Ash-lee

Ash-Lee is a residential care home providing personal care to 6 adults with a learning disability at the time of the inspection.

The service is a large home, bigger than most domestic style properties. It is registered for the support of up to 10 people. Six people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

People received safe care. The provider had systems to protect people from the risk of abuse. Staff assessed and managed risks to people to help keep them safe. Staff managed people’s medicines safely and kept the home clean and hygienic.

People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively, following good practice guidance. Staff supported people with their healthcare needs and worked well with external healthcare professionals. The service met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences. 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be independent. We received positive feedback about the caring approach of staff.

The service put people at the centre of the care they received. Staff used detailed assessments to identify people’s needs and preferences and worked to ensure people were happy with the care they received. If people were not happy, they were confident they could speak with staff to make improvements. The service made sure people were supported to communicate and planned activities to enhance people’s wellbeing.

The service was led by a registered manager who people described as friendly and caring. People felt the care they received was of a good standard and liked living at the home. The culture was open and inclusive. The registered manager understood their responsibilities and monitored the quality of the service using a range of systems. Where areas for improvement were identified, the registered manager involved people who used the service and staff to shape improvements.

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 good (published 04 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 last comprehensive inspection of this service was carried out on14 January 2016, at which two breaches of legal requirements were found. This was because the provider had failed to ensure people were protected against the risk of malnutrition and they had failed to notify us of significant events at the home.

Following that inspection, the provider supplied us with an action plan which told us how they were going to make improvements for people who lived at Ash-Lee. We carried out a focussed inspection on 12 July 2016 to check what improvements had been made. We found the provider had implemented the improvements detailed in their action plan and were meeting legal requirements. We were not able to improve the rating of the service at that time because to do so requires consistent good practice over time.

During this inspection, we found the provider had continued to meet legal requirements and, as such showed consistent good practice. Therefore, we have improved the rating for the service.

Ash-Lee is a small home registered to provide care and accommodation for up to eleven persons who live with learning disabilities, dementia or a mental health condition. The home is situated in a residential area of Morecambe close to the sea front and within walking distance of a number of facilities and amenities. There are ten single bedrooms and one shared room. Bedrooms are located on four floors. Rooms on the ground and first floor can be accessed via a stair lift should people require assistance. At the time of our inspection, nine people were living at Ash-Lee.

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.

We found the registered manager had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We looked at the recruitment of two staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed an induction and training programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Individual risk assessments had been completed for people who lived at the home. This helped to ensure risks had been identified and measures put in place to reduce risks to people’s safety and wellbeing. Written plans of care provided a good level of guidance for staff with regard to supporting people safely.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they knew how to work within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. We saw staff followed infection control guidelines.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were stored appropriately.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

During our inspection, we observed people were involved in activities which they appeared to enjoy. A range of activities were provided at the home to help ensure people received a good level of stimulation.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

We found people had access to healthcare professionals and their healthcare needs had been met.

We observed staff supporting people with their care during the inspection visit. We saw they were kind, caring, patient and attentive.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We carried out this unannounced focused inspection on the 12 July 2016 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ash-Lee' on our website at www.cqc.org.uk'.

Ash-Lee is a small home registered to provide care and accommodation for up to eleven persons who live with learning disabilities, dementia or a mental health condition. The home is situated in a residential area of Morecambe close to the sea front and within walking distance of a number of facilities and amenities. There are ten single bedrooms and one shared room. Bedrooms are located on four floors. Rooms on the ground and first floor can be accessed via a stair lift should people require assistance. At the time of our inspection, nine people were living at Ash-Lee.

The service had a registered manager in place. 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.

At our focused inspection on the 12 July 2016, we found improvements had been made. We found there was documentation to monitor people’s weights. We saw strategies to manage weight loss and weight gain. There was information for staff on special diets and staff we spoke with knew people’s food likes and dislikes.

We saw the registered manager had researched information to underpin their knowledge on what and when to notify CQC. We found no evidence incidents went unreported to the Commission.

We could not improve the rating for effective and well led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

At the last inspection in July 2013, the service was meeting the requirements of the regulations that were inspected at that time. 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.

Feedback from people who lived at the home was positive. Staff demonstrated they had a good understanding of the needs of people they supported. Staff were aware they should report concerns should they identify when someone was at risk of abuse. Staff had received safeguarding vulnerable adults training. We noted that following reporting a recent safeguarding incident to the Local Authority, the provider and registered manager had failed to submit a notification to CQC and inform all appropriate bodies. They told us in future they would ensure they notified the Commission of such events. We found notifications regarding other incidents affecting the health and well-being of people who lived at Ash- lee had not been reported to CQC.

Records in staff files showed us there were safe recruitment processes in place. Staff told us they were safely recruited and did not start their employment until all checks were completed. We found staff were supported through an induction process. New staff told us they felt well supported by their registered manager. Staff were supported to undertake training courses and received supervision by the registered manager.

People told us staff were friendly and caring and this was observed during our inspection. We found members of the staff team were welcoming and there was a friendly atmosphere in the home. Records and surveys showed us relatives were encouraged to visit and be involved in the care of their loved ones. People were supported to comment about the support they received by using easy read questionnaires. These were available for people to use when they find reading and writing more difficult. Questionnaires were available for people`s relatives to comment on the quality of care people received. In the questionnaires we viewed we read many positive comments regarding the care and staff support. However in two of the easy read questionnaires we found some comments had not been managed in a timely way. There were no formal complaints at the time of the inspection.

There was a new registered manager in post since the last inspection. The registered manager had worked at Ash-Lee and had been promoted to her new role. We found there were career development opportunities for staff. Although the registered manager provided regular support and supervision for her staff team, we found there was no formal supervision process in place for the new registered manager. At this inspection we found gaps in her knowledge and experience in her new role.

We were told the service was short staffed. Staff provided cover for each other during times of absence. This meant people benefitted from being supported by staff who knew them well and understood their care needs. However staff were responsible for the cooking, cleaning in the home as well as providing care and support for the people who lived at Ash-Lee. We found the deployment of staff at lunchtime was not always managed for the benefit of the people who lived at the home. There were two new staff on duty and two other staff had recently been recruited. They were awaiting all appropriate recruitment checks before they commenced working at Ash-Lee.

Care plan records showed us people were involved in their care. We found staff had a received training regarding the Mental Capacity Act 2005 (MCA).

Some essential maintenance checks of the building was not always carried out. There was no risk management in place regarding the hot water in people`s bedrooms. We found the hot water temperature in one person`s bedroom too hot. We found that regular monitoring was not in place regarding window restrictors and hot water temperatures in some areas of the home. We have made a recommendation about the maintenance of the home.

Although we found there were quality monitoring systems in place these were not always effective. We found that risk management for people was not always well managed. Information regarding changes in people`s health was not always responded to in a timely way. One care plan record indicated this person had lost a substantial amount of weight. There was no evidence action had been taken. We found there was a breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to meeting the nutritional and hydration needs of people. You can see what action we told the provider to take at the back of the full version of this report.

Staff knew and understood people’s history, likes, dislikes, needs and wishes. We found staff demonstrated positive relationships with the people they supported. We found staff treated people with respect and patience. Although we found some signage in use regarding the menus at mealtimes, this had not been extended to other parts of the home. We have made a recommendation about incorporating dementia friendly signage in the home.

Since the last inspection we found several incidents had not been reported to the Commission. These related to a safeguarding incident, a pressure ulcer, a fall resulting in a hospital admission and the boiler breaking down resulting in no heat or hot water for several days. It is a requirement for the provider and the registered manager to submit notifications regarding these incidents. We found there was a breach in the Regulation18 of the Care Quality Commission (Registration) Regulations 2009in relation to the failure to notify the Commission when incidents have affected the health, safety and welfare of people. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved relatives, where possible to ensure people received the right care and support.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with people about the care and support they received. They said they were happy living at the home and said that staff were polite and kind.

This home cares for people with a range of learning disabilities and conversation with some residents was limited. We therefore spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed.

We observed staff assisting people who required care and support. Staff treated people with respect and provided support or attention as people requested it. We spoke with one person about the care and support they received. They said "The staff are very good and always pleasant."