Ash Lodge Care Home

At the last inspection in June 2017 the service was rated requires improvement in the safe and well-led domains. Staffing levels required adjusting to ensure the service remained clean and quality monitoring was not effective and there was no registered manager in place. At this inspection we found the issues had been addressed. There were enough staff to keep the service clean and quality monitoring systems were in place.

Ash Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ash Lodge Care Home provides accommodation and care for up to 22 people who have mental health needs. The service is two houses joined internally. There are communal lounges and garden patio areas for people to use.

The service has 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.

Staff understood their responsibilities to protect people from harm and abuse. Accidents and incidents were monitored. Infection control was maintained. Medicines were safely monitored and minor issues with people's medicine administration record (MAR) charts were robustly addressed. Risks to people's health and wellbeing were monitored. People's care was monitored and health care professionals were contacted for their help and advice to maintain people's wellbeing.

Staffing levels provided met people's needs and they remained under review by the management team. Staff undertook training, supervision and received an annual appraisal to maintain and develop their skills. Robust recruitment procedures were in place.

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

Staff treated people with compassion and supported them in a kind and caring way. People’s privacy and dignity was respected. Advocates (independent representatives) were available locally to help people raise their views.

People’s dietary needs were met. The food served looked appetising and nutritious. People who required monitoring of their dietary needs had this in place.

People’s care records were personalised and staff were aware of their preferences for their care and support. People’s communication needs were known by staff. The provider had a complaints policy in place, issues raised were used as learning to improve the service provided.

The registered manager had an ‘open door’ policy in place so people living at the service, staff or visitors could speak with them at any time. Resident, relative’s and staff meetings were held to gain people’s views of the service provided. Quality monitoring systems were robust. The provider reviewed their policies and procedures to ensure they were up to date.

Ash Lodge Care Home is situated on a main road into Hull city centre. It is close to local amenities including shops, pubs, library, swimming baths and a park. The home is owned by a partnership and offers support up to 22 adults who have mental health needs. At the time of the inspection, there were 20 people using the service.

The service had 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. The registered manager also managed another service within the organisation. This meant they divided their time during the week between the two services.

During this inspection we had concerns about some aspects of the environment caused by domestic shortages and overall governance.

The dining room and some bedrooms required cleaning. External areas leading from both ends of the dining room required sweeping and tidying and more bins were required for the disposal of cigarettes ends. We found domestic and catering hours were insufficient.

There was no structured quality monitoring system. Some checks were carried out, for example on medication, everyday maintenance jobs, and care plans, which had been checked during their input into a new computer system. However, there had not been any environmental checks recorded and no evidence the registered manager and registered provider were aware of the issues we found with cleanliness and specific furniture. The environment was suitable for people’s needs, however some items of furniture needed replacement. This related to two settees, some bed bases and mattresses, a wardrobe and a dining table; these were ordered on the day of inspection. There had not been any questionnaires to people in 2016 apart from to four relatives and there was no action plan to record negative comments so it was difficult to see if they had been addressed.

You can see what action we have asked the registered provider to take regarding staffing and governance in the full version of this report.

We found staff knew how to keep people safe from the risk of harm and abuse. The registered provider had policies and procedures to guide staff and they had completed safeguarding training. Staff completed risk assessments for people and there were plans in place to help minimise risk whilst still ensuring people had control of their lives.

The recruitment process had some shortfalls in regards to ensuring people had references in place prior to the start of employment. The registered provider told us they would address this straight away. Other employment checks were carried out appropriately.

Staff supported people to be independent and ensured they gained consent prior to carrying out tasks. People who used the service all had the capacity to make their own decisions. Staff were aware of mental capacity legislation and had completed training in this.

Staff supported people to access community health professionals and monitored their general and mental health, offering advice when required and an escort to appointments.

People’s nutritional needs were met. Menus provided people with a nutritious diet with choices and alternatives. Drinks and snacks were served throughout the day and people who used the service could help themselves to hot and cold drinks in the dining room.

People’s needs were assessed prior to admission and the registered manager formulated a care plan for each person. These helped to guide staff in supporting people in the way they preferred to be cared for. Some minor amendments were required to ensure all the information was included in care plans; this was mentioned to the registered manager to address. As they were in the process of transferring paper records to computerised ones, they told us this would be completed straight away. One of the directors of the organisation is an approved mental health practitioner and told us they were supporting the registered manager with updating the care plans.

People told us the staff treated them well and had a caring approach. We observed staff had developed good professional relationships with people who used the service. There were activities for people to participate in and staff encouraged people to pursue their own hobbies and interests; staff supported people to access community facilities. An enablement co-ordinator was employed two and a half days a week to support people with activities of daily living and to help prepare them for a move to more independent accommodation.

We saw staff had access to training, supervision and on-going support. This enabled them to feel confident when supporting the people who used the service.

People who used the service told us they were happy with the level of care and support they received and told us that other people visited them such as their community psychiatric nurse.

We saw the menu offered was varied, healthy and nutritious. People told us how good the food was especially since the new cook had been in post. Comments included; "The food is marvellous", "It's very good" and "We get enough and staff ask us what we would like."

We saw the environment was clean and there were systems in place for staff to follow.

We saw that staff had undertaken appropriate training to ensure they fully understood the needs of the people they supported.

People told us they were able to express their views and also knew about the complaints procedure and what to do if they had any concerns. They also said they were kept fully informed with regard to any changes.

People who used the service told us they were happy with the level of care and support they received and commented, "I have a care plan and I sat with my key worker to develop it."

People told us they felt safe within the home and had access to their finances. They commented, "Yes I feel very safe here" and "I have my own post office account and I pay my bills myself."

People told us that they received their medication safely and that staff supported them with this.

When we spoke with people who used the service they told us there were sufficient numbers of staff to support them and commented, "There are always staff around if you need them." People spoke highly of the staff and commented, "The staff are lovely" and "They are very polite and help you."

People told us they knew about the complaints procedure and what to do if they were to have one.