About the service:

Aspen Place was previously known as Greenways Nursing Home. The service has undergone extensive remodelling and refurbishment which included extending the service to accommodate more people. Aspen Place is registered to provide nursing and personal care and support for up to 52 older persons living with dementia or nursing needs. The service provides long term and respite care. At the time of our inspection there were 39 people living at the service.

People’s experience of using this service:

We spent time with people during our visits and without exception feedback received from people living in the service was extremely positive. People and their relatives said that the service was of a high standard. People were cared for by genuinely kind and compassionate staff who were dedicated and committed to ensuring that people received the care they needed and wanted.

The remodelling and refurbishment of the service was of a high standard. The service had embraced the use of technology to enhance people’s quality of life. Feedback received included, “The open plan kitchen is a fabulous idea. The residents really benefit from it. They can see what’s going on and ask for a snack whenever they want. It has more of a restaurant / hotel vibe”, and, “There’s always someone about. It feels safe. The hustle and bustle is like normal life. The kitchen is great, they like to watch the chef and chat.”

People's wishes for their end of life were clearly documented and the care and support provided was exceptional. Staff demonstrated a depth of compassion and empathy and genuinely cared for people they supported.

The management and staff created a warm and relaxed environment and we observed a strong caring relationship between people and all grades of staff. Relationships were professional, but two way and people knew about the registered managers and staff families and interests which helped maintain these relationships.

People received care from a dedicated staff team who were very kind, caring and compassionate. Staff had built very strong relationships with people.

There were quality assurance systems in place to help monitor the quality of the service, and identify any areas which might require improvement. The provider and registered managers listened to feedback and reflected on how the service could be further improved.

The service was well led. The provider's values and vision were embedded into the service, staff and culture. The provider and registered managers were passionate and committed to developing a service where people received genuinely person-centred care. This was evident throughout our visit.

The service was safe, with systems and processes which ensured that any concerns were reported to appropriate authorities without delay.

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

Rating at last inspection:

At our last inspection we rated the service good. The last inspection report was published 13 June 2016. At the inspection we found that the lack of outside space was an area in need of improvement, this was due to the building work at the time of the inspection. Following the completion of the building work this shortfall has been met.

Why we inspected:

We completed a planned inspection based on the previous rating of Good.

Follow up:

We will review the service in line with our methodology for 'Good' services.

The inspection took place on 26 April 2016 and was unannounced. Greenways Nursing Home provides nursing and personal care and support for up to 31 older people living with dementia or nursing needs. The service offers long term and respite care. Accommodation is provided in an older style building over three floors. There are 26 single rooms and four shared rooms. At the time of inspection there were 29 people living at the service with complex nursing and/or dementia needs requiring support for all activities of daily living. The service is located on a main road in a quiet residential area. The service was last inspected on 29 April 2014 and no concerns were identified.

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. The registered manager was not available on the day of inspection but the provider was on site supporting the service and was present throughout the inspection.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We looked at this and other information we held about the service. This included previous inspection reports and notifications. Notifications are changes, events or incidents that the service must inform us about. We contacted stakeholders, including health and social care professionals involved in the service for their feedback.

Greenways Nursing Home has been undergoing extensive building work over the past 12 months. There were appropriate risk assessment and arrangements in place to reduce the impact of the building work such as noise, however people did not have access to an outside space and we identified this as an area that required immediate improvement. There were plans in place for a temporary outside space for people and the provider agreed to have this area completed by the end of April.

There was a system in place to monitor reported accidents and incidents. However, reporting of accidents and incidents was not consistent which meant that the risk of recurrence was not always managed appropriately and this was identified as an area which needs improvement.

Lifting equipment such as hoists and slings were stored in the dining room. This represented an infection control risk and the provider agreed to find an alternative place to store these items.

People were protected from harm. Staff had received safeguarding training, knew how to recognise the signs of abuse and understood their responsibilities to report any concerns or poor practice.

Individual risk assessments were in place to ensure that people’s health needs were appropriately managed and these were updated regularly and in accordance with any guidance from health care professionals. Planned care accurately reflected care delivered. Environmental risks were managed through regular checks and servicing and there were emergency plans in place for the service and individuals.

There were sufficient numbers of skilled staff on duty to support people’s needs. Safe recruitment practices and the use of regular temporary staff through an agency ensured continuity and maintained the quality of support offered to people.

The management of medicines was safe. People received their medicines from nurses correctly and on time. The nurses were knowledgeable and experienced and knew people well.

Staff received induction when joining the service. Staff felt supported and encouraged. They received regular supervision and appraisal and there were individual staff development plans in place.

The service acted in accordance with the Mental Capacit

A single inspector carried out this inspection. The focus of the inspection was to check if the provider had taken sufficient action to meet the compliance actions set when we inspected the home on the 28 November 2013. On the day of our inspection there were 30 people living at the home. We spoke with people during the day but what they told us did not always relate to the essential standards we were assessing. People used a mixture of verbal and non-verbal communication to give us their views of living at the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

We found people experienced care and support that was planned and delivered in a way that was intended to ensure their safety and welfare. There was a system in place to monitor how many accidents or incidents had taken place over a given period. The head of care was able to demonstrate how they had been analysed to make sure that the manager and staff learned from such events. There were enough staff on duty to meet the needs of the people living at the home and a member of the team was available on call in case of emergencies. Staff personnel records contained all the information required by the Health and Social Care Act. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Before people received any care they were asked for their consent and the staff acted in accordance with their wishes. Staff took time to explain what was happening and made sure they agreed with any changes. Staff demonstrated an understanding and showed consideration when providing care to people with dementia. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Observations we made on the day of our inspection showed staff were experienced and had the skills they needed to support the people living at the home. Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions and their own responsibilities under the requirements of the Mental Capacity Act 2005.

Is the service caring?

During our visit all interactions we saw between the staff and the people who lived at the home were respectful. Support was offered and provided in a way that ensured people's rights to privacy and dignity. People were spoken with in a sensitive, respectful and professional manner. We saw that personal care was carried out in private and staff always knocked and awaited permission before entering people's private rooms. In our observations of interactions between staff and people who lived at the home, we saw people were respected. People's care plans were clearly written and person centred. Staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed in a manner which enabled people to maintain their dignity and independence.

Is the service responsive?

We saw that people were asked their opinion during the day where a choice was available. Staff gave examples of how they had made changes to peoples care in response to people’s requests. We were told that one person was not happy with having a pureed diet on admission to the home. The service arranged for the person to have another speech and language assessment. Following the assessment the service were able to make the requested changes. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. Staff were able to give examples of activities they had introduced in response to requests from people, this included decorating cupcakes, posting their own letters and, “Enjoying a beer in the garden”.

Is the service well-led?

Staff we spoke with were clear about their roles and responsibilities. All said they received the advice and support they needed from their managers and colleagues. Since our last inspection we found that improvements had been made in relation to the incident and accident reporting system. The provider had an effective system to regularly assess and monitor the quality of service that people receive against the requirements of the essential standards. An action plan had been drawn up to identify any actions that needed to be taken. We saw that shortfalls identified had been addressed promptly. We saw the manager's assessment of the outcomes we assessed during this inspection matched our own findings of compliance.

Prior to this inspection we received information of concern that related to the care of people, infection control measures, medicines and recruitment practices. During the inspection we explored these matters. We spoke with six people who lived at the service. We also spoke with the relatives of three people. We also gathered evidence of people's experiences of the service by observing how people were supported by staff, looking at records and talking with staff and the manager. Everyone told us that they were happy with the care and support they received. For example, one person told us, "I'm perfectly happy. The whole place is excellent. I get asked what I want and this is always provided". A relative told us, "X (referring to their family member) sometimes doesn't eat. They monitor and give supplements. Staff are very friendly and understanding. I know X is happy here".

When we spent time observing the interactions between staff and people who used the service we found this to be positive, friendly and caring.

People also told us that they were happy with the environment that they lived in and the levels of cleanliness at the service.

We found that when people who lived at the service sustained an unexplained injury or bruising sufficient steps had not been taken to identify the cause of harm and protect them from further injury. We also found that recruitment practices did not always provide protection to people who lived at the service.

During our visit we met and spoke with 14 of the 29 people using the service.

People using the service had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

We also spoke with the home’s administrator, a nurse, four care staff and a cleaner

We were concerned that people’s care was not always planned and delivered in a way that promoted their safety and welfare.

We were concerned that the environment and equipment was not clean and hygienic to minimise the risk of infection.

We spoke with six people during our visit to Greenways.

All of the people that we spoke with were complimentary about the service that they received at Greenways.

People told us that they were well cared for and that the staff were kind and respectful.

One person described the home as having a lovely atmosphere. They said, “We are all friends here”.

Another person said, “I am very happy to spend the rest of my days here."

On the day we visited we found the home had a calm and relaxed atmosphere, and saw staff interacting with people in a respectful and polite manner.

We spoke with two people who live at Greenways Nursing Home. Although conversation was limited due to mental frailty they told us they were very happy with the care afforded to them. One person told us, “I am looked after well. They are nice people and very kind to me.”

We also spoke to the relatives of two other people. They also confirmed they were satisfied with the care that had been provided. One relative told us, “The staff are all so caring. They are friendly and helpful.” Another relative said, “I have been quite happy with the care provided here.”

We spoke with three members of staff who were on duty. They demonstrated they knew about the level of care that each person required. They also told us they had been well supported by the manager.