This inspection took place on the 23 and 29 November 2017 and was announced.

At the last comprehensive inspection in November 2015 the service was rated overall Good.

A focused inspection took place in January 2017 due to an increased amount of statutory notifications detailing medication errors. The inspection specifically focused on those areas. The rating for the service remained Good overall; however the rating for the safe domain was changed to Requires Improvement.

At this inspection we found the provider had made the necessary improvements. The medicines storage arrangements had been reviewed and all people using the service had been provided with a lockable medicines cabinet within their bedrooms.

Aspen House is a residential care home that provides care for up to 10 people with complex learning disabilities, autistic spectrum disorder and mental health needs. At the time of the inspection nine people were using the service.

At the time of the inspection an acting manager was in post. They had submitted a registered manager’s application to the Care Quality Commission (CQC) and the application was in progress. 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 continued to feel safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risks to people were assessed and monitored regularly. The premises were maintained to support people to stay safe.

Staffing levels ensured that people's care and support needs were met. Safe recruitment processes were in place. Medicines were managed in line with the prescriber’s instructions. The processes in place ensured the administration and handling of medicines was suitable for the people who used the service.

Systems were in place to ensure the premises were kept clean and hygienic so people were protected by the prevention and control of infection. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff who had received training and support to carry out their roles.

People were supported to maintain their health and well-being. Staff supported people to attend appointments with healthcare professionals. People were encouraged to eat healthily and staff made sure people had enough to eat and drink.

People’s diverse needs were met by the adaptation, design and decoration of premises and they were involved in decisions about the environment. Staff demonstrated their understanding of the Mental Capacity Act 2005 and they gained people's consent before providing personal care.

Staff were caring and compassionate. People were treated with dignity and respect and staff ensured their privacy was maintained. People were encouraged to make decisions about how their care was provided. Staff had a good understanding of people's needs and preferences.

People were listened to; their views were acknowledged and acted upon. Care plans were focused on the person and their wishes and preferences. People and their relatives were involved in the assessment process and reviews of their care.

People were supported to take part in activities which they wanted to do, and encouraged to participate in events within the local community. There was a complaints procedure in place to enable people to raise complaints about the service.

The provider understood the need for people, and their family, friends and other carers to be involved in planning, managing and making decisions about end of life care.

The service had a

Aspen House is located in Rushden, Northamptonshire. The service provides personal care and accommodation for up to 10 people with a learning disability and other complex needs. The service is split into two units, referred to as the 'house' and 'lodge', each with self contained kitchens and additional communal areas. On the day of our inspection there were 10 people living in the service.

At the last inspection the service was rated as Good. At this inspection we found although the service remained Good overall, that the rating for the safe domain had changed to Requires Improvement.

This inspection was prompted by an increased amount of statutory notifications detailing medication errors and system breakdowns. The information shared with CQC about these errors indicated potential concerns about the safe administration and management of medication. This inspection specifically focused on those areas.

People were provided with their medication in accordance with prescribed guidance, however we found that there was an issue in respect of the storage, disposal and recording of some medication. Systems were in place to ensure people’s daily medicines were managed in a safe way, but these had not always been followed adequately. Although we found that these aspects had been identified by the provider prior to our inspection, and some action taken to make improvements, more time and further work was needed to fully implement and embed required improvements.

Further information is in the detailed findings below.

Aspen House is registered to provide accommodation and support for up to ten people with learning disabilities and complex needs. On the day of our visit, there were ten people living in the service.

Our inspection took place on 10 November 2015. At the last inspection in June 2014, the provider was meeting the regulations we looked at.

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.

People felt safe. There were systems in place to protect people from the risk of harm and to ensure staff were able to report suspected abuse. Staff were familiar with these and knew how to use them to keep people safe.

Risks to people were assessed and control measures were put in place to reduce the chances that harm may be caused.

There were sufficient numbers of staff to meet people’s needs. Robust recruitment processes had been followed to ensure that staff were suitable to work with people.

Systems were in place for the safe administration, storage and recording of medicines.

Staff received training which helped them to deliver safe and effective care to people which met their assessed needs. They received regular support from the registered manager, including frequent formal supervisions.

Some people who used the service did not have the ability to make decisions about aspects of their care and support. Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People had sufficient food and drink to maintain a healthy, balanced diet and had choices about what they wanted to eat and drink.

Staff supported people to attend health appointments and made referrals to appropriate health professionals to ensure people’s general health and well-being.

Staff were knowledgeable about how to meet people’s needs and how people preferred to be supported. People were able to make choices about what they did on a daily basis and about how their care was provided.

Staff had access to specific information on people’s ability to communicate, which allowed them to understand what people’s expressions and gestures meant and how they should respond to provide good quality care.

Dignity and privacy were promoted by the service and people’s rights were protected.

People received person-centred care, based on their individual strengths, interests and needs.

Feedback was sought from people and those important to them, such as family members. This was used to help identify areas for development at the service.

There were effective systems in place for responding to complaints.

The service had an open, positive and forward thinking culture. There were internal and external quality control systems in place to monitor quality and safety and to drive improvements.

The inspection was carried out by an inspector who gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? 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.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People’s needs had been assessed before they were admitted to Aspen House. After admission to the home we saw that people’s needs were reassessed on a regular basis, to ensure they received the safe care they needed. This meant that staff had the information they needed to minimize identified risks to people.

We found that the provider had effective infection control processes in place. This meant that people were cared for in an environment that was clean and hygienic.

When we inspected there were sufficient numbers of experienced and competent staff on duty to safely meet people’s care needs. Records showed that staff had been appropriately trained and received the support they needed to do their job. This meant that people were protected from the risk of neglect or unsafe care.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager who demonstrated appropriate knowledge of the procedures to follow. We saw evidence that applications had been submitted following correct procedures and proper policies relating to DoLS were in place.

We saw evidence that staff had been trained in DoLS, in the Mental Capacity Act 2005 and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found associated risk assessments; with clear action plans were in place to ensure people remained safe.

Is the service effective?

People told us they were happy with the quality of care that had been delivered. One person told us they were going on holiday and we were told that the activities they would engage in were detailed in their care records. We confirmed this to be the case and that the delivery of care was in line with people's care plans and assessed needs.

We spoke with staff and observed their engagement with people and we determined that they had a robust knowledge of each person’s care needs and preferences.

We found that the staff had received training to meet the needs of people living at the home. Staff received additional training when needed and when they requested it. Training courses included challenging behaviour, mental health and infection control.

Is the service caring?

We saw that staff were able to communicate effectively with people with limited verbal communication and to meet their needs with respect and dignity.

We found that people who lived in Aspen House were supported by friendly, respectful and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw staff helped people with their care and support, with patience and kindness.

Is the service responsive to people’s needs?

People's needs had been assessed before they moved into the home and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included people's history, wishes and preferences and goals to be achieved. People and/or their representatives were involved with reviews of care plans and were kept informed of any changes. People had frequent access to daily activities that included outings, life skills (including cooking) and holidays.

We observed that staff responded very promptly to people's needs, both physical and social. We saw that care plans and risk assessments had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and supported them to access a variety of activities.

We saw that there was enough staff on duty to meet people’s needs, in a timely manner,

Is the service well-led?

There was a registered manager in post on the day of our inspection that had support from a wide range of staff. This meant that the support systems in place facilitated staff to provide an effective level of care for people.

We found comprehensive policies and procedures that addressed every aspect of the service were in place. The registered manager operated a system of quality assurance and completed audits to identify how to improve the service. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent and analysed.

Staff told us they were able and encouraged to express their views and concerns they may have and were listened to. Complaints, incidents and accidents were appropriately recorded and audited. Staff's practice was regularly observed and supervised by the registered manager to identify whether additional training or refresher courses were needed.

Because many people who live at Aspen House have cognitive disability or communication difficulties, we were unable to ask people directly about their experiences, we spent time with people in the lounge areas and saw that people appeared relaxed and interacted with staff members in a positive way. We visited the farm project where some of the people using the service attend for activities. Again people were relaxed and appeared to engage and enjoy the varied tasks presented to them.

We looked at outcome areas covering people’s consent to receiving care in the home and how the staff are organised to assist in delivering people’s care. We looked at the composition of care plans and how people are assisted with their diet and medication. We also looked at the general safety around the home and staff support. We found all these areas to be well detailed and compliant.

We observed staff talking with and assisting people throughout the day, this was done with the peoples’ privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs.

We looked at the quality assurance questionnaires that were put out in August 2012, both to people using the service and their relatives. People were asked to comment if they were satisfied with the services provided in the home and could add comments or return these anonymously if they wished. We looked at the feedback compiled from the 16 returned forms. We noted comments such as “(My relative) is happy being at Aspen House so it must be ok” another relative stated “I am very happy with the physical aspects of the home i.e. furnishings, appearance and upkeep on my visits and the staff always come across as helpful and friendly.” Another person stated “Need more flowers in the garden. Like to have a relaxation room.”

On our tour around the home we saw people in a relaxed state, though those we spoke with did not make specific comments about their home or the staff.

When we spoke with staff they were aware how to support people and this reflected the support plans we viewed at the time.

We observed and spoke to people in the two units of the home.

People we spoke with told us that they liked living at the home and felt safe. They told us they would talk to staff or tell their family if they were not happy. One person told us “we can go on holidays, bowling, and to the local club”. Another person told us that they helped with gardening and enjoyed this. They all told us that they enjoyed cooking at the home and staff helped them with this. The staff were said to be very helpful and listened to them.

The staff we spoke with told us that they enjoyed working at the home and they all worked well as a team.