About the service: Aspen Lodge is registered to provide nursing and personal care to 35 people, including people living with dementia. The service was supporting 34 people at the time of our inspection.

People’s experience of using this service: The registered manager displayed a commitment to providing high quality person-centred care. However, owing to other work commitments they had not maintained effective management systems to achieve this.

The provider had not submitted statutory notifications to the Care Quality Commission to tell us about significant events. The registered manager and provider did not follow all their systems to check safety and quality issues within the service. The issues we found during our inspection had not always been identified or addressed by the provider. The provider’s representative was very responsive when we highlighted our concerns to them.

Staff sickness rates had been high and there was insufficient staff to meet people’s needs on those shifts when cover was not available. Satisfactory standards of hygiene had not been maintained and improvements were made during the inspection with cleaning schedules and the provision of new furniture. The adequacy of cleaning hours was under review.

Risk was not managed consistently which placed people at risk of harm. Accidents and incidents were not analysed so that lessons could be learned to reduce the risk of future harm. People had assessments and plans regarding their care and support needs. However, the care plans were not always kept up to date when changes occurred. There were limited opportunities for social stimulation.

Although the registered manager understood mental capacity legislation, they had not properly overseen and made applications for authorisations under Deprivation of Liberty Safeguards (DoLS).

Staff understood how to identify and report any safeguarding concerns. Medicines were managed safely. Safe recruitment processes had been followed.

Staff received appropriate training, which was updated when needed. Staff felt well-supported and gaps in the supervision and appraisal programmes were being addressed. Staff said they enjoyed their work, there was good teamwork and a positive culture within the service.

People spoke positively about the registered manager; they felt they received good care and support from staff. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their lives, this was carried out with compassion and dignity.

There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Good (report published 27 July 2016).

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least good.

We inspected Aspen Lodge Care Home on 17 May 2016. This was an unannounced inspection. The service provides care and support for up to 52 people, including those requiring nursing care. When we undertook our inspection there were 34 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. There were many positive interactions with staff and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information. However, there was a lack of social activities for people to take part in, which the registered manager was addressing.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. Some changes were being made to the environment to ensure it was safe and addressed the specific needs of everyone with in the home.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

Our inspection team on this occasion was made up of one inspector. We considered our evidence to help us answer 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 who use the service, their relatives, 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 safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured safety checks were completed for staff prior to their commencement of employment.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. People told us they could express their views at group meetings, meetings on a one to one basis and by completing surveys.

Is the service caring ?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "Staff respect my wishes" and "All my needs are being met."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

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

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

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.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

You can see our judgements on the front page of this report.

When we visited Aspen Lodge 35 people were living there. We spoke with eight people as well as the manager, members of nursing and care staff and two relatives. We also had discussions with visiting health care professionals and a training provider.

We looked at records and observed how staff supported the people living in the home.

Before people received care or treatment they were asked for their consent. Staff respected their wishes. For people who could not make an informed decision, the provider acted in accordance with legal requirements.

People told us they were happy living in the home. One person said, “I’m cared for properly; no doubt about it. I couldn’t be looked after any better.” Care records were comprehensive and reflected people’s needs.

Staff did not administer medication unless they had received appropriate training. However, we found the home was not following the provider’s policy for the control and administration of medicines.

People we spoke with had divided views about whether there were enough staff on duty all the time. We found at the time of our visit there were enough qualified, skilled and experienced staff to meet people’s needs. A validated dependency tool for assessing people’s individual needs was not in place.

People told us they knew how to make a complaint and to whom. There was an effective complaints system in place. Comments and complaints people made were responded to appropriately.

People told us they felt respected and involved with their care. We saw they were able to make choices about what they did during the day and personalise their rooms. One person told us, “I love my photographs; it cheers me up when I look at them.”

We were told by people they thought the care was very good and the care staff and nurses were kind to them. They felt involved in their care, although the care plans did not evidence they had been part of this process. Care plans were not easy to follow.

People also told us they always had a member of staff to go with them to an appointment with a doctor if a relative was unable to go.

A member of the community nursing team told us, “The care is marvellous and they always tell us anything they think we need to know, for example if someone’s skin is looking a little pink.”

People said they felt safe in the home. One person said, “I feel absolutely safe.”

Although some areas of the home had been recently refurbished, we found the two sluices were in need of maintenance, for example a ceiling tile was missing in one of them. The décor in both areas was poor.

People felt supported by knowledgeable staff. One person told us, “They all know what to do for me. They’re great.”

They also felt involved in the running of the home and knew how to complain if anything was wrong.

Records for both people and the running of the home were up to date, maintained properly and kept securely.

We did not receive any comments from people who use the service during our review.