Archived: Ash House Residential Home

Ash House Residential Home 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. Ash House is registered to provide accommodation and personal care for up to 40 older people, some of whom are living with dementia. At the time of the inspection there were 27 people living at the home. The service is a detached building in its own grounds and divided into two units. Beech Walk unit specialises in care for people living with dementia. Beech View unit is a residential unit. There are two double and 36 single rooms. Communal lounges and dining rooms are provided on both units.

Our last inspection at Ash House Residential Home took place on 14 September 2017 and we rated the service requires improvement overall. We found the service was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents. When we completed our previous inspection in September 2017 we found the registered manager was not always submitting notifications to the CQC every time a significant incident had taken place. At this inspection we found the service had made sufficient improvements to meet compliance with this regulation. However, other aspects of the service provision had deteriorated since the previous inspection and we found two breaches of regulation and the rating remains requires improvement. We have also made three recommendations to the provider where we expect improvements.

There was a manager at the service who had been in post since June 2018. The manager informed us it was their intention to be registered with the CQC. 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 and associated Regulations about how the service is run.

People living at the service told us they felt safe. Staff were aware of their responsibilities in protecting people from abuse. We found systems were in place to make sure people received their medicines safely so their health needs were met. Regular checks and audits to medicines management were undertaken to make sure full and safe procedures were adhered to. On the day of the inspection we found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. However, we have had asked the provider to make improvements to the consistency of staff at the home.

The service worked collaboratively with external health services to promote people's wellbeing. People’s care records contained detailed information and reflected the care and support being given. All staff told us they enjoyed working at the service and had received support and supervision to help them to carry out their support role effectively. However, we found gaps in some care staff members training records, which meant we could not see clear evidence they had the right skills and knowledge for the role. 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 support this practice. We found people’s nutritional needs were met.

During the inspection we observed staff treated people with respect and dignity, and staff supported them in a way which met their needs. We received mixed feedback about the quality of the activities provided and people said there were limited opportunities for meaningful social opportunities.

There were systems in place to monitor and improve the quality of the service provided. We also saw an action plan was in place to drive continuous improvements at the service, which identified actions for completion by who and by when. During the inspection the manager demonstrated she was responsive to our feedback and understood further improvements were needed.

At the time of our inspection the home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Our last inspection at Ash House took place on 5 and 9 September 2016. The home was rated Requires Improvement overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

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

This inspection took place on 14 September 2017 and was unannounced. This meant the people who lived at Ash House and the staff who worked there did not know we were coming.

People spoken with were very positive about their experience of living at Ash House. They told us they were happy, felt safe and were respected.

We found systems were in place to make sure people received their medicines safely so their health was looked after. PRN (as and when needed) medicine protocols were in place to ensure staff knew when PRN medicine was required. However, we found stocks of expired prescribed nutritional supplements had not been disposed of appropriately.

Staff recruitment procedures ensured people’s safety was promoted. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment.

We saw the service had a general fire evacuation plan in place. Individual support needs to evacuate the building safely had not been identified to make sure risks to people’s safety had been mitigated.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. We found staff were receiving regular supervision and appraisal at the frequency stated in the registered providers own procedures.

Sufficient numbers of staff were provided to meet people’s needs. We saw staff responded in a timely way when people required assistance. However, we found during busier periods, such as lunch, staff were not always deployed effectively.

People’s individual needs were not currently met by the design, adaptation and decoration of the service. However, we saw a refurbishment plan was in place and work had already commenced at the service. The plan included things like improvements to the lighting in the Beech Walk lounge so it was more dementia friendly, which would be completed by October 2017. Other actions included the replacement of existing carpets in bedrooms on the residential unit and replacement of bedroom flooring on Beech Walk unit with cushion flooring. This plan was over an 18 month period and all actions would be completed by March 2019.

We looked at care records and found they contained detailed information and reflected the care and support being given.

A part-time activities coordinator worked at the service and provided a programme of activities to suit people’s preferences. We observed activities taking place and feedback from people who used the service was positive.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

We found the registered provider was not submitting notifications to the Care Quality Commission every time a significant incident has taken place, in line with regulations. For example, we looked at safeguarding records and saw that in 2017 there had been 7 safeguarding incidents at the service. We saw in each case the registered provider had notified the Local Authority and taken appropriate action to minimise risk of harm. However, the registered provider did not notify the CQC, which meant we were not aware of potential incidents of abuse that had occurred at the service. We asked the manager about this who told us they were not aware these types of events need to be reported to CQC. The registered manager is now aware of requirements to submit notifications to the CQC.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

Ash House provides personal care and accommodation for up to forty older people. The service was divided into two units. Beech Walk unit, which cared for people living with dementia and Beech View unit, which was classed as the residential unit. There were two double and thirty six single rooms. Communal lounge and dining rooms were provided on both units. An outside seating area overlooking the grounds is provided. The home is a detached building in its own grounds. It is situated in the Dore area of Sheffield. At the time of the inspection the home was providing care for 36 people, some of whom had a diagnosis of dementia.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The current registered manager is in a temporary position since February 2016 until a new manager is recruited.

People told us they felt the home was a safe place to live. Systems were in place to protect people from the risk of harm. Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind.

At the time of our inspection we found there were adequate staff on duty to meet people’s care needs in a timely manner. Although staff told us that at weekends and at night it could be busy. They said during the week they had the assistance of the registered manager and the activity coordinator, who did not work at weekends.

The registered manager told us they did not have or use a staffing dependency tool. This would determine people’s so they were assured there were adequate staff on duty at all times to meet people’s needs based upon their level of dependency. Some of the care records we saw lacked detail, were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where there was no care plans in place, so staff were not aware of people’s needs and how to meet them safely.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. However, we found these systems were not always followed and people did not always receive their medication as prescribed.

The manager was aware of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. We found some improvements were still required to ensure mental capacity assessments and best interest decision records were more individualised and decision specific.

We found staff approached people in a kind and caring way. However, some of the interactions we observed were task orientated. Signage around the home was not dementia friendly. Notice boards were not kept up to date and menus were not always displayed.

People were supported appropriately to eat and drink sufficient to maintain a balanced diet and adequate hydration. However we found the meal time experience was not as pleasant an experience for people who were living with dementia, as it was for others.

We saw the provider followed safe recruitment procedures to ensure people employed to work with vulnerable people were fit to do so. However, we found staff had not received supervision in line with the provider’s policies.

The company’s complaints policy was available to people using or visiting the service and people and their relatives we spoke with raised no concerns. We saw that when concerns had been raised these were documented, but there had been a period of time for which we found no documented evidence of investigation undertaken and outcomes. There was a system in place to enable people to share their opinion of the service provided and the general facilities available. We also saw an audit system had been used to check if company policies had been followed and the premises were safe and well maintained. The registered manager was aware of all the shortfalls we had identified during our inspection and they had been identified, either by the registered manger or the consultant that the provider had commissioned to improve the services provided. The registered manager acknowledged there were significant improvements required to be made, but told us they were supported by the provider to ensure improvements were implemented and sustained.

We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; 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?

People spoken with told us staff treated them with dignity and respect. People told us they felt 'safe' and did not have any concerns.

Staff were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse. We found the service had a copy of the local protocols and followed them to safeguard people from harm.

The manager operated an effective recruitment procedure and carried out the relevant checks when they employed staff.

The home had access online to the proper policies and procedures in relation the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager told us the local authority was providing further training and guidance. To ensure the home only deprived someone of their liberty in a safe and correct way and that this was only done when it was in the best interests of the person.

Is the service effective?

People's health and care needs were assessed with them and/or their representative and where able they were involved in writing their care plans.

People's relatives and representatives were kept informed of their family member's wellbeing and invited to attend care plan and GP reviews. We saw evidence on people's care records that they had been referred to other health professionals when needed.

Is the service caring?

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Therefore we used a formal method to observe people in two of the lounge areas. Staff treated people in a caring and supportive way. In the dementia unit we observed some people finding comfort stroking toys, cuddling dolls and undoing knitting. We also observed staff using these items to interact with people and to provide comfort.

People told us they were satisfied with the quality of care they had received. Their comments included: 'the staff are not bad at all, can't grumble', 'the staff notify the GP if you are not well' and 'they [the staff] are caring people'. People told us they were encouraged to come and have their meals in the dining area and they were given a choice about what they would like to eat.

Relatives were satisfied with the quality of care their family member had received. They also made positive comments about the staff. Their comments included: 'the staff are fabulous', 'staff are very friendly', and 'very happy with the quality of the care'.

Is the service responsive?

A copy of the service's complaints procedure was displayed in the reception area of the home. People and/or their representatives told us if they had any concerns they would raise these with the manager.

People told us staff responded promptly when they used their call buzzer's to call for assistance during the day or night.

Relatives spoken with told us staff kept them fully informed when there were changes in their family member's wellbeing.

Is the service well led?

We saw there was a range of quality monitoring checks in place to make sure the manager and staff learned from the findings of checks.

Staff training was being monitored and a comprehensive system was in place to highlight when staff refresher training was due.

The home held regular resident meetings and completed relative's surveys. This showed the home actively sought the views of people or their representatives to improve the quality of service provided.

Comments from relatives included 'The place is always spotless' and 'There are no smells which is important'. We found the people using the service happy and well cared for. Comments included 'It's a lovely place' and 'the staff are extremely good to us' and that they could not wish for better care.

We observed that people were treated with respect and dignity and the staff were kind and considerate in their conversations with service users. The staff knew people well and were aware of how to respond to them. We saw that any requests made by service users about their welfare were accommodated where possible.

People using the service told us of the various activities they were involved in. These included listening to music and playing board games and chatting to other residents. One service user told us that if they asked the staff they would take them out. Another commented 'The staff will not let us go out on our own; they like to be with us'.

We observed that the home had recently celebrated Remembrance Day which people using the service told us they had enjoyed very much.

The three relatives and the advocate we spoke with told us they were very satisfied with the quality of care at the home. Their comments included: 'It's really, really good.' 'It's marvellous, the manager, the staff are excellent.'

We observed staff providing reassurance and care to people. People we spoke with made positive comments about their care and the staff. Their comments included: 'Staff are very respectful.' 'Staff do understand when people have their ups and downs'

We saw that people in the home benefited from equipment that was comfortable and met their needs.

We found that the home had appropriate staffing levels and could respond to unexpected absences. We spoke with two district nurses who had no concerns regarding the staffing levels in the home. Their comments included: 'On the whole the staffing levels are good.' 'The care here is superb.'

We found that staff had received training and were supervised but that some staff training in safeguarding was overdue. We saw evidence that staff had the opportunity to develop and improve their skills.

We also saw that the home had provided people with information about how to complain. All the people we spoke with told us that if they had a concern they would speak to staff or a relative.