Archived: Asher House

Asher House is registered to support up to 20 older people, some of whom may be living with dementia. At the time of our inspection, 13 people were being supported at the service.

Asher House provides accommodation on two floors with access via a stair lift. It is situated in a quiet residential area in Walton on the Naze.

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

The provider failed to safely maintain the environment to ensure it was safe for people living in the service. Appropriate checks were not in place by competent staff to ensure the environment was safe.

People's medicines were not managed safely.

People’s risk assessments were not updated in line with their current needs and risks. Where people had additional physical and mental health needs, care plans did not always inform staff how to manage these well.

Mental capacity assessments were not always completed where capacity was questioned.

Staff had not received training in how to support people living with dementia, despite of some people living with this diagnosis. We made a recommendation about this.

The environment of the home had not been adapted to ensure that it met with the needs of people living with dementia.

We made a recommendation about this.

Staff were instinctively caring but did not always have the skills and knowledge to undertake their role.

Care plans were not reflective of people’s current needs and did not reflect support they required.

The service did provide meaningful activities for people.

End of life care plans were not always in place for people. We have recommended end of life care planning for people to be developed further.

The service was not well led. Systems were in place to monitor the quality of the service; however, these were not effective and failed to highlight concerns raised during the inspection.

The provider had failed to put systems in place to support the registered manager to have oversight 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

The last rating for this service was requires improvement (report published 2 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Special Measures

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 act 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 five key questions it will no longer be in special measures.

Asher House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to support up to 20 older people, some of whom may be living with dementia. At the time of our inspection, 14 people were being supported at the service.

Asher House provides accommodation on two floors with access via a stair lift. It is situated in a quiet residential area in Walton on the Naze.

The service required, and did have, a registered manager. 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.

Risk assessments had been completed but we found they were incomplete, confusing and not sufficiently detailed to ensure staff knew how to deal with risks to people appropriately.

Medicines were not administered to people in a safe way. The medicines were handled in a way which did not follow good practice. Appropriate hygiene measures were not used when dispensing and giving medicines to people.

People’s capacity to make their own decisions and consent to their care and support was not always assessed and recorded. Systems to protect people’s human rights were not always in place.

Staff recruitment systems were in place. However, we found gaps in three staff members employment which needed to be verified to ensure they were safe to work with people at the service.

Staff undertook training in their roles and responsibilities but it was not always effective.

There was an infection control process in place. Despite staff not using protective gloves whilst administering medicines, staff used aprons and gloves and followed processes to minimise the risks from the spread of infection.

There were systems in place to regularly assess and monitor the quality of the service. However, not all areas of the service were checked and monitored in line with required legislation.

People, relatives, staff and health care professionals spoke positively about the service and the care provided. People and their relatives told us the service was a safe place to live.

Staff had received training in safeguarding adults from abuse and understood their responsibilities and the actions they should take if concerns were identified.

There were sufficient numbers of staff deployed to meet the care and support needs of people.

People had sufficient food and drink and were provided with choices at mealtimes. Where required, people were supported to access health care services to maintain their health and well-being.

People were treated with kindness, compassion and courtesy. Staff knew people well and were sensitive to their needs. People's independence was promoted and people were encouraged to do as much as they could for themselves. People were treated with dignity and respect and staff ensured people's privacy was maintained at all times.

People received a responsive service. The content and design of the care plans had been reviewed. The service was in the process of updating and completing them to make them more person centred which reflected people's current care and support needs.

The involvement and feedback from people and their relatives was actively encouraged. Social and leisure activities were individually tailored to people’s needs and people from the community provided entertainment.

Information on how to raise concerns or complaints was available, and people and their relatives were confident any concerns would be listened to and acted upon.

The registered manager was accessible and open and worked in partnership with external agencies.

There was a positive relationship between management, staff, people and their relatives and the values demonstrated by staff were positive.

Further information is in the detailed findings below.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Staff had undergone a thorough recruitment and induction process and had also received appropriate training and guidance.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst 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.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training in administering medication. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One relative said, "I feel that my relative is safe here, the staff treat my relative with respect."

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well. People we spoke with told us that, "Staff are well trained, polite and caring."

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One person who used the service said, "The staff always listen to me and respond positively if I have any concerns."

Is the service responsive?

The manager told us that they had regular contact with the relatives of people who used the service. Relatives we spoke with were very positive about the communication with them by the manager and the staff.

A visiting district nurse told us, 'People who have tissue viability issues have healed very well because they received good nutrition and regular fluid intake.'

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw that the home ensured that the relevant health care professionals had been involved in assessing, planning and meeting people's changing health needs.

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they had received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

People told us that they had been given the opportunity to visit the service prior to admission. Their consent had been obtained before any care or treatment had been given.

During our inspection we saw that staff were knowledgeable about people needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people's care needs and preferences. One person who used the service told us: 'The staff are lovely, they listen to me and take notice of me".

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service. Staff told us about the training they had received to enable them to carry out their roles in supporting people. Staff told us they felt supported by the manager.

We saw that regular audits of health and safety, medication and care plans and risk assessments had taken place and action was taken to address any concerns. An annual customer, stakeholder and staff survey takes place and the information is used to improve the service. The providers director carries out monthly audits and talks with the people who use the service to gain their views.