Asher Care

Asher Care is a residential care home providing personal care to up to 25 people. The service provides support to both adults and older people with mental health needs, including dementia. At the time of our inspection there were 23 people using the service.

People’s experience of the service and what we found:

People were safeguarded from abuse and avoidable harm. People told us they felt safe and felt comfortable raising any concerns they had with staff. One person said, “I’m very happy here. I get on well with other people, I go out when I want to, and I feel safe”. The provider assessed risks to ensure people were safe. Staff took action to mitigate any identified risks. Each person had personalised assessments that considered their individual risks and circumstances, and medicines were well managed.

There were enough staff to meet people’s needs and staff had the skills and knowledge to support people safely. One relative told us, “There seemed to be enough staff. It is very good. From the very first visit, I could tell they were not just at work – it seemed a proper team feel and they were all very friendly and relaxed towards the residents”. People were protected from the risk of infection and were able to receive visitors in line with best practice guidance. The provider was working in line with the Mental Capacity Act.

There was an open and positive culture at the service. People were supported in a person-centred way, which supported them to achieve good outcomes. Quality assurance systems ensured the registered manager had oversight of the delivery of care and identified any areas for improvement. Feedback was sought from people, relatives and staff in order to engage them and improve the service. One member of staff said, “I can confidently say that I have never felt more comfortable in a working environment than I have here. The management team are always there if you need them.” We received positive feedback from health professionals.

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 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Asher Care on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The registered manager ensured people received support to maintain contact with family and friends during the pandemic and ensured visits to the home were managed safely.

• For example, the service built a cabin in the garden and equipped it like a tea shop. This meant people could meet family and friends safely, in a pleasant environment, outside the main home.

• Good use was made of visitors accessing people’s rooms via patio doors, again reducing contact with anyone else in the home.

• A designated person was appointed mask monitor. This ensured all staff changed their masks every 4 hours to be compliant with PPE guidance.

• Revamping the laundry system maximised infection prevention and control as well as reducing the frequency of people’s laundry getting mixed up.

• People told us they were still able to go out and to have visitors or other contact with friends and family if they so wished. They were reassured staff did what was needed to protect them from COVID-19, for example, washing hands, wearing masks and cleaning the building.

• People told us they still had their needs met. One person said “I can’t fault them here, I give them 100 out of 100, if you have any problems they will sort it.” Another person told us “It’s a good home, they’re good the staff.”

We found the following examples of good practice.

The registered manager and deputy worked closely together providing clear leadership on good infection control practice. They updated staff on changes to guidance and practice in the home linked to infection control practice. Regular spot checks and competency checks were made to ensure staff continued to follow best practice guidance. All staff were wearing appropriate PPE and the provider had invested in scrubs for staff to wear to help minimise cross infection. The registered manager had instigated changes, for example to laundry practice, to promote good infection control. They had worked closely with other agencies to enhance infection control measures.

The registered manager praised her staff team and the support she had received from the staff group and the providers. The registered manager had presented each staff member with a gift to show she valued how they had pulled together for the benefit of people living at the home. She recognised the impact of Covid-19 on people's mental health as well as their physical health.

The providers have invested in the home during the pandemic to help with infection control which has included new beds, new lounge furniture and an attractive summerhouse, which was decorated in the theme of a tearoom. This was used as a pod for visitors, which could be accessed through the garden so visitors did not have to enter the home.

The registered manager recognised the importance of reassuring and keeping people living, working and visiting the home up to date with information. We saw positive feedback from these groups of people on how they had been supported during the pandemic.

At the last inspection in January 2016 the service was rated Good overall. The ‘Responsive’ key question was rated ‘Requires Improvement’ due to lack stimulating activities available for people. We had made a recommendation to the provider for them to improve in this area. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Action had been taken to improve people’s access to personalised, stimulating activities. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

Following our previous inspection in January 2016 action had been taken to improve the activities offered to people. People’s views were sought and staff ensured people had access to activities which met their personal needs and preferences. People were supported to remain independent and take part in activities such as flower picking and gardening.

The people who lived in Asher Care had a wide variety of needs and health conditions. People living in the home had been diagnosed with dementia, Korsakoff’s, mental health conditions such as bipolar disorder and alcohol abuse. The home was set over two floors, with bedrooms on each floor and two standalone flats in the rear of the building. These flats were used by people who were more independent but still needed staff support.

Staff received training in a number of areas and support from healthcare professionals. However, we identified that further improvements could be made with regards to providing training for staff relating to people’s individual mental health and needs relating to addiction. We made a recommendation for the provider to undertake a review of the training provided to ensure this met people’s complex needs.

The people who lived in Asher Care were provided with care that was person centred and met their individual needs. People made comments including, “I’m happy. I’m very happy” and “I can do what I want.”

People spoke highly of the staff who worked at Asher Care, with comments including; “They are marvellous”, “The staff are the best bit” and “They’re all wonderful.” Relatives made comments including, “They’re kind the staff” and “The staff are very lovely and very helpful.” Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people spoke highly of the food at the home.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff received regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice.

People who lived in Asher Care had a variety of needs and were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below.

The Lindons is registered to provide personal care, without nursing care, for up to 25 adults. People living at the service are older and have physical and dementia care needs. During the inspection there were 20 people living at the service.

The inspection took place on 7, 19 and 20 January 2016 and the first day was unannounced. The service was last inspected on 25 November 2014 when it met the requirements relevant at that time.

There were two managers registered in respect of the service. 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 were told that one of the registered managers no longer worked at the service. The registered manager who was working at the service told us they would contact the other registered manager to remind them of the need to apply to deregister as manager.

Prior to the inspection we received concerns about the way infection control procedures at the home were affecting the health and welfare of people living at the home. There had been a fire in the laundry over the Christmas period and this had resulted in a change to the way laundry was managed at the home. There were also concerns that there was a lack of hot water in some bedrooms. Due to these concerns a scheduled comprehensive inspection was brought forward.

We discussed the situation with the registered manager, care staff and people living at the home. People told us they knew about the fire, but that it had not affected them in any way. Laundry was being taken to a local laundrette. Extra sheets and towels had been purchased to ensure there was a good supply. Staff told us there had never been a time when they had run out of either. Staff told us some items of personal clothing had been destroyed during the fire, but that these had now been replaced.

We had also received concerns that not all bedrooms had access to hot water. On the first day of our inspection we tested the water in all bedrooms and found that 15 of the 25 had either no hot water or the water was tepid. The registered manager told us they knew there was a problem and the heating engineer visited during our inspection. Staff told us that while some rooms had no hot water they had taken water from the bathroom to people’s rooms so that they could wash. They said people had still been able to have a shower or bath. Following the inspection the registered manager informed us the boiler had been replaced.

People did not benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. The was no regular programme of activities, but staff told us they did spend some time with people when not carrying out personal care tasks. The registered manager had already identified the lack of social activities and a staff member had been identified who was to increase the level of social interaction. They had begun to identify activities people might like. The reminiscence magazine ‘The Daily Sparkle’ was available for people to look at. A small ‘snug’ area had been redecorated and contained a small library. Plans were in place to use this area to hold film nights.

People’s needs were met by kind and caring staff. People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. One relative told us they thought staff provided “A good level of care”, and their relative “Always seems well cared for”.

Staff were responsive to people’s individual needs and gave them support at the time they needed it. One person told us “Alright they are [staff] they help you when you need it”. Staff were able to tell us about people’s preferences. For example, staff told us about one person who liked a fixed routine. The person’s care plan clearly detailed this, and the person confirmed staff always followed their preferred routine. One person told us “They [staff] are always asking, are you alright to get up or go to bed?”

People were protected from the risk of abuse because staff understood the signs of abuse and how to report concerns. People we spoke with told us they felt safe living at the home. One person told us “Safe? Yes, I’m alright, I’m fine”. Not everyone we spoke with was able to tell us if they felt safe, so we watched how they interacted with staff. People smiled and took hold of staff’s hands when talking to them, showing us they felt safe in their company.

People’s needs were met in a safe and timely way as there were enough staff available. During the inspection staff were busy, but met people’s needs in a timely manner and call bells were answered promptly.

The systems in place for the management of medicines were safe and protected people who used the service. Records confirmed people had received their medicines as they had been prescribed by their doctor. Topical creams and charts detailing where and when they should be applied were kept in locked cupboards in people’s bedrooms.

Risks to people were identified and staff had information on how to manage risks to ensure people were protected. Moving and transferring, falls and pressure area risk assessments were in place. However, on the first day of inspection not everyone’s risk assessments were up to date. The registered manager told us this was because a new care planning system was about to be introduced and everyone was being completely reassessed. On the other days of inspection we saw this was happening. Pressure relieving equipment was used when needed. Staff knew how often people’s position needed changing and charts indicated people were being repositioned as required.

People were supported to maintain a healthy balanced diet and receive the healthcare they needed.

Staff ensured people’s privacy and dignity was respected and all personal care was provided in private. For example, staff addressed people with their preferred name and spoke with respect. People responded to this by smiling and engaging with staff in a friendly way. We heard staff respectfully reassuring one person they were assisting to move.

Relatives told us they were involved in developing and planning their relation’s care. One relative said staff always asked for their input when reviewing care. Another relative said they had helped to develop their relative’s care plan and staff always let them know if there were any changes to their care. Visitors said they could visit at any time and were always made welcome.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). When a person had been assessed as not having the capacity to make a decision other people were involved to determine what decision would be in the person’s best interest. This procedure had been followed where one person had needed dental treatment.

Staff had received a variety of training such as medicine administration, first aid and moving and transferring to help meet people’s needs. They had also received more specific training relating to people’s needs. This included caring for people living with dementia. We saw a series of training events were due to be held in the forthcoming weeks in order to update staff on such topics as medicine administration, safeguarding people and first aid.

Relatives, staff and a healthcare professional spoke highly of the registered manager who was keen to drive improvements in the home. Improvements introduced included changes to care plans and the environment.

People benefited from systems to assess and monitor the quality of care. The systems enabled issues to be identified and acted on. Suggestions for improvement were encouraged from staff and visitors. For example, staff had suggested name badges would ensure people and visitors knew who they were speaking with. The name badges arrived during our inspection.

We have made a recommendation about increasing social interaction and activities for people living with dementia.

We initially inspected The Lindons on 18 September 2014. We found concerns at this time in respect of how the home was meeting their requirements in relation to the management of medicines under the Health and Social Care Act 2008. We requested the provider send us a written action plan on how they were going to address the concerns raised. We also asked them to provide us with a date when they would have put these concerns right. They told us this would be by the 30 October 2014.

We inspected the home on the 25 November 2014 and looked at how the service had made improvements to the management of medicines at the home since the last inspection. We did not inspect any other outcomes during this inspection.

We spoke with one person who lived at the home and two of their relatives. We also spoke with the registered manager. A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Below is a summary of what we found. The summary is based on what we were told by the people we spoke with, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

The provider had made improvements to the management of medication and appropriate arrangements were in place to manage medicines safely since the last inspection. They had sent us an improvement plan clearly showing how the improvements had been made. The improvements had been made within the time schedule agreed between the providers and CQC. This meant that people were protected against the risks associated with medicines.

There were 23 people living at The Lindons when we inspected, some of who were there for a short stay only. This was the service's first inspection since the current provider was registered with us.

We looked around the home and spoke with nine people. We met five other people who spoke with us but who were not able to answer our questions fully because of their physical frailty or communication needs. We observed some of the support that people received from staff. We looked at care records, following up three people in more depth, and at records relating to the management or running of the home.

We spoke with the relative of another person who lived at the home, two visiting health professionals, six ancillary or care staff and the Registered Manager.

The manager was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Below is a summary of what we found. The summary is based on what we were told by the people we spoke with, including the staff, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

Care was planned and delivered in a way that was intended to ensure the safety and welfare of people who lived at the home. There was management of risks relating to individuals' needs, such as to prevent malnutrition and falls, in part through the use of recognised assessment methods. People's care was reviewed regularly, ensuring they continued to receive support they needed even if their needs changed. However, the provider did not have appropriate arrangements fully in place to manage medicines safely. This meant that people were not protected against the risks associated with medicines. A compliance action has been set for this, and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards. Relevant staff were trained to understand when an application should be made. People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

People were positive about the support they received. One person commented, for example, 'They talk to you and help with anything you want.' People looked content and at ease with the staff. The home's annual quality assurance survey showed that the majority of respondents were satisfied with the support they received. We saw that staff received training, development and on going support, so that they could understand and meet people's needs in the best way possible. Staff we spoke with evidenced that they understood people's care and support needs, and that they knew them as individuals.

Is the service caring?

People told us that staff were respectful, listened to what they said, and treated them as individuals. One person added 'You can have a laugh and a joke with them, which is nice.' Another said 'The staff are quite fun. They do a good job.' A third commented 'They've been very kind', as other people reflected. People's decisions about their daily activities were respected, such as where to spend their time. Their privacy and independence were supported, such as during personal care.

We observed that staff took time with people when approached by them or assisting them. They engaged with people in a friendly or calm way. The language in care records was appropriate, and reflected a caring attitude towards people and their needs.

Is the service responsive?

People's needs had been assessed and reviewed, with care planned to meet their needs. Visiting health professionals told us that staff acted on their comments and followed their advice. We saw that people were given opportunities to discuss their care and care plan, which included their preferences, interests and diverse needs.

Records, our observations and conversations with people confirmed support had been provided that met their wishes. For example, people told us that staff responded quickly to call bells and to requests, such as for pain-relieving medication. Visitors were made welcome, enabling people to maintain relationships with their friends, relatives and others important in their lives.

Is the service well-led?

A variety of quality assurance processes were in place. Systems were also in place to identify and manage risks to the health and welfare of people living at the home and others. These included risk assessments and regular monitoring.

We saw that people had opportunities to give their views of the service through surveys and meetings. Action plans and our conversations with people or staff showed that people's views were used to improve the service. People who had made complaints had been responded to, with action taken to address or rectify the issues they raised. Staff also told us that their views and suggestions were sought and listened to by senior staff.