The inspection of Ashgrove House took place on 16 October 2018 and was unannounced. At the previous inspection in September 2017 we found an issue with medication which was swiftly dealt with. As this was a breach of the Health and Social Care Act regulations the home was rated requires improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well led, to at least good. On this inspection we found significant improvement had been made.

Ashgrove House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashgrove House accommodates 30 people in one adapted building. During this inspection there were 27 people living at Ashgrove House.

There was a registered manager in post on the day of the inspection and we spent time with them. 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 and relatives told us they felt safe and secure at Ashgrove House. This was because they knew all the staff, many of whom had been at the home some time, and also because they felt staff were well trained and knowledgeable. They also felt there were sufficient numbers of staff.

Risks were managed according to individual need and we saw staff support people safely and appropriately with transfers. These were supported with detailed risk assessment and management plans which were regularly reviewed. There were few accidents in the home but those that did occur were properly assessed and reviewed to ensure all possible risk reduction measures were in place, and lessons learned were shared.

Medication was administered, recorded and stored safely, and people’s medication needs were regularly assessed with the support of the local GP who had established a weekly surgery in the home. This ensured any issues were dealt with promptly. Staff were aware, and practised, effective infection control reducing the likelihood of harm.

Best practice principles were adhered to and known as they were fed through the Director of Care, who attended many good practice forums. The registered manager was experienced and shared their knowledge and led by example. Staff had access to regular supervision and training, and were supported by newsletters and meetings of changes in policy or procedures.

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

People had effective nutritional and hydration support and staff were attentive to people’s differing abilities. They encouraged people to be independent as far as possible, and promoted choice and involvement. Teamwork was evident in the home and staff were extremely supportive of each other, to the extent if any were ill, they would cover for each other. There was a strong commitment to person-centred care and staff supported people discreetly and sensitively, always mindful this was people’s home.

The home was in the midst of a significant extension but had utilised as much as possible of the outdoor space, including the building of a large decked area accessible through the lounge.

Staff were consistently kind, patient and compassionate with people, and clearly knew all residents well. They were involved in reviews of people’s care needs and responded to changes quickly and appropriately to ensure the person had the maximum quality of life. People’s privacy and dignity was promoted.

The

The inspection of Ashgrove House took place on 12 September 2017 and was unannounced. The home was previously inspected in June 2016 and rated requires improvement. The provider was in breach of Regulation 12 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 due to issues with medication. The registered provider had submitted a comprehensive action plan to remedy these breaches. During this inspection we checked to see whether improvements had been made.

Ashgrove House accommodates up to 30 older persons, the majority having either dementia or mental health care needs. The property is an adapted detached Georgian house. The service is owned by Warmest Welcome Ltd and is located in Sandal near Wakefield city centre, which is easily accessible by public transport. On the day of our inspection there were 24 people in the service, three of whom were on respite.

There was a registered manager in post on the day of the 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 and their relatives told us they felt safe, partly due to the availability of staff but also because staff were attentive to the smallest of risks, especially around falls management. Risk assessments provided detailed guidance for staff which we observed being used in practice.

Medication administration was much improved from the previous inspection. However, we found some issues with stock levels of supplement drinks which had been identified by a recent home audit and ‘as required’ guidance was not as detailed as it should be.

People were supported appropriately with nutrition and hydration, and were able to access other health and social care services as needed.

Staff had received relevant and detailed supervision along with regular training on key topics to ensure they followed best practice.

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

We observed staff to be caring, kind and patient with people, clearly knowing everyone very well. There was plenty of positive interaction between people and staff, helping to promote a positive atmosphere in the home. We saw people’s dignity was promoted such as ensuring they were dressed appropriately and had their personal effects with them. Privacy was also respected as staff spoke discreetly to people in need of assistance.

There were many and varied activities in the home which we saw people really engage in and people, relatives and staff spoke highly of all the opportunities available to join if they wished to do so.

Care records evidenced people’s needs and were regularly reviewed. Staff had detailed guidance around people’s preferences and how they were to support a person safely.

The home had not received any complaints since the last inspection but we saw the policy and procedure was clear and available.

The home was well led by a competent registered manager, supported by the Director of Care and provider who offered regular visits and support as needed. Staff felt valued and were confident if concerns were raised these were dealt with promptly and appropriately.

Quality assurance processes were detailed and showed any discrepancies were highlighted and action plans generated. In most instances, we saw these were completed effectively and reviews took place to ensure there were no further issues.

There was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to issues with stock control of supplement drinks and insufficient information on ‘as required’ medication protoc

The inspection of Ashgrove House took place on 14 June 2016 and was unannounced. The home was previously inspected in May 2015 and found to be requiring improvement. It was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to issues with medication and Regulation 18 as there were not enough staff present. The registered provider had submitted a comprehensive action plan to remedy these breaches. During this inspection we checked to see whether improvements had been made.

Ashgrove House accommodates up to 30 older persons, the majority having either dementia or mental health care needs. The property is an adapted detached Georgian house. The service is owned by Warmest Welcome Ltd and is located in Sandal near Wakefield city centre, which is easily accessible by public transport. On the day of our inspection there were 28 people in the service, two of whom were in hospital.

There was a registered manager present during the 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 told us they felt safe and staff were able to explain to us what may constitute a safeguarding concern. They were aware of the necessary reporting procedures and confident in their knowledge.

The home had risk assessments in place but not all were pertinent to the specific person and some needed further detail around the risk reduction measures to be used to minimise the risk of harm. The Director of Care responded quickly to our concerns and sent a revised moving and handling assessment the day after our inspection which showed how eager they were to ensure best practice.

Staffing levels were appropriate for people’s needs on the day of our inspection and we felt staff had time to talk to people in addition to carry out their key tasks.

There were serious issues in the competency of the staff member responsible for the administration of medication. We did not see appropriate infection control procedures in relation to people receiving medication, people were not supervised while taking their medication which resulted in a tablet being found on the floor and records were falsely completed in relation to people receiving their medication.

Staff had received a detailed induction and their knowledge was obvious in that they knew how to care appropriately for people. This was reflected in some of the compliments the home received. Staff also had regular supervision which reflected current good practice guidelines.

The registered manager was compliant with the requirements of the Mental Capacity Act 2005 as they had requested Deprivation of Liberty Safeguards authorisations where necessary. However, the registered manager needed to further develop their assessment of decision specific capacity in line with legislation as the current assessments were not sufficient.

People were supported with access to health and social services as needed, and there was evidence of positive relationships with other services in the area. Nutritional and hydration needs were met throughout the day and specialist support obtained if required.

Staff displayed kindness, empathy and patience, ensuring their focus was on the people in the home. We heard numerous engaging conversations which reflected staff’s interest and knowledge of people’s specific circumstances. Staff were pro-active in seeking consent before undertaking any care provision.

The home had an activities co-ordinator, who along with the staff, supported people with a variety of engaging things to do such as communal games and gentle competitions. People appeared happy and settled and there was a positive atmosphere. The home had received a number of comp

We carried out this inspection visit earlier than planned after receiving notification of a serious incident involving a member of staff and a person with dementia who was using the service.

During our visit we spoke with two people who used the service and three relatives.

People living at the home said that staff were respectful and encouraged them to make their own decisions. One person who was using the service told us “Staff treat us with respect and are always polite.” Another person said; “I do like to join in with activities sometimes but if I don’t want to then I am not pressurised to do so.”

One person who was living at the home told us “This is a vey nice place. We are like one big family.” Another person commented “Staff are kind and treat us well.”

All three relatives spoken with told us how good staff were at involving them in their relative’s care, keeping them informed and notifying them about any incidents. One relative said; “Staff are always welcoming and involve you in any decisions about our relative’s care.” Another relative told us “We attend meetings to discuss our relative’s care and progress. Our views are always taken into consideration and staff ask for our agreement before any changes to our relative’s care are put in place.”

Relatives told us that staff were “patient, tolerant and understanding.” A relative said; “Our relative can be short tempered for no reason and has mood swings. They have a go at staff for no reason but staff just take it in their stride.”

Relatives described the care as “very good.” On relative commented “Whenever I have visited I can not recall seeing anyone with dirty or untidy clothing.”

Relatives told us that the management and staff team were always approachable and available if they had any concerns. A relative told us about one occasion when they had raised a concern and said; “This was acted on immediately and what I liked was that I was not treated any differently afterwards for bringing this to staff’s attention.”

People using the service and relatives all spoke highly about the abilities of the staff team and said they were confident in their roles and had a good understanding about the care and support people needed.

We inspected the service on 5 and 6 May 2015. The visit was unannounced. Our last inspection took place on the 17 and 20 June 2013 and there were no identified breaches of legal requirements.

Ashgrove House accommodates up to 30 older persons, the majority having either dementia or mental health care needs. The property is an adapted detached Georgian house. The service is owned by Warmest Welcome Ltd and is located in Sandal near Wakefield city centre, which is easily accessible by public transport.

There was a registered manager in post. 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.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). People’s care records demonstrated that all relevant documentation was securely and clearly filed.

There was little guidance for staff to follow about how to give medicines which were prescribed “when required” or where there was a choice of dose. Without this information people were at risk of not being given their medicines safely and consistently. We found this a breach of regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We discussed the way staffing levels were determined at the home. We found a total of two carers were on night duty. We found this was not enough to ensure people were safe at all times. Care is provided on three floors. The registered manager told us they had at least three people that required two members of staff to support them with care needs. This means other people would have to wait a long time if they wanted support whilst those people were been attended to. We found this a breach of regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We found in people’s bedrooms the call system was not in reach for them to summon assistance/help. This put people at risk and we spoke with the registered manager about this, they said they would be instructing staff at once to ensure all service users have the call system within their reach. We found this a breach of regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014

Staff we spoke with told us they were aware of their responsibilities with regard to safeguarding people who lived at the home. They were able to tell us about the symptoms of possible abuse taking place and how they would report this.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service.

We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable to work with vulnerable adults.

There was an on-going training programme in place for staff to ensure they were kept up to date and aware of current good practice.

We looked in people’s bedrooms and found people had personalised their rooms with ornaments and photographs.

Records showed that the provider investigated and responded to people’s complaints, according to the provider’s complaints procedure.

There were systems in place to manage, monitor and improve the quality of the service provided. The provider and manager showed a commitment to seeking feedback on the service in order for it to continually improve.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.