This inspection was conducted on 27 and 28 September, and 12 October 2018. The first day was unannounced and the other days were announced. Aspen Court Nursing Home is a ‘care home’ that provides personal care or nursing care and accommodation for older adults. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection. Aspen Court Nursing Home can accommodate up to 72 people and 68 people were residing at the service at the time of the inspection. The premises are purpose built and divided into three separate units. People are provided with a single bedroom with en-suite facilities, and the service provides permanent placements and respite care. The ground floor and first floor units can accommodate up to 46 people with personal care needs in relation to frailty due to old age and dementia. The second floor can accommodate up to 26 people with nursing care needs.

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 h

This focussed inspection was conducted on 6 and 12 September 2017. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second day. Aspen Court Nursing Home provides residential and nursing care for up to 72 older people, many of whom are living with dementia. At the time of the inspection there were 59 people residing at the service, and three people were in hospital.

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.

The inspection took place on 10, 11 and 15 February 2016. The first day of the inspection was unannounced; the provider knew that we would be returning for the subsequent days. Aspen Court Nursing Home provides residential and nursing care for up to 72 older people, many of whom also have dementia. At the time of the inspection there were 59 people living at the service.

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.

We spoke with 15 people who used the service, five family members, one professional visitor and six members of staff which included the registered manager. We observed people using the Short Observational Framework for Inspection (SOFI). The people we spoke with told us they were happy with the care they received. One person said, "everyone is lovely and care for me. All the staff are very attentive and there are a lot of them." Another person said, "very comfortable here, the food is good and enjoy it a great deal." A relative told us, "staff are really good, can't fault. I was involved in the assessment and reviews."

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."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

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.

The people who spoke with us said that they felt able to talk to members of staff about their individual needs. They praised the helpful nature of staff and that staff are willing to talk and listen to them.

A relative who spoke with us said that they are always consulted about the care of their husband and staff keep them up to date about how their spouse is doing.

A visitor to the home on the day of this inspection told us that they do not have any concern about the safety or wellbeing of their relative. No residents made any specific comments about having any concerns and information that we saw from residents meetings and other documents show that the people who live here feel that they are cared for safely by staff.

The inspection took place on 14, 15 and 17 April 2015 and was unannounced. At the last inspection on the 15 April 2014 we found the provider was not meeting the regulations in relation to care and welfare such as the management of medicines and consent. Following the inspection the provider sent us an action plan telling us how they were going to address the shortfalls.

During this inspection we found that the provider had not made all necessary improvements with regard to the management of risk.

The provider had made strides to comply with legal requirements contained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards but required improvements to obtain people’s consent.

Aspen Court Nursing Home provides personal and nursing care for up to 72 older people, many of whom also have dementia.

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.

We found the service was not safe with the majority of concerns found on the nursing unit. Records demonstrated that the provider did not deploy sufficient staff at the service to meet people’s needs. We reviewed the payroll for 2015 to date and noted there were routinely less staff on shift than required under the provider’s procedures. The rota was irregular with staff working excessively long hours and shift patterns.

Medicines were not administered, stored or disposed of safely. Furthermore records were not completed accurately. We noted that morning medicine rounds finished late and people were at risk at receiving medicines at the wrong time and without a sufficient gap between doses.

The control and prevention of infections was not always well managed, for example, we observed bathrooms on the nursing unit were unclean but the residential units were clean and staff had completed barrier nursing training.

Staff had a good understanding of how to safeguard people from abuse, however, they were not supported to whistleblow or raise concerns to external agencies.

People were not protected from risks to their health and wellbeing because the provider did not have an effective system to identify and mitigate risks to people’s safety.

Accidents and incidents were well managed and we reviewed action plans that were used to reduce the likelihood of the event occurring again.

The provider supported people who whose behaviour may have challenged others. Staff demonstrated an awareness of how to defuse such situations.

The provider had a robust recruitment system which meant the staff were suitable to work with the people using the service.

Staff had a good understanding of the principles of the Mental Capacity Act 2005. The provider had worked hard to submit Deprivation of Liberty Safeguards applications to the local authority when people’s liberty was restricted to protect their safety. However, staff were not always supported to carry out care tasks in line with someone’s best interests because representatives were not always consulted and care plans did not always contain sufficient guidance.

People were at risk of poor nutritional intake because the provider did not always monitor that people were eating and drinking enough or receiving supplements as required.

The provider had good links with healthcare professionals and referrals were made in a timely manner. Care staff received specialist training to meet people’s needs. However, clinical staff required further training in areas such as catheter care to meet people’s needs effectively.

Some staff had developed caring relations with people and we observed positive interactions between staff and people using the service. However, at times we observed staff talking to each other rather than focussing on supporting the people for whom they cared. People were not always supported to make choices about day-to-day care tasks such as what food to eat.

The provider developed care plans based on clear and detailed assessments of people’s needs and preferences. These plans were updated following incidents to ensure staff responded to their changing needs. However, routine reviews of care plans did not always take place and time constraints meant staff were not able to respond to people’s emotional needs by spending extra time with people who were receiving end of life care.

People were able to take part in day-to-day activities at the services and celebrate festivals. However, a lack of human resources meant outdoor activities were limited.

Complaints were dealt with effectively when raised by relatives or healthcare professionals. However, formal methods to elicit the views of people using the service were not utilised effectively to form a basis of service delivery.

The provider did not always promote a positive culture because staff were not always supported to express their views about service improvement. We found there were discrepancies in quality of care between the units which had not been identified demonstrating the service was not set up to consistently promote good quality care. The registered manager did, however, make daily walks around the service and seemed to know the people using the service well.

We found six breaches of the regulations relating to consent, staffing, medicine management, safe care and treatment, infection control and good governance. You can see what action we told the provider to take at the back of the full version of the report. We have made a recommendation about supporting people to partake in hobbies in the community.