Ashness View

Ashness View is a residential care home providing personal care to up to 5 people. The service provides support to people with mental health issues. At the time of our inspection, there were 4 people using the service. The care home is an adapted period property with 5 bedrooms with a small communal lounge, kitchen and medium sized garden.

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

People told us they were safe living at the service. Risks of harm were assessed and mitigated as much as possible. Medicines were managed safely. Staff were recruited safely. There was a clear procedure in place for preventing the spread of infections.

Care plans were written in a person-centred way. People's likes and preferences were recorded and staff knew them very well. People were involved in care planning. People were able to choose what activities they wanted to do. There was a clear complaints process in place.

The provider had effective governance systems in place. Auditing the quality of care was done on a regular basis and this helped to improve the service. Staff told us they were well trained and well supported in their role. Staff told us they could raise any concerns and they would be addressed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 November 2019) and there was a breach 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 improvements had been made and the provider was no longer in breach of regulations.

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

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

The care home is an adapted period property with 5 bedrooms with a small communal lounge and kitchen and medium sized garden.

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

People told us they felt safe living at the service. The provider had assessed the risks people faced, however, had not always developed guidance about how to reduce these risks and what to do in emergency medical situations.

Medicines were not always managed safely. Medicine errors found during the inspection were corrected immediately and the provider implemented a new system to check medicines immediately.

Care records were not always personalised to reflect people’s preferences. People told us staff knew them well and were caring. Staff supported people’s diversity. People were involved in planning their care and were supported to maintain their independence.

The provider’s systems were not always robust enough to identify the issues we found at the service and ensure quality care. The provider had an ongoing development plan to improve the service and had developed partnerships with other organisations to develop the service.

People knew how to make a complaint about their care and felt the service listened to them. The service was open and inclusive and people spoke highly of the management team.

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. People were encouraged to eat and drink enough and to access healthcare services.

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 good (published 20 April 2017) and there was one recommendation about safe care and treatment. At this inspection we found enough improvement had not been made and the provider was now in breach of the regulation to provide safe care and treatment.

Why we inspected

This was a planned inspection based on the previous rating and to check the safety and quality of care people received.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified one breach in relation to safe care and treatment at this inspection.

We made a recommendation about good governance .

Please see the action we have told the provider to take at the end of this report.

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.

The service is located in a large terraced house with access to a back garden.

The last inspection took place on 26 November 2015. At that inspection we found two legal requirements were not being met in relation to safe care and treatment, as medicines were not being safely managed and there was insufficient action taken to prevent fire in people’s bedrooms.

At the time of this 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.

People told us staff were kind, caring and offered them support as they needed. There was a calm and relaxed atmosphere at the service on the day of the inspection. We saw staff talking and working with people in a calm and respectful manner.

People told us they felt safe and that the service was a good place to live in. We spoke with staff who were aware of the importance of safeguarding adults and knew what to do if they had any concerns.

The majority of people living at the service were independent and went out to meet friends and participate in hobbies and activities without support. But staff offered assistance with appointments when required, monitored and supported people with their mental health needs and ensured they had appropriate additional professional support if their needs changed.

Care and support plans were comprehensive and up to date. Risk assessments were in place for identified risks, but not all gave clear detailed advice to staff in how to manage these.

Medicines were stored safely and within the correct temperature range. We noted that records did not show tablets carried over from one month to the next so it was not possible to check stocks against records for all medicines, but this has been rectified since the inspection.

Supervision took place regularly and staff received training in key areas to ensure they were skilled to carry out their role.

The provider had ensured that recruitment checks, including Disclosure and Barring Service (DBS) certificates, were completed before staff started working with people. For some staff the provider had obtained verbal references but was still awaiting written references. However, these staff had worked as agency staff prior to becoming permanently employed so at that point the provider had received historical references. In this way they had satisfied themselves staff were considered safe to work with people who used the service.

We found the premises were tidy and whilst it was clear that daily cleaning took place there were areas where the service had built up grime. The registered manager undertook to carry out a deep clean of the service by the end of March 2017. A number of rooms had been decorated in the last six months and there were plans in place for other areas to be decorated by the end of March 2017.

We found that measures were in place for infection control through the use of specific mops for particular areas and chopping boards for specific food stuffs. However we found a fridge in the kitchen with a meat product that was cooked but not entirely sealed or labelled. It had been cooked just prior to our arrival. Also staff had stored their own food in the fridge that required freezing. These issues were resolved by the end of the day of the inspection.

One person had their money managed by the service and we saw the process was robust with records maintained and receipts retained.

Regular checks were completed for fire safety equipment and fire panels, electrical testing, lighting systems and gas safety.

The provider had quality assurance processes in place to monitor the quality of the service. Quality checks of the service took place by a member of the management team monthly, and management minutes showed the findings were discussed by the management group. The deputy manager also carried out checks of medicines and the management of people’s money.

Staff, people living at the service and relatives told us the management was a visible presence within the home, and the registered manager and deputy manager were well regarded.

We have made a recommendation in relation to risk assessments.

We found that staff at Ashness Two care home encouraged people to be independent and provided a good service. People told us that staff supported them, their views were listened to and they were learning to be independent so that they could eventually live more independently. We found that people's mental and physical health needs were assessed and met.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

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

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard but the lack of experience of some staff meant that their knowledge of mental health was limited.

We spoke to the provider and a staff member and looked at health and medication records to find the evidence that the home had made improvements to medication and health records.

We found that people's health needs were being met. There was information on each person's medical history so that staff knew their health needs. Staff supported people by going with them to their medical appointments and keeping clear records of their appointments and health support needs.

There was clear information for staff about people's medicines, what they are prescribed for and what were possible side effects. The provider had given staff written guidance about how they should support people to take their prescribed medication safely. Medication charts were clear and accurate. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.