Aden House Care Home

Aden House is a care home providing personal care for up to 60 people. At the time of our inspection there were 29 people living at the service. There are communal areas and accommodation on both the ground and first floor. The Butterfly unit on the ground floor supports people living with dementia.

People’s experience of using this service and what we found

There had been insufficient improvement in management and oversight of the service since the previous inspection and we continued to identify repeated shortfalls that compromised the safety of people and the quality of care at the service.

Risks to people were again not safely assessed, monitored and mitigated. People continued to not always be protected from the risk of harm when they had been involved in incidents of a safeguarding nature. Accidents and incidents continued to not be appropriately addressed to ensure lessons learned were identified and the risk of harm reduced.

Concerns were again identified in relation to infection prevention and control (IPC) particularly regarding the management of a recent outbreak at the service. There were not enough staff to adequately respond to people’s needs, and medicines were not always managed safely.

Quality assurance systems were still not effectively implemented and consistently overseen by the manager. They were not always effective in identifying and monitoring shortfalls and driving improvement at the service. Whilst some improvements had been made to the environment, which appeared more homely, there were still significant shortfalls in other aspects of the service.

There was an activities staff member in place. However, the available activities were not always suited to the needs of people with dementia. People who were unable to participate in group activities received little to no activity.

The service was working within the principles of the Mental Capacity Act (MCA) and appropriate legal authorisations were in place when needed, to deprive a person of their liberty. Policies in the service supported this and staff supported people in their best interests, in the least restrictive way possible. However, people were not supported to have maximum choice and control of their lives and care was not delivered in line with their needs and preferences. Care records were not always complete and contained inaccurate and conflicting information. People’s care was not always collaboratively planned, or person centred. People’s varying communication needs were not always considered or met.

Staff were kind caring and respectful towards people. Systems were in place to support staff and they received appropriate training.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 10 August 2023) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider reviewed systems and processes for safe recruitment. We also recommend the provider sought advice and guidance from a reputable source to ensure people's privacy, dignity and independence was respected and promoted. At this inspection both recommendations had been actioned and resolved.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. During this inspection, we checked whether the provider had followed their action plan to confirm whether they now met legal requirements.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service remains inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to assessing and managing risks to people, IPC, medicines management, staff numbers, person centred care, record keeping and oversight of the service.

We have made recommendations in relation to joint care planning, people’s communication needs and obtaining feedback from people fully considering their equality characteristics.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the 5 key questions it will no longer be in special measures.

Aden House is a care home providing personal care for up to 60 people. At the time of our inspection there were 34 people living at the service. There are communal areas and accommodation on both the ground and first floor. The Butterfly unit on the ground floor supports people living with dementia.

People’s experience of using this service and what we found

There were not enough staff deployed at the service to meet or respond to people’s needs safely and effectively. The environment was unclean, in a state of disrepair and was not dementia friendly. Risks associated with infection prevention and control (IPC) were not effectively managed. Risks to people’s safety were not adequately assessed, monitored or managed. Medicines were not managed safely.

The service was working within the principles of the Mental Capacity Act (MCA) and appropriate legal authorisations were in place when needed, to deprive a person of their liberty. Policies in the service supported this and staff supported people in their best interests, in the least restrictive way possible. However, people were not supported to have maximum choice and control of their lives. People’s care was not delivered in line with their needs and preferences and their personal care needs were not always met. People’s privacy and dignity was not consistently maintained. Staff did not always speak to people in a way that was respectful. People did not always have fluids readily available to them.

Staff did not always complete relevant training to ensure they had the right skills and knowledge to support people safely. Appropriate support was not in place for staff. Care records did not contain an accurate overview of people's care and support needs. They were not person centred and were often incomplete. There was a lack of engagement and activities for people.

Shortfalls identified at the previous inspection had not been addressed. Systems and processes to monitor and improve the quality of the service were ineffective as they had not identified issues found at this inspection. Where issues had been identified, no action had been taken to improve the quality of the service. Incidents were not always reported appropriately. There was no oversight with regards to reporting, analysing and learning from incidents. Effective systems had not been established for gathering feedback from people and relatives. The provider did not always effectively work in partnership with other agencies as a means of improving the quality of the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 July 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been made and the provider remained in breach of regulations.

At our last comprehensive inspection (published 17 September 2019) we recommended the provider consider current guidance in meeting the requirements of the MCA. At this inspection we found the provider was now meeting the requirements of the MCA.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During this inspection, we also checked whether the provider had followed their action plan to confirm whether they now met legal requirements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to managing risks to people, infection prevention and control (IPC), medicines management, staff numbers, support and training, record keeping, person centred care, and oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Aden House is a care home providing personal and nursing care for up to 60 people aged 65 and over. At the time of inspection there were 42 people living at the service. There are communal areas and accommodation on both the ground and first floor. There is a unit called Butterfly which supports people living with dementia.

People’s experience of using this service and what we found

Medicines were not always managed safely. Medicines were not stored appropriately and records relating to medicines were not always accurately completed.

Risks to people were not always safely managed. Assessment and monitoring of care needs was not always in place and staff did not always receive necessary training. This placed people at increased risk of harm.

Safe infection prevention and control (IPC) practices were not consistently in place and improvements were required.

Systems in place to monitor the service had not been effective in identifying and addressing areas requiring improvement. The service had not obtained feedback from people to inform improvements in quality and safety. Records were not always up to date and accurately completed.

People were safeguarded from the risk of abuse. The service worked with the relevant authorities to keep people safe.

Staff had a positive approach towards people. People were happy living at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aden House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aden House is a care home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 60 people. There is accommodation and communal areas on both the ground and first floor. There is also a unit (Butterfly unit) with 20 beds which provides personal care for people living with dementia

People’s experience of using this service and what we found

People were safe and protected from avoidable harm. Individual risk assessments were in place. People and their relatives told us they felt people were kept safe. People's medicines were managed well. The home was clean and tidy throughout. There were enough staff to support people and they had been recruited in a way that helped to keep people safe. Staff received appropriate training, support and supervision.

Care plans were personalised and provided enough detail to inform staff how to support people. They included information about people’s preferences and abilities. Staff supported people to participate in a range of person-centred activities. There was a system in place to manage complaints. People’s practical end of life wishes were recorded, however, further work was required to ensure these were person centred.

Systems of governance were effective. Quality monitoring systems were in place. Relatives were generally happy with the care provided and staff felt supported by the registered manager. Regular meetings were held with staff and people who lived at the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 27 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aden House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aden House is a care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 60 people. There is accommodation and communal areas located on both the ground and first floor. The home provides care and support to people who are assessed as having nursing and personal care needs; there is also a unit (Butterfly Unit) with 20 beds which provides personal care for people living with dementia.

People’s experience of using this service and what we found

Not all equipment had been checked for safety. Improvements were needed to ensure people consistently received their medicines as prescribed. Not all areas of the home were clean. There was ongoing recruitment to a number of vacant positions within the home. The recruitment of staff was safe.

New staff received an induction. Staff training and supervision was not up to date. Feedback about the meals was mainly positive. Staff received the input of other healthcare professionals where needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, not all the requirements of the Mental Capacity Act 2005 had been met. We have made a recommendation about meeting the requirements of the Mental Capacity Act (2005).

Staff were caring and kind. People were treated with dignity and respect. Staff knew people’s preferences, likes and dislikes. We have made a recommendation about involving people in their care plans.

Care records were not always accurate or complete, although they were detailed, and person centred. People were not always provided with meaningful engagement which met their individual needs. Four complaints had been received during 2019 but we were unable to evidence they had all been dealt with appropriately.

There was no registered manager in post, a manager from another of the provider’s services was supporting the home and a new manager had been appointed. Staff told us there had been a number of managers at the home in the previous twelve months. Staff morale had begun to improve as a result of the support manager being assigned to the home. A number of audits had been completed, these had not always been completed at regular intervals. Where issues were identified, action had not always been taken. The findings of this inspection demonstrate a failure of leadership and governance at the home at provider level.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, safe care and treatment, staffing, complaints and good governance at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aden House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Aden House accommodates a maximum of 60 people; there is accommodation and communal areas located on both the ground and first floor. The home provides care and support to people who are assessed as having nursing and personal care needs; there is also a unit (Butterfly Unit) with 19 beds which provides personal care for people living with dementia. There were 48 people living at the home at the time of the inspection.

The registered manager had left the service the week prior to our inspection; a peripatetic manager was present on both days of the inspection. 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 staff understood their responsibilities in identifying, recording and reporting concerns safeguarding concerns.

Where people were nursed on pressure relieving mattresses we found two of the three mattresses we checked were not set correctly and people’s position change records did not always evidence staff were repositioning people in line with their care plan.

Not all the in-house maintenance checks had been completed due to changes in personnel and we were unable to locate any thermometers in communal bathrooms to enable staff to check the water temperature prior to showering or bathing people.

We found the recruitment of staff was safe. Feedback from staff and people who lived at the home was mixed regarding their being sufficient numbers of staff to meet people’s needs. People told us staff did not always meet their needs in a timely manner and staff did not have time to talk to them.

The management of people’s medicines was safe although improvements were needed to the management of people’s creams.

West Yorkshire Fire Service had highlighted shortfalls in fire training for staff. The registered providers training matrix indicated other areas of staffs’ training was also not up to date.

Very few people ate in the main dining room. People who ate their meal in their bedroom, staff served both the main course and pudding at the same time, meaning the dessert was probably cold by the time the person ate it.

People had access to external health care professionals.

Staff supported people to make daily decisions and supported them in the least restrictive way possible. Although further improvements were needed to ensure the requirements of the Mental Capacity Act 2005 were fully met.

People told us the staff were caring and kind. Staff knew people well and were pro-active in ensuring they respected people’s privacy and dignity. People’s care records were not stored securely and we were unable to evidence people or their families were involved in the care planning process.

People told us they did not have enough to do during the day. Two activities organisers had recently left, leaving one in post. During the period of our inspection, we saw minimal activity to engage or stimulate people.

New care planning paperwork was being implemented throughout the home. Each of the care files we reviewed contained care plans which had been updated, reviewed and were reflective of people’s needs.

Complaints had been logged but from the information available, we were unable to evidence, the investigation had been robust and we could not ascertain the outcome had been acceptable to the complainant.

In March 2018 the company responsible for the management of Aden House Care home, Aden House Limited had changed. Feedback from staff about this change was positive.

From discussions with the peripatetic manager present at the time of the inspection, it was clear they were aware of the key areas where improvements were required to ensure people received a high standard of care.

We reviewed a number of audits completed over the previous eight months, we found they had not been completed as frequently as the registered provider specified and they were not robust. The company responsible for the management of the home at the time of the inspection had begun to implement its own audits and systems of governance but we were not able to evidence the effectiveness as they had only recently been commenced.

This is the third time the service has been rated Requires Improvement. We found 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.

Aden House provides a care home service with residential and nursing care for up to 60 older people. There were 50 people living at Aden House at the time of the inspection.

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. The registered manager was due to leave the service and there was also an acting manager working alongside the registered manager in order to take over the running of the home.

The home was welcoming and friendly. People, staff and visitors reported a homely atmosphere, although the provider acknowledged there was planned refurbishment and we saw equipment was not always stored appropriately. The environment was clean and tidy, although we identified some odours in some of the upstairs areas.

Staffing levels were appropriate to meet people’s needs. Secure recruitment procedures ensured staff were suitable to work with vulnerable people, although not all photograph identification was in place to support the verification of agency staff.

Accidents and incidents were recorded well, with clear systems to identify any patterns or trends.

Moving and handling practice was carried out appropriately on the whole, although we observed one incident which put a person at risk of injury.

Medications were managed safely and staff were confident about their responsibilities to make sure people had their medicines on time.

Staff understood the Mental Capacity Act (2005) and the implications for ensuring people’s rights were promoted. However, the recording of people’s mental capacity was not always clear and there was conflicting information about whether family members had lasting power of attorney.

People enjoyed their meals and the chef and care staff had a good understanding of people’s dietary needs.

Staff were caring and attentive to people’s needs and there was evidence they had a good rapport with people and their families.

People’s dignity and privacy were maintained at all times in their care and the daily routine.

Staff knew people’s interests and used time well to engage with people, with plenty of resources to interest people. Some people remained in bed and it was not always clear the reasons for this.

Care plans contained up to date information, although there were some gaps in daily recording and it was not always evident people had been involved in their care planning.

People and their relatives knew how to raise a complaint if they felt this was necessary and we saw complaints were managed appropriately

The registered manager was visible in the service and there was evidence of clear leadership, with any changes being managed in a planned and measured way. People, staff and relatives said the home was well run and managed.

Systems were in place to monitor the quality of the provision and drive improvement and the management team were aware of the strengths and areas to improve.

You can see what action we told the provider to take at the back of the full version of the report.

The inspectors also through observation and looking at records used the information they were given to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Before this visit we had received information about people’s care and support not being properly planned and delivered and some issues relating to staffing and general management. We looked at these issues during our visit and have recorded our findings within this report.

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. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and had submitted one application. This meant that people were safeguarded as required.

We found some areas of the home were not clean. Staffing was not always arranged to make sure people who lived at the home were cared for safely.

Is the service effective?

People had not been involved in the assessments of their needs or been involved in writing their plans of care. However we observed effective care delivered with respect and kindness. People who lived at the home told us they received the care they needed. Some visitors we spoke with were complimentary of the care whilst others expressed concerns. We saw meals were nutritious and monitoring of food and fluid intake was taking place.

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with knew about people’s care and support needs and their individual preferences.

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

Is the service responsive?

Staff were aware of people's needs and how to support them to meet their needs. Complaints made to the service had been managed well.

Is the service well-led?

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.

A new manager was in post and was in the process of making an application to us for registration. The area manager for the service was also relatively new.

We saw that the new management team were in the early stages of completing their own quality audits and taking action to improve the service for people.

We found care and treatment was planned and delivered in a way that was intended and to ensure people's social needs were being met.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was enough permanent qualified, skilled and experienced staff to meet people's needs.

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

Comments from relatives and of people using the service included:

“I think they (the staff on Butterfly Suite) are well trained in dementia. They seem to know how to treat people properly.”

“The staff are lovely. It’s a tough time for me and they look after me as well as my dad because I need support while he’s so poorly.”

“They’re lovely staff, so friendly and cheerful. That includes everyone.”

“I can’t fault the carers – they’re always busy, but they do a great job for me.”

“I get all the help I need and they (the carers) are excellent. So willing.”

“I chose this home for my mum because I like the attitude of the staff. They’re so friendly and caring.”

Two relatives said they had seen a reduction in the staffing and unfamiliar agency staff at weekends, evenings and nights. One relative told us that they often waited for the evening shift to come on duty to reassure them that there was enough staff to care for their relative.

There was an effective complaints system available and people were confident that staff would act appropriately should they have concerns.

We had concerns the service were not meeting people's social care needs, and there were insufficient permanent staff. We have judged that these have a minor impact on people who use the service. Compliance actions were made.