This inspection of White Ash Brook was carried out on the 20 and 21 December 2016 and the first day was unannounced. We last visited White Ash Brook on the 26, 27 April and 4 May 2016. Breaches of legal requirements were found. These were in relation to medicine management, risk management, nutrition and quality monitoring. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Following the inspection of White ash Brook meetings had been held with the registered persons, Care Quality Commission (CQC), the safeguarding team and commissioners of services. Quality Improvement Planning meetings had continued to discuss and monitor progress made and to also provide support and guidance on how to improve the service people received. After the last inspection we took enforcement action to stop any admissions to the service without prior consent from CQC. This was to ensure best practice was firmly embedded into the service. The provider agreed to this decision. As a result of this inspection we have written to the provider of our intention to remove this condition we imposed.

During this inspection we found improvements had been made and the service was meeting the current regulations.

White Ash Brook is a purpose built home registered to provide accommodation, nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms located on the ground floor. Communal lounges and dining rooms are also on the ground floor. The gardens are easily accessible to people using the service. The home is situated in the small town of Oswaldtwistle and close to local amenities. There is a car park for visitors and staff. At the time of this inspection there were 15 people resident at the home.

There was a manager in post who was registered with the Care Quality Commission. A 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.

All the people, their relatives, and a visiting professional we spoke with told us the service provided a good level of care and support that placed people at the heart of their care. We found people’s rights to privacy, dignity, and freedom of choice was embedded into the culture of the home and people’s diversity was embraced.

People living in the home told us they felt safe and very well cared for. They considered staff were always available to support them when they needed any help.

Recruitment processes and procedures that were followed ensured new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively at all times.

Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. Staff was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.

Risks to people’s health, welfare and safety were managed well. Risk assessments relating to people’s care were good and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Charts used to monitor people at risk were being used effectively.

There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines. Staff responsible for administering medicines had been trained.

All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately. Staff felt confident in their roles because they were well trained and were supported by the registered manager to gain further skills and qualifications re

This inspection of White Ash Brook was carried out on the 26, 27 April and 5 May 2016 and the first day was unannounced. We last visited White Ash Brook on the 26, 27, 31 August 2015 and 14, 15, 16 September 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection we found the provider had taken action to improve staffing levels, infection control, dignity and respect, training and supporting staff, care planning and making sure staff knew how to support people properly and quality assurance processes. However further improvements were needed to ensure the provider was fully compliant with regulations.

White Ash Brook Nursing Home is a purpose built home registered to provide nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms located on the ground floor. Communal lounges and dining rooms are also on the ground floor. The gardens are easily accessible to people using the service. The home is situated in the small town of Oswaldtwistle and close to local amenities. There is a car park for visitors and staff. At the time of this inspection there were 39 people resident at the home.

There was a manager in post who had submitted an application to the Care Quality Commission to be registered as the manager for the service. A 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 found improvements had been made with the ordering and disposal of medicines. We identified some issues we saw on our previous inspection had not improved. You can see what action we have asked the provider to take at the end of the full version of this report.

Quality assurance systems were being formalised to support the manager to assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service and others. However further improvements were needed to ensure these systems were more robust.

Risk assessments relating to people’s care had improved and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Further improvements were needed to ensure a more robust approach was taken in managing risk.

People received a balanced diet and special diets were catered for. People unable to swallow had their nutrition given through a PEG (percutaneous endoscopic gastrostomy) by nursing staff assessed and trained as competent to undertake this. However charts used to monitor people’s nutritional and hydration intake were not being used effectively and this resulted in people being at risk not having their nutritional needs consistently met.

Information sharing between staff had improved but we found records used by staff to review people’s needs were not always completed. Specific issues such as nail care and physiotherapy exercises were not effectively planned for and we have made a recommendation about this.

There had been an increase in staffing levels and people using the service, relatives and staff told us this had been beneficial to them. People did not have to wait for assistance when they needed staff support.

Infection control within the service was good and infection control measures had been introduced. The home was clean and odour free and there had been an increase in domestic hours to maintain cleanliness.

Training was being provided to support the staff to deliver safe and effective care and support. Staff training needs was being routinely assessed and planned for, and staff received regular supervision.

Staff we spoke with were aware of the principles of the Mental Capacity Act 2005 and the De

We carried out an unannounced inspection of White Ash Brook on the 26, 27 and 31 August 2015 and 14,15,16 September 2015. This was the first inspection of the service since the registration of White Ash Brook (Accrington) Limited in April this year.

White Ash Brook Nursing Home is a purpose built home registered to provide nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms located on the ground floor. Communal lounges and dining rooms are also on the ground floor. The gardens are easily accessible to people using the service. The home is situated in the small town of Oswaldtwistle and close to local amenities. There is a car park for visitors and staff.

There was a registered manager in day to day charge of the home. 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.’

Before this inspection we had received concerns regarding inadequate staffing levels and details of how this was impacting on the care people were receiving. During this inspection we found staffing levels were not sufficient to ensure people’s care and welfare. People told us they felt safe in the home and they were treated well by staff. However people also told us they did not get the attention they needed when they needed it. This had impacted on their well-being and we saw occasions during our visit where people’s dignity had been compromised as a result. You can see what action we told the provider to take at the back of the full version of the report.

Before this inspection we had received concerning information in relation to medication errors. During this inspection we found there were shortfalls in the ordering, administration and disposal of people’s medicines that could result in mishandling or error. One person we spoke with told us they had concerns as to the time they got their medicines. You can see what action we told the registered provider to take at the back of the full version of the report.

During this inspection we found infection control was not being managed appropriately. This meant people were at increased risk of contracting an infection. You can see what action we told the registered provider to take at the back of the full version of the report.

Before this visit we had received concerning information about incidents of assaults that had occurred in the home between people who were living with dementia. Whilst these had been dealt with at the time of our visit, we found managing risk overall was not sufficient to ensure people were cared for safely. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff we spoke with were aware of their responsibilities to safeguard people from abuse and were confident to report any such concerns. Principles of the Mental Capacity Act 2055 (MCA) had not been fully embedded into practice and we found some concerns over how best interest decisions were handled. We have made a recommendation regarding this.

Before this inspection we had received concerning information people did not get a drink mid-morning and in the afternoon. People we spoke with told us staff did not always give them a drink, although one person said they could have a cup of tea at any time. Meals served were nutritious and portions served were generous. However not everyone who needed assistance to eat and drink was given this support. Supervision people needed during meal times was poor. We had concerns how nutritional monitoring was carried out. You can see what action we told the registered provider to take at the back of the full version of the report.

Staff providing care and support for people were not adequately supported to undertake their role effectively. We found they were not regularly supervised, appraised or trained in more specialist care to support them and make sure they were confident, safe and competent to provide people living with these conditions with effective care. You can see what action we told the registered provider to take at the back of the full version of the report.

We found people’s charts had gaps in recording which made it difficult to determine whether they were receiving their care safely and appropriately. We also found care plans and risk assessments were not properly completed. We were told new documentation was being introduced which would improve this. You can see what action we told the provider to take at the back of the full version of the report.

All but one care plan we looked at provided staff with sufficient information to care for people properly and staff told us they did not routinely read these. Communication regarding people’s care was not effective to ensure staff were kept up to date with people’s needs. You can see what action we told the registered provider to take at the back of the full version of the report.

The number of shortfalls we found indicated quality assurance and auditing processes had been ineffective. There was evidence of limited monitoring and support from the registered provider to ensure the registered manager was achieving the required standards in the day to day running of the home. Checks on systems and practices had been completed by the registered manager but matters needing attention had not always been recognised or addressed. This meant the registered providers had not identified risks to make sure the service ran smoothly. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.