The inspection of Aden House Care Home took place on 16 and 23 May 2018. We previously inspected the service on 16 December 2016; we rated the service Requires Improvement. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

Aden House 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. Aden House accommodates a maximum of 60 people; there is accommodation and communal areas located on both the ground and first floor. The home provides care and support to people who are assessed as having nursing and personal care needs; there is also a unit (Butterfly Unit) with 19 beds which provides personal care for people living with dementia. There were 48 people living at the home at the time of the inspection.

The registered manager had left the service the week prior to our inspection; a peripatetic manager was present on both days of the inspection. 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.

People told us they felt safe and staff understood their responsibilities in identifying, recording and reporting concerns safeguarding concerns.

Where people were nursed on pressure relieving mattresses we found two of the three mattresses we checked were not set correctly and people’s position change records did not always evidence staff were repositioning people in line with their care plan.

Not all the in-house maintenance checks had been completed due to changes in personnel and we were unable to locate any thermometers in communal bathrooms to enable staff to check the water temperature prior to showering or bathing people.

We found the recruitment of staff was safe. Feedback from staff and people who lived at the home was mixed regarding their being sufficient numbers of staff to meet people’s needs. People told us staff did not always meet their needs in a timely manner and staff did not have time to talk to them.

The management of people’s medicines was safe although improvements were needed to the management of people’s creams.

West Yorkshire Fire Service had highlighted shortfalls in fire training for staff. The registered providers training matrix indicated other areas of staffs’ training was also not up to date.

Very few people ate in the main dining room. People who ate their meal in their bedroom, staff served both the main course and pudding at the same time, meaning the dessert was probably cold by the time the person ate it.

People had access to external health care professionals.

Staff supported people to make daily decisions and supported them in the least restrictive way possible. Although further improvements were needed to ensure the requirements of the Mental Capacity Act 2005 were fully met.

People told us the staff were caring and kind. Staff knew people well and were pro-active in ensuring they respected people’s privacy and dignity. People’s care records were not stored securely and we were unable to evidence people or their families were involved in the care planning process.

People told us they did not have enough to do during the day. Two activities organisers had recently left, leaving one in post. During the period of our inspection, we saw minimal activity to engage or stimulate people.

New care planning paperwork was being implemented throughout the home. Each of the care files we reviewed contained care plans which had been updated, reviewed and were reflective of people’s needs.

Complaints had been logged but from the information available, we were unable to eviden

The inspection took place on 19 December 2016 and was announced. At the last inspection in April 2015 we found the service required improvement in all areas. At this inspection we saw the provider had taken positive steps to improve the quality of the service.

Aden House provides a care home service with residential and nursing care for up to 60 older people. There were 50 people living at Aden House at the time of the inspection.

There was a registered manager in place. 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 was due to leave the service and there was also an acting manager working alongside the registered manager in order to take over the running of the home.

The home was welcoming and friendly. People, staff and visitors reported a homely atmosphere, although the provider acknowledged there was planned refurbishment and we saw equipment was not always stored appropriately. The environment was clean and tidy, although we identified some odours in some of the upstairs areas.

Staffing levels were appropriate to meet people’s needs. Secure recruitment procedures ensured staff were suitable to work with vulnerable people, although not all photograph identification was in place to support the verification of agency staff.

Accidents and incidents were recorded well, with clear systems to identify any patterns or trends.

Moving and handling practice was carried out appropriately on the whole, although we observed one incident which put a person at risk of injury.

Medications were managed safely and staff were confident about their responsibilities to make sure people had their medicines on time.

Staff understood the Mental Capacity Act (2005) and the implications for ensuring people’s rights were promoted. However, the recording of people’s mental capacity was not always clear and there was conflicting information about whether family members had lasting power of attorney.

People enjoyed their meals and the chef and care staff had a good understanding of people’s dietary needs.

Staff were caring and attentive to people’s needs and there was evidence they had a good rapport with people and their families.

People’s dignity and privacy were maintained at all times in their care and the daily routine.

Staff knew people’s interests and used time well to engage with people, with plenty of resources to interest people. Some people remained in bed and it was not always clear the reasons for this.

Care plans contained up to date information, although there were some gaps in daily recording and it was not always evident people had been involved in their care planning.

People and their relatives knew how to raise a complaint if they felt this was necessary and we saw complaints were managed appropriately

The registered manager was visible in the service and there was evidence of clear leadership, with any changes being managed in a planned and measured way. People, staff and relatives said the home was well run and managed.

Systems were in place to monitor the quality of the provision and drive improvement and the management team were aware of the strengths and areas to improve.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 13 April 2015 and was unannounced.

When we last inspected Aden House Care Home in April 2014 we found the home was failing to meet the standards required in relation to cleanliness and infection control, staffing and assessing and monitoring the quality of service. We told the provider that improvements must be made. On this visit we checked to see if improvements had been made.

Aden House Care Home is registered to provide residential care for up to 60 older people. The home provides a unit dedicated for people living with dementia. This is known as the Butterfly Unit. Butterfly unit provides 20 ground floor bedrooms; lounge and dining areas and direct access to a safe garden. Bedrooms for the nursing and residential care unit are situated on both the ground and first floor with communal lounges and a dining room on the ground floor. There were 52 people living at the home at the time of our inspection.

A registered manager has been in post at Aden House since January 2015. This person was previously registered as manager in one of the providers’ other care homes. 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.

We found that sufficient action had been taken to meet with the compliance actions set as a result of our inspection in 2014.

People told us they felt safe and staff knew how to maintain people’s safety, although some had not had the required training.

We found the home to be clean and odour free.

Staff training was in need of updating although this was being arranged. Systems for supporting staff were in place although some slippage had occurred which meant staff had not received formal supervision as frequently as the provider intended.

Staff treated people with kindness. People who lived at the home told us the staff were very caring and responsive to their needs.

People received a nutritious diet and found the food enjoyable. Closer monitoring of people’s nutritional intake was needed although any weight loss was identified and responded to.

Care plans were in place but were in need of further development in relation to a more person centred approach.

People did not always have access to meaningful activities.

People felt able to tell staff if there was something they were not happy with and we saw that concerns and complaints were managed well.

There was little available to support the orientation of people living with dementia.

Processes were in place for auditing the quality of service provision.

This visit was carried out by three inspectors who spoke with the manager, two members of the provider’s senior management team and eight staff, including one nurse. We also spoke with six people who lived at the home and three people visiting their relatives.

The inspectors also through observation and looking at records used the information they were given to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Before this visit we had received information about people’s care and support not being properly planned and delivered and some issues relating to staffing and general management. We looked at these issues during our visit and have recorded our findings within this report.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and had submitted one application. This meant that people were safeguarded as required.

We found some areas of the home were not clean. Staffing was not always arranged to make sure people who lived at the home were cared for safely.

Is the service effective?

People had not been involved in the assessments of their needs or been involved in writing their plans of care. However we observed effective care delivered with respect and kindness. People who lived at the home told us they received the care they needed. Some visitors we spoke with were complimentary of the care whilst others expressed concerns. We saw meals were nutritious and monitoring of food and fluid intake was taking place.

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with knew about people’s care and support needs and their individual preferences.

People’s preferences, interest and needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

Staff were aware of people's needs and how to support them to meet their needs. Complaints made to the service had been managed well.

Is the service well-led?

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

A new manager was in post and was in the process of making an application to us for registration. The area manager for the service was also relatively new.

We saw that the new management team were in the early stages of completing their own quality audits and taking action to improve the service for people.

At the time of our inspection there were forty six people living at the home. We spoke with the area manager, manager, a nurse and a senior carer. We spoke with some people living at the home; however, due to their medical needs and complex care needs, not everyone was able to comment on the service they received.

We found care and treatment was planned and delivered in a way that was intended and to ensure people's social needs were being met.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was enough permanent qualified, skilled and experienced staff to meet people's needs.

On the day of our inspection there were 46 people living in the home. We spoke with five of those people, five relatives of people who were living with dementia, six staff and this included the registered and area managers.

The staff were heard speaking with people in a respectful manner. For example, when using the hoist the staff were heard explaining to the person what they were going to do and they did this in a quiet, reassuring voice.

Comments from relatives and of people using the service included:

“I think they (the staff on Butterfly Suite) are well trained in dementia. They seem to know how to treat people properly.”

“The staff are lovely. It’s a tough time for me and they look after me as well as my dad because I need support while he’s so poorly.”

“They’re lovely staff, so friendly and cheerful. That includes everyone.”

“I can’t fault the carers – they’re always busy, but they do a great job for me.”

“I get all the help I need and they (the carers) are excellent. So willing.”

“I chose this home for my mum because I like the attitude of the staff. They’re so friendly and caring.”

Two relatives said they had seen a reduction in the staffing and unfamiliar agency staff at weekends, evenings and nights. One relative told us that they often waited for the evening shift to come on duty to reassure them that there was enough staff to care for their relative.

There was an effective complaints system available and people were confident that staff would act appropriately should they have concerns.

We had concerns the service were not meeting people's social care needs, and there were insufficient permanent staff. We have judged that these have a minor impact on people who use the service. Compliance actions were made.

There were forty nine people living at the home on the day of the inspection, nineteen people on the ‘Butterfly’ unit and thirty people in the rest of the home.

People who live on the ‘Butterfly’ unit were living with dementia and therefore not everyone we met was able to tell us what they thought about the service. We saw that staff treated people with respect and supported them to maintain their privacy.

A visitor told us they had chosen the home for their relative as the person was not able to choose for them self. The same person said they were really pleased with the level of care and respect the staff gave to people.

One person told us that staff knock before they come into their bedroom, whilst another person who showed us their room, had their own key. These are examples of how staff respects people’s privacy and support them to maintain their independence.

People told us they were visited by the manager before they came into the home, their care was agreed and so they knew what care they would receive when they moved into the home.

People told us they were happy living at the home and they were looked after by the staff.

People told us they had signed their care records to show their agreement with the care they receive.

A visitor told us that their relative had been asked to sign their care records but they had declined. The same person said they were happy with the care and did not think it was necessary to sign the record.

People told us they felt safe, and they knew who to speak with if they were concerned.

One person said that when they had a concern it was dealt with quickly and to their satisfaction. The same person said that the manager was approachable and they felt that if they had any further concerns, they would be quickly sorted out.

People told us there was always staff about when they needed assistance.

A relative, who said they visited each day, also told us there was always plenty of staff on duty.

The staff are really nice.”

“The food is lovely, and there is now a choice of what to have.”

People said there were activities taking place each day, and it was up to each person if they wanted to join in.

Relatives said that staff keep them up to date with any changes in their relatives care and they had no concerns.

During the visit we observed staff providing support to people in a sensitive and dignified way.

People and their relatives told us they were confident that if they had a concern it would be properly dealt with, and they felt safe.

People said they liked living in the home and it was always clean.

Relatives said the home was clean, however, it looked ‘tired’ and in need of redecoration. They also said that prior to their relatives admission their bedroom was redecorated.