Ash Grove

Ash Grove is a residential care home providing personal care to up to 6 people. The service provides support to younger people with a learning disability and autistic people. At the time of our inspection there were 8 people using the service. People were cared for in 1 adapted building with bedrooms over 2 floors.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

Staff supported people to be independent and have the maximum possible choice and control over their own lives. Staff provided people with care in the least restrictive way possible and in line with their best interests; the policies and systems in the service promoted this practice. The service worked with people to plan for when they experienced periods of distress so that their freedom was restricted only if there was no alternative. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs effectively and keep them safe. People were able to communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture:

Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviour of the management and staff.

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 16 October 2018).

Why we inspected

We received concerns in relation to the management of medicines and alleged financial and emotional abuse. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, caring and well-led sections of this full report.

Recommendations

We have made a recommendation about submitting statutory notifications.

Follow up

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

At the last inspection in February 2016 the services was rated Good. At this inspection we found the service remained Good. The evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in place at the time of our inspection. 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 continued to be cared for in ways which promoted their safety and people benefited from being supported by staff who knew the individual risks to their safety well. Staff adjusted how they cared for people so people were still able to choose what they wanted to do, as safely as possible.

There were enough staff to care for people, and checks were made on the suitability of staff before they were recruited. Changes had been introduced to the way people’s medicines were managed, to further reduce the likelihood of errors. Systems were in place to reduce the chance of people having infections. Staff had a positive approach to people’s safety and told us they were supported and encouraged to learn from any untoward incidents.

People’s needs were considered and planned for before they came to live at the home. Arrangements were in place to support staff to seek the advice of other health and social care professionals when determining if they could provide the care people needed.

People told us staff knew how to care for them. We found staff were provided with opportunities to develop the skills and knowledge they needed to support people living at the home. We saw staff used these skills so people’s individual needs were met.

Staff supported people to have enough to eat and drink so they would remain well. People told us they enjoyed their meal time experiences, which reflected their choices, and some people liked to make their own drinks. One relative we spoke with highlighted how well staff worked together and with other organisations, so people’s health and well-being was enhanced.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The caring approach of staff was highlighted by people and one relative we spoke with. There were strong bonds between people living at the home and the staff who cared for them. Staff encouraged people to make their own decisions about the care they wanted and spoke respectfully to the people they supported. People’s right to dignity and privacy was taken into account in the ways staff cared for them.

Care was offered to people which reflected their individual needs, goals and preferences. Staff used different ways of communicating with people so they could be involved in making decisions about their care and lives. The views of relatives and other health and social care professions were listened to, to help to ensure people’s care was planned in the best way for them.

There were systems in place to support people to raise any concerns they had or to make a complaint. Everyone we spoke with told us they had not wanted to make any complaints because the care provided was good.

The registered manager had been appointed since our last inspection. They spent time working with people, so they could be assured people were receiving good quality care. Staff were confident if they raised any concerns the registered manager would address them.

Checks were made by the provider and registered manager so they could be sure the people benefited from living in a home where planned development was focused on the experiences of people who lived there.

We had the opportunity to talk with two people who lived at the home on the day of the inspection. We have therefore not used quotes within this report and the examples we have given are brief because we respect people’s right to confidentiality.

A registered manager was in post at the time of our inspection. 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 were supported by staff who knew how to recognise and report any concerns so people were kept safe from harm. We saw there were processes in place to protect people from the risk of harm, and staff supported people to stay safe as their independence increased. Relatives told us they felt staff worked in ways which promoted their family members’ safety. People were also assisted to take their medicines by staff who had been trained and knew how to manage medicines in a safe way.

Staff suitability to work with people was checked and staff had received the type of training they needed to care for people living at the home. People’s health and well-being needs were met as there were sufficient numbers of staff with the skills and experience to care for people. Staff knew how people liked to be cared for and used their knowledge and skills to meet people’s individual needs. Care was delivered in a way which protected people’s rights and freedom.

People enjoyed the food and drinks which were available, and were encouraged to choose what they would like to eat from a range of healthy options. Some people enjoyed helping to prepare their own food with assistance from staff. Staff were aware of people’s nutritional needs and followed advice from appropriate professionals when required, so people would receive the correct diet and remain well. People were supported to access healthcare services to maintain and promote their health and well-being.

Staff were kind towards people and treated them with respect when caring for them. People enjoyed being in the company of staff, who took time to involved them in making decisions about what they would like to do. People’s privacy was respected and they were supported to maintain and increase their independence and well-being.

People were supported by staff to do the things they enjoyed and to keep in touch with family and friends who were important to them. People who lived at the home and their relatives had been involved in the development of the care plans which were regularly reviewed to reflect changes in people’s needs.

Staff understood what their responsibilities were and were encouraged by the registered manager and senior team to make suggestions for improving the care people received. The provider, registered manager and senior team checked people’s experiences of living at Ash Grove, and took action to develop the quality of the care provided, so people would benefit from living in a home where they received a good quality service at all times.

Is the service safe?

People were treated with dignity and respect by staff. We saw that staff were protective towards people to prevent them from risks of accidents and injuries when they mobilised. We observed a relaxed atmosphere and positive relationships between people who were using the service and staff. There were risk management plans in place for people and for general health and safety, such as the premises, fire safety and emergency evacuation of the premises. We looked at staffing levels. This showed us the provider had ensured enough qualified and experienced staff were available to provide appropriate care and support. We were told staffing levels were reviewed when the numbers of people living in the home changed and their dependency needs had been assessed.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Some relevant staff had been trained and training was arranged for other staff to attend so they would understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and support plans were in place. We observed staff providing people with choices about what they wanted to eat and what they wanted to do during the day. We saw evidence that relatives had agreed support plans and regular reviews of them. Staff encouraged and supported people in developing living skills and in leading meaningful and enriched lifestyles. We saw that staff respected people's individual cultures. Staff demonstrated knowledge of people's needs and support that matched their support plans. Staff had received training to meet the specific needs of the people living in the home. We found that support plans were accompanied by health care plans hospitals had supplied to the home. Arrangements were made so that staff could accompany people in attending GP and hospital appointments.

Is the service caring?

We observed people being supported by staff in a sensitive way that was tailored to each person's preferences. People were cared for by kind and attentive staff. Staff encouraged and supported people in maintaining their independence. Staff had adopted a flexible system so that they could respond to people's requests. Staff were aware of people's rights and respected decisions people made. The care worker who was in charge briefed all new staff about people's changing needs at the beginning of each shift when there was a change of staff. People were supported by a team of health and social care professionals who worked closely with staff in providing people's care needs.

Is the service responsive?

Talking with staff and looking at records confirmed that staff acted on the recommendations made by health professionals. Before people were admitted to the home staff ensured they had enough information about people's needs to ensure they were able to meet them. People were supported in accessing the community. People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes. We saw the complaints procedure was written in a simple way and had been made available to people and their relatives. The senior care worker showed us that complaints received were investigated and acted on in accordance with the procedure.

Is the service well led?

The service had a system in place for obtaining relatives opinions about the standard of care and support people had received. Regular audits had been carried out that enabled staff to make changes that could be of benefit to the people who used the service. The audit tools included improvements that staff had made. A senior member of staff regularly visited the service and carried out a range of audits. A report was developed and given to senior staff who worked within the home so they could make further improvements. Staff told us they were clear about their roles and responsibilities and the ethos of the service. Staff received regular supervisions by senior staff to ensure they remained competent for their roles.

We looked at care plans for three of the people who used the service. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

We saw that staff helped and supported people. We spoke with one relative of a person who used the service. They told us that staff were: "Doing a good job". We saw that people received care that met their individual needs.

We found that medicines were being appropriately stored and administered.

We found that there were regular audits and quality checks. We also saw that the provider sought on-going feedback from families and carers. This ensured that the provider was able to monitor the quality of its service delivery.