Ashlar House

Ashlar House is registered to provide accommodation for up to 44 people who are living with dementia. It is located in the grounds of St Margaret's hospital in Epping and provides nursing care. At the time of inspection there were 43 people living at the service. People's accommodation was situated on one floor.

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

Effective arrangements were in place to ensure recruitment checks on staff were safe.

Minor improvements were required to staff recruitment files. We have made a recommendation about the management of staff recruitment files.

We received positive feedback about the service. A relative told us, "Staff are excellent. They have genuine concern for the resident's wellbeing. The manager is approachable, and I have no concerns."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People were cared for and supported by staff who had received appropriate training. There were systems in place to minimise the risk of infections. There were safe medicine procedures for staff to follow.

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

Staff understood how to raise concerns and knew what to do to safeguard people.

The provider had monitoring and audit systems to ensure they provided good care and these were kept under regular review.

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

Rating at last inspection

The last rating for this service was good (published 9 May 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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.

Enforcement and Recommendations

We have made a recommendation in relation to recruitment practices.

Follow up

We will continue to monitor information we receive about the service, which will help us inform when we next inspect.

Ashlar House is registered to provide accommodation to up to 36 people who are living with dementia. It is located in the grounds of St Margaret’s hospital in Epping and provides nursing care. At the time of inspection there were 35 people living at the service. People's accommodation was situated on one floor.

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 operations manager for the provider was currently in the process registering as the manager as the previous manager had left the service.

At our last inspection in March 2017, the comprehensive the overall rating for this service was Requires Improvement. A breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. This was because people told us there was not enough staff. At our last inspection, we also identified other areas they needed to improve, staff refresher training was overdue, staff had not received a recent appraisal and people were not always supported to take part in activities. The registered provider sent us an action plan detailing the improvements they would make. They kept us informed of their progress.

Staffing levels had improved since our last inspection and people’s needs were now met in a timely manner. The provider completed relevant pre-employment checks to ensure staff were safe to work with older people. Medicines were managed safely and administered as prescribed.

The staff received training and support to ensure they had the skills to provide people's support in a safe way. The provider kept an overview to ensure refresher training, supervision and appraisals were kept up to date.

People were provided with activities and entertainment of their choosing and regularly accessed activities within the community. People knew how to raise concerns and were confident any concerns would be listened and responded to.

There were systems in place to minimise risks to people and to keep them safe. When we identified a concern related to one person’s behaviour support plan and risk assessment the provider responded immediately. People were relaxed and at ease in their surroundings and told us they felt safe. Procedures were in place, which safeguarded the people who used the service from the potential risk of abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff worked closely with healthcare professionals to promote people's well-being, and make sure health needs were monitored. People’s nutritional needs were assessed and professional advice and support was obtained for people when needed.

People had the opportunity to give their views about the service and feedback was acted upon in order to ensure improvements were made to the service when required. The service had a robust quality assurance system and identified shortfalls were addressed.

Some of the people using the service and their relatives felt there were not enough members of staff to support them properly. The provider addressed this immediately and increased the staffing during the morning.

People were not always supported to follow their interests and limited activity or stimulation was provided. The registered manager had recognised this and an activity co-ordinator was about to commence work at the service.

We looked at people's care records and saw that people had detailed risk assessments and plans in place to manage risks in order to keep people safe. People told us they felt safe

The registered manager had systems and processes in place to ensure that staff were kept up to date with their core training. We saw that there were some gaps in staff training, however the registered manager had plans in place to ensure this was delivered.

We saw that people's needs had been assessed and care plans had been put in place for staff to follow to ensure people's needs were met. People had been referred for specialist input and advice received had been followed. Staff were made aware of people's changing needs.

People who used the service felt they could talk to the registered manager and that they would address any issues if required. Relatives found the registered manager to be approachable.

Systems were in place to monitor the quality of the service being provided but the registered manager had not had sufficient time since appointment to address the issues identified. The registered manager had begun the process of addressing shortfalls in supervision and appraisals.

Is the service safe?

People's care records contained risk assessments and care plans to ensure the care provided was safe and appropriate for their needs. Care plans were reviewed in conjunction with the people who used the service, and their relatives where appropriate, to ensure care was provided in accordance with their wishes.

The servicee had policies in place in relation to Adult Safeguarding, the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Mental capacity assessments were completed when people lacked capacity to make decisions in relation to their care and treatment and best interest decisions documented. Staff had received training and demonstrated an understanding of the implications of the policies in relation to their practice. This meant people's rights could be protected.

Policies and procedures to prevent and control the spread of infection were seen. Cleaning schedules were in place and the standards of cleanliness monitored through regular spot checks and audits to ensure that cleanliness was maintained. We saw staff washing their hands prior to providing care and serving meals and wearing protective clothing as necessary. This meant steps were taken to protect people from infection and keep them safe.

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Is the service effective?

Full assessments of each person were undertaken prior to their admission to the service. Care plans were reviewed regularly and updated as necessary to ensure the care provided was appropriate to each person's individual needs.

We saw there was involvement of a range of professionals in the care of each person to ensure care was effective and specialist input obtained where necessary.

There was a structured approach to training and appraisal of staff to ensure staff were supported to function effectively in their job roles.

Is the service caring?

When we talked to people who used the service and their relatives, they told us that staff were caring and understood people's individual needs and preferences. We observed a good rapport between the people who used the service and the staff which demonstrated their empathy and sensitivity to people's needs and wishes.

Several people had visitors during the inspection and the visitors told us they were able to visit at any time and staff always greeted them warmly and were welcoming.

People were encouraged to participate in activities they enjoyed both individually and as part of a group thus promoting their well-being.

Is the service responsive?

Systems were in place to make sure that themes and trends from events such as accidents and incidents, complaints, and concerns were identified and lessons learnt to prevent recurrence. This reduced the risks to people and helped the service to continually improve.

Feedback on the service was sought from people and their relatives and we saw a number of examples of improvements which had been implemented as a result of this feedback .

People told us they had had no need to complain but if they raised a concern or issue of any kind they were confident it would be addressed. They said staff were approachable and always listened to their views.

Is the service well led?

There were structures in place for clinical governance and quality assurance. We saw a planned approach to quality audits and evidence that action was taken as a result of these to improve the quality of the service provided.

Staff told us they felt well supported and encouraged to provide standards of care they could be proud of. They had received the training they required to deliver safe and effective care. There were systems in place for the appraisal of staff and personal development planning.

Key areas we looked at such as infection control and consent to care and treatment were supported by policies and procedures which identified the standards and practices expected.

People told us that the care and support people received from the staff and management team was good. One person told us, 'I think the staff are marvellous, caring, loving, patient and long suffering. Whether I am here or not the care is always here. I am confident to leave [relative] in their charge.'

We found that the provider had comprehensive and up to date safeguarding and whistle-blowing policies in place. Information about complaints and safeguarding was displayed in communal areas in the home for staff, visitors and residents to refer to.

We saw that the provider had carried out checks on staff to ensure they were suitable to work in this environment. Visitors to the home made positive comments about the staff team. One person told us, 'I have always found the staff to be very helpful and caring. I think everybody does their best in bordering on an impossible situation.'

Comments made included, 'Excellent care.' One relative said, 'There are no angels, but the staff here come pretty close.' Another relative said, 'It's a very good home. Any complaints are dealt with. We never had anything other than very minor complaints over the years.'

A person spoken with said, 'It's lovely here. Staff are very nice and friendly.' Another person said, 'Everyone is really nice here.'

We found that people and their relatives were involved in care plans and preferences were generally known and met by competent staff.

Care plans were comprehensive and risks identified were acted on. Other external professionals were actively involved in supporting the person's needs with some success noted in relation to wound care and nutrition.

People's nutritional needs were being met. Where people were known to be at risk of excessive weight loss or dehydration, extra support was provided by staff and external professionals and closely monitored by the Registered Manager.

Medication was safely managed and administered at the home.

We found suitable and sufficient levels of competent staff to meet the needs of people at the home.