Archived: Three Ashes Residential Care Home

Three Ashes Residential Care Home is a ‘care home’ for up to 11 older people, some of whom were living with a physical or sensory disability. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Three Ashes is registered for older people living with dementia, physical disability and/or sensory impairment. At the time of this inspection 9 people were living there.

Accommodation at Three Ashes is provided over two floors with bedrooms located on the ground and first floors. The ground floor was wheelchair accessible. A stair lift was fitted to assist people with limited mobility to access the first floor. Most bedrooms had en-suite facilities with a shower and a communal bathroom was located on the first floor. Two lounge areas, one in a large conservatory overlooking the extensive gardens, were located on the ground floor and a dining area was situated, open plan, between the two lounges.

Three Ashes has changed ownership twice since our last inspection in November 2015 but the legal entity remained the same. At our last inspection in 2015 the service was rated Good. The home has been under the current ownership since August 2017. Staff working at Three Ashes at the time of the sale transferred across to the new owner, remaining in post at the home.

There had been no registered manager in post at Three Ashes since February 2018. 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. The service was being managed by the provider’s representative until a new registered manager was appointed.

During this inspection we identified two breaches of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. The service has been rated ‘Requires Improvement’ overall.

People were not always supported by staff who had received the training and support they needed to carry out their duties effectively. The systems and processes in place to monitor the safety and quality of the services provided to people were not always effective in identifying and addressing shortfalls. Complete records of the care and treatment provided to people had not always been kept. We recommend that the service review good practice guidance for managing medicines in care homes and take action to update their practice accordingly.

Risks to people were managed with the support and guidance of health professionals to ensure people remained safe. There were enough suitable staff to meet people's needs. Staff worked openly with other agencies to safeguard people from harm. The building and equipment were appropriately maintained and people were protected from risks associated with cross infection.

People benefitted from a stable and caring staff team who knew them well. They were supported to access appropriate health care. Staff took a personalised approach to meeting people’s needs and outcomes for people were good. People’s preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People’s privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. People received good end of life care.

People's views about the service they received were sought and these were used to improve the service. People were able to raise complaints and these were responded to promptly. The culture at the home was open and transparent. Staff and managers worked together to provide a friendly service where people told us they felt at home.

This is the first time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with five people who use the service, two visitors, the manager, three staff and observed how people were being cared for. We also reviewed records relating to the management of the service which included, three care plans, daily care records, quality assurance systems and staff rosters. People we spoke with were living with dementia, we have indicated in the report where we were unable to obtain feedback from them.

At the time of our inspection the provider did not have a registered manager in post. The provider had appointed a manager and they had submitted an application to become a registered manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff used both formal and informal methods to share information on risks associated with their care, treatment and support. Hazards were minimised and procedures were in place to keep people safe.

The service was safe because people were protected from infections. The home was kept clean and hygienic. Systems were in place to prevent, detect and control the spread of infection.

People were safe because staffing levels were assessed and monitored to ensure they were sufficient to meet people's identified needs at all times. The provider had strategies in place to respond to emergencies. The service considered and ensured staff had the competencies, knowledge, qualifications and experience when arranging staffing so that people's individual needs were met.

Is the service effective?

People received an effective service because their individual needs, choices and preferences were reflected in their care plans. People's likes, dislikes and routines important to them had been recorded in their care plans. Staff spoken with had a good understanding of people's needs.

The service was effective because people's health was regularly monitored to identify any changes that might require additional support or intervention. Referrals were made to health care professionals when people's needs changed.

Is the service caring?

The service was caring because people were given the time they needed to make decisions. People were given information about the choices available before they were asked to make a decision in their own time.

People received a caring service because staff understood and promoted respectful communication. Staff supported people in a caring and meaningful way, responding to their needs in a timely fashion.

The service was caring because people could be as independent as they wanted to be. Staff encouraged people to maintain their mobility and to feed themselves.

Is the service responsive?

The service was responsive because people had their individual needs regularly assessed. Staff understood people's care and support needs.

The service was responsive because it allowed staff the time to provide the care and support people needed. Staff spent quality time with people giving them individual attention and support.

People, their relatives and friends were encouraged to provide feedback. People and their relatives were given information about how to make a complaint. They were encouraged to discuss any issues or concerns with staff as they arose.

Is the service well led?

Feedback from people who live in the home, their relatives and staff was encouraged. Action had been taken in response to their feedback.

The service was well led because resources and support were available to the manager and the team to drive improvements. An open culture encouraged staff to express their views about the standards of care which resulted in improvements to the service provided.

Systems were in place to monitor accidents and incidents. The necessary action was taken to prevent these from happening again.

The service was well led because robust quality assurance processes were in place to check on the experience of people living in the home. A person told us, "It's marvellous really."

We found staff had received additional safeguarding training and the manager completed monthly audits to check the staff's understanding. We found meetings took place with staff and people who used the service. The minutes of these meetings showed a wide range of topics were discussed and opportunities for feedback were present. A satisfaction survey had been completed since our last inspection. The results from this survey were mainly positive from both people who used the service and their relatives. The provider had reviewed the care files for people who used the service. We found these to be person centred, up to date and reflected people's needs.

Staff we spoke with told us they felt supported by their manager through informal supervision during the course of their day-to-day work.

Care records did not accurately reflect people's needs or contain sufficient detail for staff to follow. This meant that people living in the home were at risk of receiving care or treatment that was inappropriate or unsafe.

There was a risk that people may not be protected from abuse. This was because the provider's safeguarding policy did not provide staff with information about when and how to contact the local authority's safeguarding team. None of the evidence reviewed demonstrated that the provider had established routine and robust processes for seeking people's views or for monitoring the quality and standard of services provided.