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Archived: Ash Cottage Requires improvement

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Reports


Inspection carried out on 22 July 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced inspection of Ash Cottage on 22 July 2015. Ash Cottage is registered to provide accommodation and personal care for up to 20 older people. The service does not provide nursing care. At the time of the inspection there were 11 people accommodated in the home.

Ash Cottage is located on a quiet lane in Edenfield, Rossendale. It is an older type property providing accommodation on four floors. There is a passenger lift and a number of stair lifts. Six bedrooms have en-suite facilities with suitably equipped bathroom and toilet facilities on all floors. There are three shared rooms available. The gardens are well maintained with a small car park for visitors at the front of the house.

There was a registered manager in day to day charge of the home who was also the owner. 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.

At the previous inspection on 7 May 2014 we found the service was not meeting all the regulations. We asked the registered provider to take action to make improvements in respect of maintaining accurate and appropriate records and having an effective system to identify, assess and manage risks to the health, safety and welfare of people.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to management of people’s medicines, policies and procedures and the training and development of staff. You can see what action we told the registered provider to take at the back of the full version of the report.

We found staff who administered medicines had not received appropriate training and regular checks on their practice had not been undertaken to ensure they were competent to manage people’s medicines.

We noted staff had not been provided with ongoing safety training which would give them the skills and knowledge to care for people safely. One to one staff supervision sessions had recently commenced and would help to identify the need for any additional training and support. However staff were not provided with a number of policies and procedures that they needed to support them with their work.

Staff had an understanding of abuse but had not received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. This meant staff may not recognise when people were being deprived of their liberty and may not make appropriate referrals to ensure people were safe and to ensure their best interests considered.

People told us they were happy with the home and with the approach taken by staff. They said, “I’ve known the staff a lot of years; they are like my family. I’m very comfortable here”, “It’s a lovely place to live” and “I feel safe here; I am treated very kindly.” Visitors told us, “I have no worries about my relative at all” and “It’s very relaxed here; staff are friendly and approachable”. A healthcare professional said, “People are looked after very well.”

We observed good relationships between people living in the home and staff. Throughout the day we heard laughter and friendly banter. We noted staff spending time to sit and chat with people in a relaxed and friendly way. People were supported to take part in a range of suitable activities of their choice.

People told us they were happy with the staff team and there were sufficient numbers of staff to look after them properly. One person said, “Staff are very good; there is always someone around if I need them.” A visitor said, “There seems to be enough staff; people get lots of attention.” A member of staff told us, “I love working here; we are like a big family.”

Each person had a care plan that was personal to them which included information about the care and support they needed. The care plans included information about people’s preferred routines and preferences which helped ensure they received the care and support they wanted and needed. People had been involved in decisions about care and support.

People told us they enjoyed the meals. They told us, “The meals are good; if you don’t like what is on the menu you can ask for something different” and “I enjoy my meals and they will make me something else if I ask.” A visitor said, “The meals always look very appetising.”

People told us they had no complaints about the service and said they could raise any concerns during day to day discussions with staff and also as part of the annual survey. One person said, “We all know each other really well and chat about all sorts of things; I suppose that’s how we deal with things.”

We found the home was clean and odour free. A visiting healthcare professional said, “The cleaner works really hard; the place is always lovely and clean.” We found some areas were well maintained, bright and comfortable whilst other were in need of refurbishment. People told us they were happy with their bedrooms and most had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments.

Checks on systems and practices had been completed which would help the registered manager to identify matters needing attention.

Inspection carried out on 8 May 2014

During a routine inspection

During the inspection we spoke with six people who used the service, one visitor, three members of staff and a visiting professional. We also spoke with the registered manager/owner and with the local authority. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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?

Everyone was very happy with the care and support they received. Comments included, "It's a lovely place; I have no concerns about anything" and "I can choose what I want to do; staff respect my choices". A visitor told us they were very happy with the care and support given to her relative. They said, "My mother is genuinely loved".

People told us they were happy with the staff team and said there were enough staff to meet their needs. Comments included, "They are lovely girls" and "There are enough staff and they are friendly, caring and kind".

People’s records about the care and support they needed and a number of policies and procedures were not up to date, kept under review or accurate. We were told the care records were currently being updated which should ensure they accurately reflected people’s needs and the care and support being given. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will address this.

People told us they enjoyed the meals. Comments included, "The food is very nice" and "I am asked what I would like; if I don’t fancy what is on the menu they get me something else". We observed staff being attentive and supportive during the lunchtime meal. People were supported to eat and drink sufficient amounts to meet their needs.

Staff had received training in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This should help staff to understand their responsibilities with supporting people to make their own decisions. We noted staff did not have current guidance to refer to if a referral was needed to safeguard a person’s best interests.

Is the service effective?

Reviews were carried out to record any changes in people's needs. We found reviews were not always done on a regular basis or in response to changes in people’s health. They did not show people’s involvement in discussions about the care they needed and wanted.

We were told the owner worked as part of the staff team, listened to people’s views and responded appropriately. However, there were no formal systems in place to demonstrate regular monitoring of the service. Effective monitoring systems should help to protect people from poor care standards and should identify any areas of non-compliance as noted in this report. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will address this.

Is the service caring?

We saw staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. It was clear from our observations and discussions with staff they were competent and confident in their work and had a good understanding of people’s needs. Some of the care staff had achieved a recognised qualification in care. This should give them the skills they needed to help them look after people properly. Staff also told us they enjoyed working at the home and described it as "A big family".

We found the care plans contained some useful information about people's preferred routines and likes and dislikes. This should help staff to look after them properly and ensure people received the care and support they needed and wanted.

Is the service responsive?

People told us there were opportunities for involvement in activities. Comments included, “There is always something to keep us interested", "I prefer to do my own thing and spend time in my room" and "We are not bored".

We found appropriate advice had been sought when people’s health had changed. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

People told us they were kept up to date and involved with any decisions about the care they needed and about how the service was run. However, the last customer satisfaction survey had been completed some years ago and there had been no resident or relative meetings to show how their views had been obtained or used to improve the service.

People told us they had no complaints about the service but were confident they could raise their concerns with the staff or managers.

Is the service well led?

We were told the manager/owner worked closely with staff and was well known to people using the service and to their visitors. Staff told us the management team was very supportive and worked closely with them. Staff were aware of their responsibilities and were able to raise any concerns.

Inspection carried out on 9 April 2013

During a routine inspection

We received many positive comments about the service and all the people we spoke with told us they would not hesitate to recommend it. One person's advocate told us, "Ash Cottage is the best thing that ever happened to my relative, I've never had a problem in all the time she has been here and the staff are friendly, capable and very able". Another person's relative said, "I've never seen anything that gives me concern, I'm very impressed by all aspects of the service".

Although most of the people living at the home could not communicate easily, we saw that they were settled, happy and occupied. We saw that staff interactions with people were inclusive and appropriate and people's individual wishes were respected. Throughout our visit staff worked hard to promote people's independence and maintain their dignity.

All evidence indicated that this was good service and we noted that all improvements actions we suggested following out last visit had been acted upon by the owners.

During a check to make sure that the improvements required had been made

At our Inspection on the 11th June 2011 we found that the provider was not meeting this standard. We judged that staff were not receiving appropriate professional development. Records did not show that staff had been provided with on-going training to enable them to develop.

We followed up the one area of non compliance identified in our previous inspection. We reviewed the evidence sent to us by the provider and found that they now demonstrated compliance in this area.

Inspection carried out on 13 June 2012

During a routine inspection

People told us they were satisfied with the quality of care and support they received. We were told the staffing levels were sufficient to meet the needs of people living in the home and that the staff were professional, caring and friendly.

People made various positive comments about the staff team, saying they thought they

"were excellent staff", "very caring" and "the staff are always considerate even when they are really busy".

People were provided with care plans which were reviewed regularly and updated when

required.

People said they felt safe living in the home and were able to discuss concerns or issues

with the staff if they wished to. We were told that the service provided enjoyable and varied activities for people.

There were comprehensive auditing and reviewing procedures in place to identify any

areas where improvements could be made.