About the service: Aspen Grange is a care home that provides personal care for up to 49 people, living with dementia. At the time of the inspection 46 people lived at the service.

People’s experience of using this service: The service had deteriorated in all domains since our last inspection. The service met the characteristics of requires improvement in all of the five key questions.

There were systems in place to monitor the quality and safety of the service provided and to manage the maintenance of the buildings and equipment. However, these systems were not always effective. They had not identified the areas of concern we found during this inspection in relation to staffing levels, staff knowledge and person centred care. We found a breach of the regulations in relation to the quality assurance processes.

We found there were not enough staff to provide person-centred care. During the inspection, there were mixed views about staffing levels. Observations and feedback indicated at times insufficient staff were deployed to meet people's needs in a timely way. Staff told us they had limited time to spend talking to people or interacting with them. At this inspection we found people were not always offered opportunities for meaningful engagement.

Overall, staff were caring and treated people with dignity and respect. Where possible staff supported people to be as independent as they wanted to be. People and relatives spoken with were complimentary about the support they received. However there were occasions where staff did not always demonstrate that their training was effective.

The service had a safeguarding procedure in place and people were protected from the risk of abuse. Staff assessed people’s risks and records of these assessments had been reviewed. The provider had systems and processes in place for the safe management of medicines. Storage was secure and stock balances were well managed.

Staff received supervision from the management team. People received support they needed to eat and drink sufficient quantities. We found in one area some aspects of the meal service required improvement in order that the mealtime was a positive experience for people using the service.

People's health needs were catered for with appropriate referrals made to external health professionals when needed.

Rating at last inspection: Good (report published July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we identified some areas which required Improvement.

Enforcement: Please see ‘the action we asked the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Aspen Grange is registered to provide care for up to 49 older people living with dementia. At the time of the inspection we were informed that 48 people were using the service. The inspection took place on 21 July 2016 and was unannounced.

The service had 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.

Staff understood what constituted abuse and the safeguarding procedures to follow to report abuse both internally and externally. People were supported to express their autonomy and make informed choices when taking risks. Medicines were safely managed and took into account people’s capabilities and preferences as to how to take their medicines.

Staff were recruited following safe and robust procedures and there were sufficient numbers of suitable staff available to meet people’s assessed needs. Staff received training to ensure they were equipped with the skills and knowledge to support people using the service. Staff supervision systems were in place to ensure they had the opportunity to reflect on their work practice and plan their learning and development needs.

People’s consent was sought before staff provided their care. People who lacked capacity to make decisions were supported following the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had a balanced and varied diet and their dietary needs were assessed and monitored. They had regular access to healthcare professionals and were supported to attend health appointments to ensure their health and well-being was maintained

Staff treated people with kindness, compassion, dignity and respect. Independence was promoted and people were enabled to make and maintain relationships. Individualised care plans were in place that reflected people’s needs and choices on how they wanted their care and support to be provided.

People and their representatives were encouraged to provide feedback on the service and suitable arrangements were in place to respond to any complaints.

The vision and values of the service were person-centred. People and their representatives were supported to be involved and in control of their care.

Quality assurance management systems were in place to monitor the safety of the environment and the quality of the service.

We had received some information of concern and therefore decided to carry out a responsive review of the service. During our inspection we spoke with nine people who used the service. We also spoke with the manager and seven staff.

Aspen Grange Care Home provided a service for people with nursing needs and dementia. We looked at the care records for six people who used the service. We also looked at how their care and health needs were met, how they were safeguarded from harm and how staff were supported and supervised.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

The service had ensured that staff were provided with the knowledge and skills to keep people safe and protect them from harm. Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place.

We found that the service had suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. No Deprivation of Liberty Safeguards (DoLS) authorisations were in place for anyone at the service, although applications had been made to the local authority after assessments had been completed.

The monitoring of people’s care through the reviews of care plans, risk assessments and daily records ensured people were provided with nursing care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence.

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. Staff had a good knowledge of people's likes and dislikes. People told us that the staff treated them respectfully. People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by staff who were respectful and caring.

Is the service responsive?

Regular checks on the dependency levels of people who used the service were undertaken in order for people's needs to be responded to in a timely way. Staff took time with people when undertaking tasks and activities. One person said, "They are good to me, they know me inside out and come when I need them."

We saw from the records viewed that the service worked well with other agencies. A range of health, mental health and social care professionals from the community were involved in people's care. This showed that people received their care in a joined up way and prevented admission to hospital.

Is the service well-led?

Regular care reviews and discussions about people's quality of life at Aspen Grange Care Home were discussed with them and their families. This ensured that people's changing needs and preferences were always taken into account.

Staffing levels were reviewed and spot checks were completed at night to ensure there were always sufficient staff to meet people's needs.