This inspection took place over two days on 9 and 15 August 2018 and was unannounced on both days. This was a comprehensive inspection. At the last inspection the service was rated as Requires Improvement overall with breaches of regulations relating to the consent of the relevant person to care and treatment, people’s nutritional and hydration needs not being effectively met, sufficient numbers of staff not being deployed in such a way as to meet people’s needs, and staff not receiving ongoing supervision.

When we completed our previous inspection on 8 and 11 May 2017 we found concerns relating to a continuous breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we issued a warning notice to the provider.

Following the last inspection we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions of the need for consent, effective management of people’s nutrition and hydration, and staffing. At this inspection we found that people’s consent to care and treatment was not effectively managed, nutrition and hydration needs were monitored effectively, and we were not assured staffing levels were deployed appropriately to ensure people’s safety and needs were met.

Aden Mount is registered to provide accommodation and personal and nursing care for up to 45 people. There were 44 people living at the home on each day of our inspection. Aden Mount is a purpose-built home offering accommodation across three floors, accessed by stairs and a passenger lift. One floor is designated for people receiving nursing care. At the time of the inspection there were two communal lounges available for people to use on the middle floor and one dining room. There was a separate activity room on the lower floor. Communal bathrooms were available on all floors, each room had an en-suite.

Aden Mount is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had a registered manager who was available throughout our 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 living at Aden Mount Care Home and staff were knowledgeable about safeguarding processes.

There was little evidence people received care personalised to them. People’s care plans and risk assessments associated with their care were not always regularly reviewed. Some people did not have appropriately recorded risks to their safety and these were not monitored effectively. There was little evidence of people being supported and engaged in meaningful activity. This meant people’s individual needs were not captured or being met nor were risks to people’s safety.

Medicines and topical creams were not always administered safely. This meant there was a risk people would not receive the appropriate dose of medicines or receive medicines not as prescribed.

People, relatives and staff told us staffing levels were not sufficient and we observed the impact of this from staff’s response to call bells. Training records showed not all staff had been adequately trained. This meant people were at risk from insufficient staffing levels and from staff not being adequately trained to support people safely.

Records did not accurately document people’s needs and choices, and these did not show current guidance had always been followed. Documents did not always show whether people had consented to care and treatment.

There was a little choice for people in terms of what they would like to eat. P

The inspection of Aden Mount took place on 8 and 11 May 2017. The location had been previously inspected in January 2016 and was found to require improvement at that time, with breaches of regulations relating to safe care and treatment and record-keeping. We received an action plan from the registered provider to show how they would address those breaches. During this inspection, we checked to see whether improvements had been made. Whilst we found improvements in some areas, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, meeting people’s nutritional and hydration needs, consent and good governance.

Aden Mount is a purpose-built home which offers personal and nursing care and accommodation for up to 45 adults. There were 44 people living at the home at the time of our inspection. All bedrooms, which are over three floors, are en-suite and all floors are accessible via a passenger lift or stairs.

The home did not have a registered manager in place at the time of our inspection. We had been made aware by the registered provider the person who was the registered manager during the last inspection had since left the service and a new manager had been appointed and had been in post for three months. They were in the process of applying to register as manager. 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 living at Aden Mount. The manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Risks to people had been assessed and measures put into place to reduce risk. The building was well maintained and regular safety checks took place.

Medicines were managed, stored and administered safely by staff who had been trained to do so, although appropriate records were not always kept in relation to topical creams.

Appropriate safe recruitment procedures were followed. However, sufficient numbers of staff were not always deployed effectively in order to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received appropriate induction and training, although staff lacked formal one to one supervision.

Appropriate referrals were made for additional support in order for people’s health care needs to be met. However, professional advice was not always followed which meant people’s nutritional and hydration needs were not always met.

Staff asked people for consent prior to providing care and support. Formal consent was not consistent and the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were not always followed. People were not always supported to have maximum choice and control of their lives.

People and their relatives told us staff were caring and we observed staff to be kind and supportive. We observed people’s privacy and dignity was respected. People told us staff encouraged them to maintain their independence.

Care records were person centred and reviewed regularly. However, not all care and support staff were aware of the content of care plans. The manager was aware of this and this was currently being addressed. The service was responsive to people’s needs.

Staff told us they felt supported by the manager and people and their relatives spoke positively about the new manager. Meetings such as staff meetings and residents’ and relatives’ meetings were held. Regular audits and quality assurance checks took place, although these were not sufficiently robust and did not identify some areas found during our i

This inspection took place on 11 and 12 January 2016 and was unannounced. The service was last inspected 20 May 2013 and was found to be compliant in all areas.

Aden Mount is a purpose-built home situated in Primrose Hill, a residential area of Huddersfield. It offers personal and nursing care and accommodation for up to 45 people aged between 18 and 65 years. All bedrooms, which are over three floors, are single en-suite and all floors are accessed via a passenger lift or stairs.

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.

People who lived at Aden Mount told us they enjoyed living there. They felt staff had the skills and knowledge to support them in a safe and caring way.

Staff we spoke with had received training in safeguarding vulnerable adults and had a good understanding of what constituted abuse. They were able to tell us what they would do if they had any concerns about the way people who used the service were being treated.

Medicines were administered by staff that had the training to do so. People we spoke with told us they received their medicines on time. However, we observed staff did not always stay with people to ensure they had taken their medicines.

We observed two mealtime experiences. At lunchtime people had a lighter meal with the main meal served at tea time. We saw people had a choice of food and drinks. The food looked nutritious and people were offered a choice of vegetables with the tea time meal. Drinks and snacks were available for people during the day. If people had issues with weight loss, we saw evidence the service referred them to the appropriate services, such as the dietician or the general Practitioner.

Staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They understood the need to ask for consent before they carried out any personal care. The registered manager was aware their responsibilities in protecting the rights of people who do not have the capacity to make their own decisions.

We looked at the training matrix for the staff team and saw all training was up to date. Staff we spoke with told us they felt the training helped them to carry out their role effectively. People and relatives we spoke with felt staff had the right skills and knowledge.

The home was spacious with rooms for people to meet their visitors privately. However, there were no signs on the doors to the bathrooms and the communal areas. The bedroom doors did have people’s name on them but did not have any other form of identification. Sometimes people living with dementia have difficulty recognising their name when it is written and use pictures to help them identify their own rooms.

We observed the interactions between staff and people who used the service. We saw it was warm and respectful. People who lived at Aden Mount told us they thought the staff were lovely and very caring. Visitors we spoke with also felt staff were very approachable and their relative was cared for.

The service carried out an annual survey which asked people who used the service to say what they think of the care and support they receive. It showed us people were being asked their opinion of the service.

In the care records we looked at we saw people had been asked how they wanted to be supported toward the end of their life.

The care records we looked at were centred on the support needs of the individual. People told us staff talked to them about their care records and we saw people had signed their consent to care. People’s bedrooms were decorated in a way which reflected their own personal tastes.

Food and fluid charts were not being comple

We decided to visit the home between 6pm and 10.45pm to gain a wider view of the service provided. This was part of an out of normal hour's pilot project being undertaken in the North East region.

At the time of our visit there were 43 people living in the home; we talked with five people who used the service and six staff, including the managers.

The atmosphere was relaxed as people were seen to be going about their daily routines and had free access to the communal areas of the building.

The staff were seen to speak with people in a respectful manner. People living at the home told us that where they had experienced concerns the manager had acted appropriately and had addressed the issues to their satisfaction.

Comments from individual people who used the service included:

“The cleaner keeps my room tidy. I love my room. I have my own computer and fridge. I have a new carpet and chose it myself. I am going on holiday soon.“

“I just buzz when I need the staff. Sometimes they are slow to answer but they always come.”

“I am happy living here.”

People told us they liked living at the home and they had made many friends, including the staff.

People told us they were well looked after and the staff were always there when they needed assistance.

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

People told us they liked the food, and they were given a choice of what they would like for their meals. People told us they could have a drink between meals and should the drinks trolley not be due to go round, all they had to do was ask one of the staff and they would be provided with a drink.

One person told us they did not like big meals, and said the cook usually made them something they fancied at the time.

No-one raised any concerns with us. The people we spoke with said they felt safe.

We spoke with four people who used the service and they told us they knew who they would speak with if they were not happy, “The manager.”

The purpose of this inspection was to check up on a compliance action made at the previous inspection about staff training, so we didn’t talk to people on this occasion.

People told us that the staff are good, and they received the care that they would expect and if they had any issues they would speak with the manager.

On the day of our visit people who use the service were observed to be relaxed and receiving good care. Staff were polite, considerate and people spoke positively about the care received.

People told us they received the right medication at the right time and there were no problems with their medication.

Comments include, “Staff look after me well, no problems with my tablets or care.”

People told us that they liked living at the home and felt they were well cared for.

Comments from people include:

“The staff are great, and you can have a laugh with them.”

“The staff are always there if you need them, and nothing is too much trouble.”

Relatives commented that staff were approachable, and kept them up-to-date with issues affecting their relative.

People that we spoke with told us that they felt safe in the home and they knew who to speak to if they had any concerns. They also said they would have confidence that any issues would be properly dealt with.

One person said, “I feel safe, and that says a lot.”

Another person said, “If I have a concern, yes I know I can go to the manager with any issue and she would sort it out.”

A relative said that they had no concerns and if they had they would speak with the manager, and that she had an open door policy.

People who use the service and visiting relatives said that the home was always clean.

People said that there were always sufficient staff on duty to care for their needs.

One person said that if they needed a member of staff all they had to do is use their call bell and someone would come.