Ash Cottage

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service was in breach of legal regulation in relation to safe care and treatment, safe staffing levels and the governance at this service.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Relatives told us they hadn’t seen or been involved in the care planning process. Care records did not evidence people or their relatives had been involved in this process. Care plans did hold elements of a person-centred approach. However, they did at times hold conflicting information which would confuse the reader and may lead to inappropriate care being received. Relatives raised concerns in relation to laundry. They said, “I don’t understand how the washing gets done here. Things do go missing.” We observed that some bedrooms contained items that did not belong to that person.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.We saw evidence of referrals being made to various healthcare professionals including the dietician, SALT team and the falls prevention team as required. Staff told us there was a regular staff team who worked well together. Relatives also praised the continuity of staff. They said, “The care group there (staff) are very kind and caring. They use agency (staff) but there is a core of around 5 carers that are regular staff and are very good.” Another relative commented on how their loved one had improved since coming into the service. They said, “One very positive thing about the home (service) is that the hospital had given up on [persons] mobility, but the home (service) have worked with [person] keeping them mobile, so they deserve credit for that.”

The service did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Concerns were raised in relation to staff and language barriers as well as a lack of communication between staff and relatives. We also found when speaking to staff they did not always understand the questions we were asking. One relative said, “They (staff) were telling me on Monday night that [person] had an appointment on Tuesday morning which gave (us) no time to sort anything out. (There is) a lack of communication sometimes.” However, other relatives felt communication was good. One said, “Communication is good and they (staff) let me know of any falls and trips [person] may have occasionally.”

Staff spoke of how they would keep people’s personal information private. However, during our visits both office doors were unlocked which contained confidential records. We were asked to sign in when we arrived at this service; however, the signing in book was not confidential and people’s names were displayed for all visitors to see. The registered manager told us the Accessible Information Standard was being followed by identifying communication needs at the point of assessment and providing information in alternative formats including large print, easy read, visual prompts or translated materials.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result. Relatives had mixed views on whether they felt listened to. One relative said, “[Registered manager] is nice and helpful whenever I’ve asked for anything and although there are sometimes niggly things, if you mention them, they sort them out.” However, concerns were raised about the flexibility of the registered manager and them not being available outside standard working hours.

We reviewed the complaints folder and the supporting policy. We saw evidence of people and relative meetings taking place where various topics were discussed including activities, meals and key worker roles. The registered manager told us all complaints were taken seriously and that learning from complaints were shared amongst the staff team, however, we saw no evidence of this.

The service was not always suitable to meet people’s needs. The building had been adapted, and signs were displayed to guide people. However, we did note some concerns with the layout of the building including, sloped flooring and open staircases which could pose risks to people. We raised this with the registered manager who sought advice from other professionals to help reduce risks. Professionals also raised concerns about the environment. They said, “The furniture is not up to standard. Cheap and not appropriate for the frail and elderly population. The home (service) itself can be dangerous for the residents (people) who are mobile. Various dangerous steps in certain areas of the home (service), especially for those with dementia and are mobile.”

People and their relatives raised no concerns about the accessibility of this service. Contingency plans were in place should an emergency occur and on call arrangements were in place. The registered manager told us, “Staff know who to contact and how to respond to emergency situations.”

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. Relative’s views on feedback were mixed but people and their relatives mostly thought their voices were heard. People and relative surveys had been completed, however, where concerns were raised, it was not clear what action had been taken as a result or whether the feedback forms had been analysed for trends and themes. Most of the feedback was however positive.

Staff told us they were treated well and fairly, and the registered manager told us they actively looked for barriers people may face and addressed these. They said, “We challenge discrimination in any form and ensure staff understand their responsibilities around equality, dignity and respect.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. However, we saw no evidence staff had completed training in end-of-life care. This meant we could not be assured staff would have the skills and knowledge should the need arise. People and their relatives raised no concerns or made any comments about planning for future care. We saw evidence of advanced wishes being documented as appropriate and sensitively.