The inspection of Aden Lodge Care Home (known to people who live at the home, relatives and staff as Aden Lodge) took place on 24 and 25 January 2018 and was unannounced on the first day. This meant the home did not know we were coming.

Aden Lodge is registered to provide accommodation and personal care for up to 40 people, some of whom are living with dementia. It is a purpose built home and provides single room accommodation with en-suite facilities. At the time of our inspection 26 people were living at Aden Lodge.

Aden Lodge 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 home had previously been inspected during December 2016 and was found to require improvement at that time. The previous inspection found breaches of regulations in relation to safe care and treatment and good governance. During this inspection, we checked and found improvements had been made in both these areas and we did not identify any breaches of regulations during this inspection.

The home 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.

People told us they felt safe living at Aden Lodge. The registered manager and staff were aware of relevant procedures to help keep people safe and staff could describe signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people’s needs. Staff told us they felt supported and we saw evidence staff had received appropriate induction, training and ongoing supervision.

Risks to people had been assessed and measures were in place to reduce risk. The building was well maintained and regular safety checks took place.

Medicines were managed, stored and administered safely and appropriately, by staff who had been trained, and assessed as competent, to do so.

People were supported to have choice and control of their lives and we observed staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People received appropriate support in order to have their nutritional and hydration needs met.

People told us staff were caring and we observed staff to be kind and considerate. We observed people’s privacy and dignity was respected. There was a pleasant, relaxed atmosphere in the home.

Care records were person centred and reviewed regularly. A ‘resident of the day’ system helped to ensure people’s care needs and assessments were regularly updated. People told us they could make their own choices in relation to their daily lives.

However, the registered provider was not always responsive to people’s needs and requests. Actions from a, ‘You Said, We Did,’ notice had not consistently been implemented. Appropriate information was shared between staff to enable continuity of care.

There was a complaints policy in place and we found complaints were responded to appropriately and in line with policy.

People received support in order to meet their wider health care needs.

Staff told us they felt supported and people and their relatives spoke positively about the registered manager. Meetings such as staff meetings and residents’ and relatives’ meetings were held regularly. Regular audits and quality assurance checks took place, to help improvements to continue at the home.

The inspection of Aden Lodge Care Home took place on 19 and 28 December 2016. We previously inspected the service on 23 November 2015 and at that time we found the registered provider was not meeting the regulations relating to person centred care, dignity and respect, consent, safe care and treatment, premises and equipment, good governance and staffing. We rated them as inadequate and placed the home in special measures. On this visit we checked to see if improvements had been made.

Aden Lodge provides care and support for older people, some of whom are living with dementia. It is a purpose built home and provides single room accommodation with en-suite facilities. The home was divided into two units, one of which was an 11 bed unit, Ladybird Suite, for people living with dementia, and a 23 bed unit for people who were assessed as having residential care needs. At the time of inspection 33 people were living at Aden Lodge.

The home had a manager in post but they were not yet registered with the Care Quality Commission. 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.

People told us they felt safe and each of the staff we spoke with understood the different types of abuse and their responsibility to report any concerns.

There were a number of risk assessments in each of the care records we looked at although they did not record an adequate level of detail to ensure people were protected from the risk of harm, particularly in regard to their safety when bathing or showering. Staff told us some people could not be bathed due to the risk of harm to the person but this was not clear from their individual records. When there was an accident or incident, staff recorded this but we found two examples where this information had not been passed on to the manager. A bathroom had exposed pipework which was a potential hazard to vulnerable people; we told the manager about this but when we checked on the second day of our inspection we found this was still a concern.

There were procedures in place to check potential staff were suitable to work with vulnerable people. People we spoke with did not raise any concerns regarding the staffing at the home but staff told us, and we saw; times when people on the Ladybird suite were unsupervised.

We found there were systems in place to ensure the management of people’s medicines were safe.

We saw evidence staff received an induction when they commenced employment along with training in a number of subjects. There was a programme of supervision but the manager acknowledged this was behind schedule.

Our discussions with the manager and staff showed they had a good understanding of the Mental Capacity Act and issues relating to consent. However where people lacked capacity to make complex decisions, mental capacity or best interests’ documentation was not always evident within their records.

People received a choice of meals and drinks. Catering staff were aware of people’s specific dietary needs including where people were at risk of weight loss and required the calorific content of their meals to be enhanced.

The layout and décor of the Ladybird suite was not dementia friendly. The lounges were not homely and the shape and size of the room meant chairs had to be arranged around the edge of the room. There was an absence of colour on the unit to assist people in differentiating between bedrooms and bathrooms.

People and their relatives told us staff were caring and kind. Staff spoke with people in a caring and inclusive manner, they respected people’s privacy and supported people in a way which maintained their dignity.

We received positive feedback from people regarding the activities at the ho

The inspection took place on 23 November 2015 and it was an unannounced inspection. The service had last been inspected 29 July 2013 and was found to be meeting the regulations.

Aden Lodge provides care and support for 40 older people, some of whom are living with dementia. It is a purpose built home and provides single room accommodation with en-suite facilities. The home was divided into two units, one of which was used for people living with dementia. At the time of inspection there were 34 people using the service.

There was a registered manager in place. 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.

Training for staff in safeguarding was up to date and staff understood their roles and responsibilities in relation to keeping people safe. People who used the service told us they felt safe.

Staff did not have a good understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards. This mean people’s human rights were at risk because the service had not taken steps to ensure staff understood their role in relation to depriving people of their liberty. However, staff did understand the need to ask for people’s consent prior to carrying out any personal care.

Some of the care records we looked at were person centred and detailed but others were task orientated. Some of the care records had gaps in information recorded. This meant there was a risk some important information could be missed.

Medicines were administered by staff who had been trained to do so. People we spoke with told us they had their medicines on time.

Prior to this inspection we had received concerns about the number of staff working at the home. People who used the service told us they felt there were not enough staff and those that were on duty worked very hard. Staff we spoke with told us they felt there were not enough staff and had raised their concerns with the manager. During the inspection, we noted there were periods of time when one of the units had no staff to supervise people who were at risk of falls. The registered manager told us there were plans to increase the number of staff who worked at night but not during the day.

We saw interaction between staff and people who used the service was respectful and considerate. However, there were times when people’s dignity was not being respected. People who used the service told us they thought the staff were very caring.

The registered manager carried out regular health and safety audits. This meant people were being protected against the risk of harm. The signage throughout the home was not very friendly for people living with dementia and there were plans in place to improve the environment.

We foundeight breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full report

The overall rating for this service is Inadequate and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

On the day of our inspection there were 22 people living in the home and we spoke with sixteen of those people and one visitor. Due to people’s complex needs not everyone we spoke with was able to tell us their views of the service they received.

Comments from relatives and of people using the service who were able to express their views included:

“The staff are nothing short of superb and they speak to relatives in a manner which make them feel alright.” The person said that they felt comfortable when they left the home leaving their relative there. The person living at the home told us, “I really like it here. They look after you alright.”

When asked about privacy and dignity, one person said, “We are treated like human beings like we should be.”

They felt that their needs were catered for appropriately and said things such as, “They really look after you here.” And “They are really good to me. I like it here.”

The staff were heard speaking with people in a respectful manner. For example, when providing care they were heard explaining to the person what they were going to do and they did this in a quiet, reassuring voice.

A relative who commented about the staffing levels said, “Whilst recognising that in some sense there could never be enough staff, there were no incidences which would indicate a shortage of staff.”

A person who used the service was asked how quickly staff responded to the call system. The person told us that if the staff were busy, “It could take a couple of minutes and when they were not, it was immediate.”

Another person, who was also speaking for their relative said the staff, “Are very helpful and very kind. We have no complaints.”

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with four people who use the service and they were all positive about the care they receive. One person told us, “I am treated as an individual, the service is first class and I have no complaints.”

One person told us they were involved in planning their care and the staff encouraged them to make choices, for example, they chose what time to get up in the morning and when they go to bed. These are examples of how staff treat people with respect and maintain their independence.

People told us the staff were kind and looked after them well. On person told us, “The care I receive is good; staff are always attentive and are there if I need them.”

People told us there were a variety of activities taking place each day and it was up to each person if they wanted to join in.

People told us they liked the food and they were given a choice at each meal time.

Comments included: “The food is really good, I have no complaints.”

Due to the complexity of people’s needs and their communication difficulties we had difficulty in obtaining the views of people who use the service.

One relative said they are fully involved in the assessment and care planning process and sign to say they agree with the way their relative is cared for.

They also said that they had no concerns and if they had they would speak with the manager and were confident that any issues would be properly dealt with. They said that the home was comfortable and their relative was happy there.

One person said that they enjoyed the garden, the lovely flowers and helped making food for the birds.