generally very happy with the care provided and care was provided safely. Relatives reported improvements in their relations wellbeing. A couple of people we spoke with during our inspection told us they had to wait for care to be provided and the response to call bells was slow. The provider identified an issue with the new call bell which they stated was due to incorrect use by staff and further training had been initiated. The provider will monitor this to ensure there is a timely response to call bells and request for support from people.

Accidents and incidents were recorded on a computerised system and monitored. Where identified, lessons were learned to reduce the risk of them happening again.

Infection control procedures were in place and the provider followed current government guidance to ensure people were protected from the transmission of infection. Visiting had commenced and strict procedures were followed to ensure people were protected from the transmission of infection.

Staff had been trained to don and doff personal protective equipment and there was enough stock of PPE. Cleaning rotas and schedules were in place to ensure risks to people were minimised. Overall, the units we inspected were visibly clean with some minor issues which we reported back.

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 23 December 2019). 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 those regulations. However, we did find the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service between 22 and 31 October 2019. Breaches of legal requirements were found. 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 remained requires improvement. This is based on the findings at 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 COVID-19 and other infection outbreaks effectively.

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

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.

Aspen Hill Village is a large nursing home, spread across five separate houses. It provides residential, nursing and dementia care services for up to 180 people. Care is provided in five separate purpose- built houses. Each house can accommodate up to 30 people and caters for different needs: Rushmore house provides residential and nursing care, Pearl Peak and Tryfan house both provide nursing care for people living with dementia, Ingleborough house provides residential care for people living with dementia and Nevis house provides nursing care. At the time of our inspection there were 123 people living at the service.

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

Medication practices were not always safe, and people did not consistently receive their medicines as prescribed. There were not always enough staff; suitably deployed, to fully meet people's needs. On four out of the five houses, people and relatives said there were not always enough staff who knew them well. The service was not consistently clean and well maintained. However, a full refurbishment was planned and underway, with areas of highest priority identified.

There were systems in place to monitor the quality of the service and identify when improvements were needed. These were not sufficiently robust to have identified the issues we found in relation to the management of medicines, staffing, some areas of risks to people’s health and wellbeing and care planning. We have made a recommendation about the need to ensure robust systems of audit are fully embedded in 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 records of mental capacity assessments, best interest decisions and obtaining people’s recorded consent to care. People's nutritional needs were met. Although, records of people’s food and fluid intake were not always completed well. People had access to healthcare services and received ongoing healthcare support as required.

People told us they felt safe. Recruitment processes were managed safely. Overall, suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Staff received appropriate training and newly appointed staff received an induction. Staff told us they felt well supported.

Staff knew people well and were aware of their individual needs and how to meet them. People and their relatives were involved in the planning and delivery of their care. Some care records were detailed and person-centred; others did not always contain all aspects of people's care and support needs. People and relatives spoke positively about staff; they described them as kind and caring.

People enjoyed a range of activities which included trips out and celebrations of important events. People were treated with respect and their privacy and dignity was maintained. People and relatives were confident to raise issues and concerns. People and their relatives spoke highly of the new provider and registered manager. They were described as approachable, visible and making positive changes in 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 26 September 2018) and there was a breach of regulation.

Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection. The previous provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been sustained and the new provider was still in breach of regulations and remains rated requires improvement.

Why we inspected

This service was registered with us on 27 March 2019 and this is the first inspection of the service under the provider Aspen Hill Healthcare Limited.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service was seriously injured. This incident is 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 concerns about the management of falls from height. This 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 domain section of this report.

Enforcement

We have identified breaches in relation to staffing and medicines management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.