Archived: Ash-leigh House

Updated 31 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

We carried out this unannounced inspection on Wednesday 07 December 2016. This meant the provider did not know we would be visiting the home on this day. The inspection team consisted of two adult social care inspectors from the CQC (Care Quality Commission), one of which is a Registered Mental Health Nurse (RMN).

In advance of our inspection we liaised with external stakeholders based at Salford Council and Greater Manchester West (GMW). This was to see if they had any information to share with us in advance of the inspection. We had also been involved in multi-agency meetings with both the local authority and proprietor at Ash-leigh House due to our previous inspection concerns. This helped us to establish how the home were progressing and if improvements were being made.

As part of our inspection planning we reviewed all the information we held about the home. This included previous inspection reports and any notifications sent to us by the home including safeguarding incidents or serious injuries.

At the time of the inspection there were nine people living at the home. During the day we spoke with the home manager, the provider, three people who lived at the home and three members of care staff. As part of the inspection, we looked around the building and viewed records relating to the running of the home and the care of people who lived there. This included five care plans, five staff personnel files and four medication administration records (MAR).

Updated 31 January 2017

This unannounced inspection took place on Wednesday 07 December 2016.

Ash-leigh House is registered with the Care Quality Commission to provide accommodation and support for up to 10 people with mental health needs. The home is located in a residential area in Eccles within walking distance of the town centre. There is one main lounge and a kitchen/dining room. There are 10 single bedrooms, two on the ground floor and eight on the first floor. There is a garden to the rear of the property and a small car park at the front. At the time of our inspection there were nine people living at the home.

At our previous inspection on 27 July and 02 August 2016, we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, good governance, staffing and fit and proper persons employed. The home was rated ‘Inadequate’ overall and in four (Safe, Effective, Caring and Well-led) of the five ‘Key Questions’ against which we inspected against. As a result, the home was placed into ‘Special Measures’. This meant improvements were required or further enforcement action would be taken. At this inspection, we found significant improvements had been made in all areas, with no regulatory breaches identified.

People told us they felt safe living at the home. The staff we spoke with had a good understanding of safeguarding and how to report any concerns.

We found medication was given to people safely and staff had received appropriate training. Medication was stored in locked cabinets in the office and only staff responsible for administering medication had access to the keys.

Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken. The recruitment files we looked at were organised and in good order, making all required documentation easy to locate.

Each care plan we looked at contained risk assessments covering areas such as falls, mobility, waterlow (to monitor skin integrity) and nutrition. Where risks were identified we saw appropriate control measures were in place. Concerns from our previous inspection such as faulty window restrictors and the cellar door being left unlocked had been addressed. Accidents and incidents were monitored, with an analysis completed to look at any re-occurring trends at the home to prevent future re-occurrence

There were sufficient staff working at the home to meet people’s needs, although several people living at the home reported they felt an additional member of staff would be beneficial at night when people were going to bed. Following the inspection, the manager contacted us to inform us that it had been agreed for an additional member of staff to work the ‘Twilight shift’ between the hours of 7pm and 12am to provide assistance to night staff.

We saw a detailed staff induction had been introduced, centred around the Care Certificate which staff completed when they first started working at the home. Staff had received supervision with the new home manager, with appropriate records maintained. We also saw that staff had received training in areas such as Safeguarding, Medication, MCA/DoLS and Health and Safety, all of which were recorded on the training matrix. We found staff still hadn’t completed training in areas such as Infection Control, Mental Health Awareness and Challenging Behaviour/Breakaway Techniques, however following the inspection the manager sent us confirmation that this had been booked for January 2017.

At our previous inspection we had found that the staff were not working within the principles of the MCA. At this inspection, we found that this had been actioned and restrictions that had previously been imposed on people were no longer in place. The management demonstrated a good understanding of MCA and DoLS. An urgent authorisation had been submitted for one person as there had been some concerns regarding their capacity to make the decision to reside at Ash-leigh and consent to their care and treatment.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. People said they were able to eat foods they liked and that alternatives were available. People had specific eating and drinking care plans in place, with MUST (Malnutrition Universal Screening Tool) assessments used to assess people’s nutritional needs. People’s weights and BMI (Body Mass Index) were monitored and we saw food and fluid charts had been implemented when required.

The people we spoke with felt they were receiving good care and support. People told us they felt staff treated them with dignity and respect and promoted their independence where possible.

People felt the home was responsive to their needs. Each person living at the home had their own care plan, which was person centred and detailed people’s choices and personal preferences. Initially, we raised concerns that life history and ’10 things to know about me’ documents were incomplete in some of the care files that we looked at, however the manager confirmed following the inspection that these had been implemented.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. There were no active complaints at the time of the inspection. Residents meetings were also held where people could raise concerns or discuss how to do things differently at the home.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns. There were systems in place to monitor the quality of the service such as audits, weekend spot checks, staff meetings and accident/incident monitoring.

Staff told us they enjoyed their work and liked working at the home and told us they felt there was an open and positive culture. All of the staff we spoke with confirmed that significant changes and improvements had been undertaken at the home since our last inspection.