We carried out an unannounced comprehensive inspection on the 19 and 20 February 2019.

Aspen Court is a care home with nursing for up to 42 people. On the day of our inspection there were 39 people using the service. People in care homes receive accommodation and nursing or 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.

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.

At the last inspection in August 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains Good:

Risks to people were reduced because there were care records in place which provided guidance to staff on how to keep people safe. Staff were trained on safeguarding adults from abuse and knew the procedures to follow to report abuse and to protect people. There were sufficient staff to meet people's needs and recruitment checks were conducted before new staff were employed. A few employment records did not explain what staff were doing between jobs.

People or their relatives gave consent to the care and support they received. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people but the records did not show how staff had arrived at best interests decisions.

People and their relatives were very complimentary about the staff and their caring attitude. People were observed to be treated with kindness and compassion by the staff. However, we also saw incidences where the staff were carrying out their duties in supporting people to meet their needs rather than using a person-centred approach.

Care records were updated and reviewed to reflect people’s changing needs. Staff we spoke with demonstrated a good understanding of people’s needs.

Activities and events were organised to make them meaningful for people using the service. Staff worked with individual people or in groups and there were a range of events outside the home. Concerns and complaints were managed effectively with a clear process in place.

Clear leadership and monitoring systems enabled the service to identify good practices and areas for improvement. People, relatives and staff said the registered manager was approachable and made themselves available to speak with them. The service collected people’s and relative’s views on their experiences of the care provided so that further improvements could be made. The registered manager was developing new ways of linking the service with their local community.

This inspection was unannounced and took place on 18 and 19 August 2016.

The last inspection of the home was carried out in November 2013. No concerns were identified with the care being provided to people at that inspection.

Aspen Court is registered to provide accommodation with nursing care for up to 42 older people living with dementia. At the time of the inspection there were 42 people living at the home. Some people were not able to tell us about their experiences of life at the home so we therefore used our observations of care and our discussions with staff and other stakeholders to help form our judgements.

There was a registered manager in post, however the registered manager was leaving the service. Another manager was in post who was awaiting an interview with the Care Quality Commission to become the registered 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. The registered manager had been managing the home for a number of years. At the time of the inspection the registered manager was leaving the home to manage another home by the provider. The new manager was awaiting their interview with the Care Quality Commission to become the registered manager.

We had limited conversations with some of the people who lived in the home as they had complex needs and were not able to tell us their experiences of living at the home. We spoke with relatives and staff, we observed how staff interacted and communicated with people and we reviewed people's care records. We asked for a variety of records and documents during our inspection, including people's care plans and other documents relating to people's care and support. We found that these were well kept, easily accessible and stored securely.

Staff had good communication skills and were kind, caring and compassionate in their interaction with people. One relative said, “There are always staff around that we know”. Staff knew people well and pro-actively engaged with them, using touch as a form of reassurance, for example by holding people's hands which was positively received.

The registered manager had a real commitment to constantly reviewing and improving the service offered to people. They sought people’s views to make sure improvements made were in accordance with people’s wishes. Suggestions made were acted upon for the benefit of people who lived at the home.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Staff took time to talk with people during the day and saw their roles as supportive and caring, but were also keen not to disempower people. People valued their relationships with the staff team, one relative said “Its home from home, Buckingham Place as far as we are concerned”.

People were supported by staff who had undergone an induction programme. The registered manager explained all new staff completed the care certificate if they did not have a qualification in care. The care certificate is a set of standards that social care and health workers should follow in their daily working life. One member of staff said, “I feel proud to be part of this care team, my induction was supported by the registered manager all the way through ,they made sure I knew what I was doing and signed my work off as I completed it”.

Staff received regular one to one supervisions. Supervisions were an opportunity for staff to spend time with a more senior member of staff to discuss their work and highlight any training or development needs. They were also a chance for any poor practice or concerns to be addressed in a confidential manner.

Care plans were personalised to each individu

Staff treated people with respect and the dignity of people was upheld. Care staff supported people in a caring and sensitive way interacting in a positive and professional manner. The service involved people or their representatives in the provision and delivering of care. Care was provided in a person centred way.

There were comprehensive and individualised care plans in place. Staff were provided with up to date information about people's health and care needs. Guidance was available so staff were enabled to respond effectively to people's behaviour and ensure individual's wellbeing was protected. People's nutritional needs were met providing choice and meals which met people's needs. Meaningful activities were available however the environment did not provide stimulation to people.

Staff received the necessary training and support to meet the needs of people living in the home. There were good arrangements for the supporting of people who needed 1:1 staffing.

There were the necessary arrangements for the administration and management of medicines. The use of "as required" (PRN) and covertly administration of medicines was undertaken in the best interests of people's safety and wellbeing. There were safeguards in place to ensure staff acted professionally when giving medicines as PRN or covertly.

There were effective arrangements for the monitoring and auditing the quality of the service. The service had responded positively to complaints.

We used a number of different methods to help us understand the experiences of people who lived in the home, because they had complex needs which meant they were not able to tell us their experiences. We spoke with relatives and staff, we observed how staff interacted and communicated with people and we reviewed people's care records.

We had limited conversations with some of the people who lived in the home. They responded positively when asked how they were, they said they were “OK” or “fine”. We spoke with the relatives of three people. They said “It’s excellent, it is a very good home” and “My relative is looked after very well. They are kept clean and tidy and changed every day”.

The home’s activity coordinators prepared daily activities programmes for each individual to ensure they received mental and social stimulation. There was also a programme of group activities.

We observed that people looked happy and relaxed with the staff who supported them. One relative said “I visit every day. I’ve got no concerns about anything. The girls are very nice and the male carers are marvellous too”.

Bedrooms and communal areas such as dining rooms, lounges, bathrooms and corridors all looked clean and tidy and there were no bad odours. This showed that people were cared for in a clean, hygienic environment.

Care plans were reviewed on a monthly basis. This meant that staff had accurate and up to date information about people and how to assist them.

This visit was part of our routine schedule of planned inspections.

The people who lived at Aspen Court had dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us record how people spent their time, the type of support they got and whether they had positive experiences. Some people that used the service were able to tell us about their experiences and we also spoke with visitors and staff that worked in the home.

People spoken with said that staff members that worked in the home were caring and polite, one person said “Oh they are all ok, and really nice, I like to stay in my room and they pop in and talk to me when they pass”.

During our observation tool we noted that staff members were polite and respected people’s right to be treated in a dignified way. We observed staff talked to people and read the newspaper with them; one staff member tried to get people interested in an activity. Other staff members were sat in one lounge with people where they talked about the day and doing a craft activity. We noted that some people spent time in their rooms and others used the communal areas of the home. One person was sat in the corridor, when asked a care worker said they liked to sit there rather than in their room or the lounge.

We saw that jugs of squash had been bought into the communal areas, but these were not touched through the morning. People asked for a drink but only received their cup of tea when the tea trolley arrived. Staff treated this time of the morning as a task rather than an opportunity to create a social atmosphere. We discussed this with the manager who agreed to look at the way staff provided fluids through the day.

We spoke with one visitor who was happy to discuss their experiences of the home. They told us that they were very happy with the care their relative received. They said the person was always relaxed and happy when they visited. They also told us that they felt that comments they made were listened to and that they were involved in care plans and care reviews.