Background to this inspection
Updated
28 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
Our inspection was completed by one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Three Ashes is a ‘care home’. 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. The second day was arranged with the service to ensure the nominated individual could be present.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
During the inspection
We spoke with all eight people who used the service, four of whom were able to give meaningful feedback. We also spoke with two relatives about their experience of the care provided and observed interactions between people and staff. We spoke with five members of staff including the nominated individual, registered manager, two care workers and the chef. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included three people’s care records, medication records and documents relating to the Mental Capacity Act and Deprivation of Liberty Safeguards. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures and reports were reviewed. We read a report by Inclusion Gloucestershire. (This charity works on behalf of people with disabilities, to ensure they have a voice and any needs related to protected characteristics, set out in the Equality Act, are met by the service.) We also looked at the commissioner’s report and action plan.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service and received written feedback from commissioners.
Updated
28 August 2019
About the service
Three Ashes is a residential care home providing personal care to people aged 65 and over. People living at the service may be living with dementia, physical disability or sensory impairment. The service can support up to 11 people accommodated in one adapted building. At the time of the inspection there were eight people living at the service.
There have been several changes in owner and management of the service in recent years, the current provider was registered to provide the service by CQC in April 2019. The registered manager had managed the service since the previous registered manager left in February 2018.
People’s experience of using this service and what we found
People living at Three Ashes did not appear to have been affected by the change of provider as the majority of the staff team, including the manager, had not changed. People enjoyed living in a small service, where staff knew them well and always had time for them.
Systems to monitor the quality of the service were in place and there was good communication between the service and the directors/new owners. However, governance systems needed further development to ensure they were robust and would reliably identify any improvements needed at the service. People, their relatives and staff had confidence in the registered manager and spoke highly of them and the nominated individual. People’s needs were put first in a friendly, positive and inclusive service where the management team were committed to ongoing improvement.
People felt safe and were assured their needs would be met with respect and dignity. They were confident in the staff who supported them. One person said, “I’m very very pleased with the staff, none of them are nasty or don’t do what I want.” Risks to people were managed through the timely involvement of health professionals when needed and through reviews of people's needs when these changed. Environmental risks, such as fire and infection control, were managed safely. There were enough suitable staff to meet people’s needs.
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. People were supported to make healthy choices and access health care services. Staff received effective support and were encouraged to develop their knowledge and skills and complete appropriate training for their role.
People were supported in a friendly and caring service where they were treated with respect and kindness. People's privacy was upheld and they were supported to maintain their independence as much as possible. People and/or their representatives were always involved in the planning and review of their care. One relative said, “I think they’re very nice, very personal, attentive to each one personally. I know mum is looked after the way I would do it.”
People's individual needs and wishes were understood by staff who had established positive and warm relationships with them. People enjoyed some activities in line with their interests. Work was ongoing to improve the provision of meaningful activities and increase people’s involvement with their local community. People were supported to follow any cultural interests and beliefs and to maintain contact with the people who were important to them. People and their representatives were able to raise concerns about the service and these were addressed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 May 2018) and there were two breaches of regulation. Since this rating was awarded, the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection. At this inspection the service was rated as requires improvement in well-led and good in all other areas and therefore good overall.
Why we inspected
This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the well-led section of this full report. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner. We will ask the provider to keep us updated on the progress made to improve the rating of the key question 'Is the service well-led?' to at least good.