17 18 &19 November 2014
During a routine inspection
We carried out an inspection of White Ash Brook on the 17, 18 and 19 November 2014. The first day was unannounced. We last inspected White Ash Brook on 5 February 2014 and found there was a breach of Regulation 9. T his was because the planning and delivery of care did not fully protect people from receiving inappropriate or unsafe care.
The service provides nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms. At the time of our visit there were 44 people accommodated in the home.
The home was managed by 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.
People told us they were cared for very well and they felt safe. They said they had never had any concerns about how they or other people were treated. Staff were described as being ‘very good’, ‘helpful’ and ‘nice’. Routines were seen to be flexible to accommodate people’s varying needs and there were no institutional practices observed. People identified as having some difficulty making choices or expressing their needs were supported. People who would act in their best interests were named, for example a relative.
People were cared for by staff that had been recruited safely and were both trained and receiving training to support them in their duties. As a result of quality monitoring an improved approach to staff selection was taken to make sure staff selected were considered to have the right qualities and characteristics to provide person centred care. Staff had relevant training to support them in their role and in response to people’s changing needs, although new staff had not completed all required training. This was in progress. Staff were kept up to date with changes in people’s needs and circumstances and new staff were mentored by senior staff.
Staff were confident to take action if they witnessed or suspected any abusive or neglectful practice. Not all staff had a good understanding of The Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS), but had an awareness of the principles behind it. The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We were given reassurance training was planned for and would be provided in the near future.
People who may be at risk of falling, developing pressure ulcers, or may not eat enough were identified and action taken to minimise the risk. Some people living in the home behaved in a way that could place themselves and others at risk of harm. We found an assessment tool was used to help staff identify reasons for changes in people’s behaviours. This supported staff to take a pro-active approach to prevent any occurrence of this nature.
People had their medicines when they needed it. Medicines were managed safely. We found accurate records and appropriate processes were in place for the ordering, receipt, storage, administration and disposal of medicines.
The home was warm, clean and hygienic in all areas and people were satisfied with their bedrooms and living arrangements. Two bedrooms were identified as being problematic in odour control despite near daily carpet shampooing. Cleaning schedules were followed and staff were provided with essential protective clothing. There were contractual arrangements for the disposal of clinical and sanitary waste and the water supply was monitored for the control of Legionella. Water temperatures at source were maintained at a safe temperature.
Each person had an individual care plan although not all staff said they read these. Staff discussed people’s needs on a daily basis and following any changes in people’s needs. They took part in ‘resident of the day’ activities. This involved looking at people’s care and welfare and their environment. Senior staff had taken lead roles, for example dignity in care, medication, fire safety, health and safety and infection control. People were given additional support when they required this. Referrals had been made to the relevant health professionals for advice and support when people’s needs had changed.
A variety of activities were provided. The activity co-ordinator also engaged with people who preferred to or benefitted from having one to one activity sessions. Memory boxes and diaries were being introduced and visiting arrangements were good.
People told us they were confident to raise any issue of concern and that it would be taken seriously. Complaints were monitored and information used to bring about improvements if needed. There were opportunities for people to give feedback about the service in quality assurance surveys. Recent surveys showed overall satisfaction with the service.
People told us the management of the service was good although one person told us they thought there was still room for improvement. Staff, relatives and people using the service told us they had confidence in the registered manager and deputy manager. There were processes in place to support the registered manager to account for the actions, behaviours and the performance of staff and deal with this effectively.
During the inspection we found the service was meeting the required legal obligations and conditions of registrations. At the last inspection there was an outstanding breach in regulation because the planning and delivery of care did not fully protect people from receiving inappropriate or unsafe care. We found there had been significant improvements in meeting the required standards relating to this regulation.