The inspection took place on 3 and 4 January 2019, the first day was unannounced and the second day was announced.

Aspen House is a 'care home'. 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. The care home can provide accommodation and personal care for 15 older people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. There were 12 people living at the home at the time of our inspection.

The home had a registered manager who was also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At our last inspection in November 2017, we found the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They were in breach of regulation 12 for not ensuring people were provided with safe care and treatment by assessing and mitigating risk to service users, and regulation 17 for not ensuring that adequate systems and processes were in place to enable them to fully assess and identify where safety was compromised. The service was rated as ‘requires improvement’.

We asked the provider to complete an action plan to show what they would do, and by when to improve the key questions of safe, effective, responsive and well-led. We also asked them what they would do to meet the legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that improvements had not been made and that the provider remained in breach of regulations 12 and 17.

At this inspection improvements had been made in some areas, for example people’s medicines were now being stored and monitored safely. The provider was no longer in breach of regulation 13 and had ensured that they were taking steps to safeguard people from abuse. However, further improvements were identified and required, including the breaches of regulation in relation to providing safe care and treatment and good governance.

The provider remained in breach of regulation 12 as people were not always protected from the risk of harm as risks to safety and incidents were not always identified or effectively managed.

The provider remained in breach of regulation 17 as quality assurance systems and audits to monitor and oversee care were ineffective. Care plans, risk assessments and guidance had failed to be updated despite records showing that quality assurance checks and audits had taken place.

Information relating to some people’s as and when medication was incorrect. This had not been identified despite medicines audits being completed.

Appropriate actions had not been taken to learn or improve from mistakes and changes when they had occurred.

There continued to be a lack of consideration, care planning and guidance on how to best support people living with dementia. The provider could further explore guidance on ensuring a more dementia friendly environment.

Care plans and risk assessments were not always detailed and personalised and did not always reflect the changing needs of the person.

Staff received ongoing training to meet the needs of people at the service, although improvements were needed in the management of ongoing competencies for the administration of medicines.

People’s communication and information needs had not been fully addressed across the service. We have continued to make recommendations in relation t

The inspection took place on 18 and 19 December 2017, the first day was unannounced and the second day was announced.

Aspen House is a ‘care home’. 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. The care home can provide accommodation and personal care for 15 older people in one adapted building. The home provides support for people living with varying stages of dementia and some with mobility and sensory needs. There were 12 people living at the home at the time of our inspection.

The home had a manager who was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. At the time of the inspection the registered manager was on planned absence and had notified the CQC of this as is legally required. They had made provision for the deputy manager to be supported by a consultant during this time and were also available if the deputy needed guidance.

At the last inspection on the 19 July 2016, we found one breach of the regulations and that the provider had met previous breaches of regulation. The home was rated as ‘Requires Improvement’ and we asked the provider to provide us with a report on the actions they planned to take in response to the breach. The provider wrote to us to say what they had done to meet the legal requirements in relation to failing to display performance assessment ratings. We undertook a comprehensive inspection on 18 and 19 December 2017 in response to information of concern we had received about the home, and to check whether the required action had been taken to address the breach previously identified. This report discusses our findings in relation to this.

At this inspection improvements had been made in some areas, for example the ratings of the home were now clearly displayed, so there was no longer a breach of this regulation. People had more choice in relation to their food choices and overall meal time experience. However, further areas of improvement were identified, including breaches of regulation in relation to safeguarding people from abuse, providing safe care and treatment and notifying us of significant incidents.

People were not always protected from the risk of abuse or potential abuse. Staff could tell us about different types of abuse and how they should report it. However, in at least three incidences, peoples’ wellbeing was not promoted as the registered manager did not effectively identify, or act on evidence that abuse may have occurred. They also failed to notify the CQC of these incidents and the local safeguarding bodies, or do so in a timely way.

People were not always protected from the risk of harm as risks to safety and incidents were not always identified or effectively managed. Where accident and incidents had been identified and records completed, action had been taken to reduce the risk of reoccurrence. However, one person’s care records contained body maps detailing three separate potential injuries relating to skin integrity. On each occasion, although the staff took action to ensure medical advice and treatment was accessed, the cause of the injuries were noted as ‘unknown’ and not investigated or analysed to effectively mitigate the risk of further injuries.

Practice around the administration and storage of medicines was not consistently safe. People’s prescribed medicines were not always available or given in a timely way. Staff did not always ensure that medicines were securely stored, monitored, and available or kept at a suitable temperature.

Communication at the home was not

The inspection took place on 19 July 2016 and was unannounced.

Aspen House provides accommodation for up to fifteen older people. On the day of our inspection there were twelve people living at the home. The home provides support for people living with varying stages of dementia along with healthcare needs such as diabetes and epilepsy. Accommodation was arranged over two floors with stairs and a stair lift connecting both levels. There was a communal lounge, a quiet lounge, dining room and gardens. The home is situated in Hove, East Sussex.

The home had a manager who was also the registered provider A registered provider is a ‘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 carried out an unannounced comprehensive inspection on 6 and 8 May 2015. Breaches of legal requirements were found and following the inspection the provider wrote to us to say what they would do in relation to the concerns found. At the inspection on 19 July 2016 we found that significant improvements had been made, however, we found a breach of legal requirements in relation to the failure to display performance assessment ratings. Further areas that needed improvement related to peoples’ dining experience and the lack of choice in relation to food, as well as the lack of signage and adaptation of the building to assist people, who were living with dementia, to orientate around the building.

Part of the requirements of the provider’s registration is to ensure that when their service is inspected by CQC, that they display their performance assessment rating to provide members of the public with an awareness of the rating of the service. The provider had not displayed the rating of the previous CQC inspection and therefore this was an area of concern.

People had sufficient quantities to eat and drink and were happy with the food. However, people told us that they didn’t get enough choice in relation to the food that was provided. One person told us “There’s a bit of choice at breakfast but you can’t have a cooked breakfast or anything like that and at lunchtime it’s a main meal in the dining room. You never know what it is unless it’s Friday and you know it’ll be fish then”. People were able to choose where they ate their meals, most deciding to eat in the main dining area. Independence, with regard to eating and drinking, was not consistently promoted. Although people were observed to be independently eating their food, observations showed a member of staff moving from person to person mixing their food and putting spoonful’s to people’s mouths. People appeared not to welcome this support, which did not promote people’s dignity or independence. This is an area of practice in need of improvement.

All of the people living in the home were living with dementia. Although the home provided a homely and relaxed atmosphere there were no adaptations or clear signage for people to orientate and know where their rooms, or other parts of the building were. Some people’s rooms had been furnished with their possessions and items that were important to them, whereas others were bare and stark and did not create a homely atmosphere. This is an area of practice in need of improvement.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments were personalised and ensured that risks were managed and people were able to maintain their independence. There were safe systems in place for the storage, administration and disposal of medicines. People told us that they received their medicines on time and records and our observations confirmed this.

Sufficient numbers of staff ensured that people’s needs were met and that they received support promptly. People told us th

Our inspection team was made up of one inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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. People told us they felt settled and at home at the service.

Systems were in place to make sure that all staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Feedback was sought from people and their relatives which helped the service develop and learn.

The service was clean and tidy. We found that shortfalls highlighted at the last inspection of the service had been addressed and people from safeguarded from the risk of cross infection.

Staff handled medicines safely. We found that shortfalls highlighted at the last inspection of the service had been addressed. Recording of medicines administered was now accurate and up to date.

Is the service effective?

People had their care needs assessed and staff understood what people’s care needs were. Care records were accurate and fit for purpose and had been reviewed regularly to reflect any change in care needs.

People’s health needs were monitored and the service worked well with outside healthcare professionals including General Practitioners (GP) and district nurses.

Staff received mandatory training and felt confident in providing care and support to people.

Is the service caring?

People were supported by kind and attentive staff. Observations reflected that people looked content in the service and care workers knew their care needs. People told us, “I’m very happy here, it has a general nice atmosphere and I get on with everyone.” Another person told us, “I’m settled down here.”

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

Is the service responsive to people’s needs?

People completed a range of activities. The service employed a dedicated activities co-ordinator who provided arts and crafts, music and exercise stimulation.

Resident and staff meetings were held to explore how positive changes could be made.

There was a complaints policy and procedure in place if people were unhappy, which was monitored by the provider. Since our last inspection, the provider had received one complaint which was acted upon immediately. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

There were 13 people who used the service at the time of our visit. We used a number of different methods to help us understand the views of these people, who had complex needs which meant they were not all able to tell us about their experiences. We observed the care provided, looked at supporting care documentation, we spoke with the registered manager who is referred to as manager in the report, the deputy manager, three care workers, a person who used the service, and a relative and a friend of two of the people who used the service.

This told us people or their representatives had been able to express their views about the care provided, and where possible people who used the service had been involved in making decisions about their care and treatment.

People’s care needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan.

People’s care had been provided by care workers who understood their care needs. One person who used the service commented, “I am very comfortable here, with three meals a day.”

People knew who to talk with if they had any concerns about the care provided.

We inspected Aspen House Care Home on the 6 and 8 May 2015. Aspen House Care Home is a residential care home that provides care and support for up to 15 older people. On the days of the inspection, 12 people were living at the home. Aspen House Care Home provides support for people living with varying stages of dementia along with healthcare needs such as diabetes, epilepsy and sensory impairment. The age range of people living at the home varied from 60 – 90 years old.

Accommodation was arranged over two floors with stairs and a stair lift connecting both levels. Some consideration had been given to the environment, making it dementia friendly. This included the use of signs and pictures to help orient people around the home.

A registered manager was in post, who was also the provider/owner. 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 and associated Regulations about how the service is run.

Staffing levels were stretched and staff commented they were often under pressure. People received the care they needed, however, poor staffing levels meant staff did not have the time to take people out for walks, to the local shops or provide one to one activities and stimulation. We have identified this as an area of practice that requires improvement.

A musical entertainer visited the home three days a week which people enjoyed. However, consideration had not been given on how to provide activities the remaining four days a week. Staff had a firm understanding of the individual activities people enjoyed doing such as painting. However, people were not consistently supported and encouraged to undertake these meaningful activities and keep their minds occupied and stimulated. We have made a recommendation for improvement in this area.

Staff understood the principles of consent to care and treatment and respected people’s right to refuse consent. However, not all staff had received training on the Mental Capacity Act 2005 (MCA) and mental capacity assessments were not consistently recorded in line with legal requirements. We have identified this as an area of practice that requires improvement.

Deprivation of Liberty Safeguards (DoLS) had been submitted for everyone living at the home. Restrictive practice was used within Aspen House Care Home, such as stair gates and locked front door. Although DoLS application had been made. Little consideration had been given to the care planning process on how to enable people to have as much choice and control within their lives as possible. We have made a recommendation for improvement in this area.

Risks to people were assessed and risk assessments implemented. However, each person had a generic risk assessment in place which was not specific or individual to them and their specific needs. We have identified this as an area of practice that requires improvement.

Incident and accidents were consistently recorded; however, they were not reviewed on a regular basis to monitor for any emerging trends or patterns. We have identified this as an area of practice that requires improvement.

People were treated with respect and dignity by staff. People were called by their preferred name and staff had clearly spent time building rapports with people. Staff members respected people’s privacy and always knocked on their door before entering. Staff understood the importance of monitoring people’s mental health and well-being on a daily basis. Staff worked closely with healthcare professionals and was responsive to people’s changing needs.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutrition and hydration needs.

People told us the manager and staff were approachable. Relatives said they could speak with the manager or staff at any time. The provider operated an open door policy and welcomed feedback on any aspect of the service. Regular meetings took place with staff which provided staff with the forum to discuss any ideas or practice issues.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.