At our inspection we gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.
Is the service safe?
People's relatives commented positively on the service. They said they felt their family member was safe and well looked after. One commented they felt comfortable to visit less as they knew their family member was 'in good hands.'
We looked at the administration of medication during our review of Ashfield in January 2014. At that time we identified concerns in relation to prescribed medicines and medication records and a Compliance Action was issued.
At this inspection we found that concerns regarding medicines had been acted upon and the provider was now meeting this standard.
As part of our review we looked at medicine records for 13 people, medicine supplies and care plans.
Most of the people who used this service had their medicines given to them by the staff. We watched a member of staff giving people their medicines. They followed safe practices and treated people respectfully. People were given the time they needed to take their medicines. Arrangements were in place for people who liked to have their medicines earlier than the normal medication administration time and arrangements were in place to help ensure special instructions such as 'before food' were followed.
People we spoke with said they were comfortable in the home. They said it was clean and they had a nice room. Comments included: 'I have a lovely room.' and 'They keep on top of everything, decorating, new carpets, it's always nice.'
We carried out observations throughout the home and noted several areas which were not safe. For example, the conservatory was very warm in the morning even with the door open, there was no fan available to keep people cool. There was a pile of items including books on the floor which were a trip hazard.
On the first floor we saw there was a step in the middle of the corridor, this was not clearly visible and could present a hazard to people with poor eyesight. There was also a frayed carpet which the provider said was being replaced, however, we were unable to see documentation confirming this.
We looked in several bedrooms and found in three bedrooms on the first floor the windows did not have 'window restrictors' so could be fully opened. The risk to people had not been formally assessed so we could not be sure people were safe.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. (DoLs). The Registered Manager did not think anyone in the home was at risk of having their liberty deprived but agreed to review this in light of new national guidance that is currently available.
Is the service effective?
The majority of staff told us they received good training and were kept up to date. They said they got regular updates as needed. Staff spoke highly of their induction training and said it had prepared them well for their role. They said they had opportunity to work alongside senior staff during their induction and get to know how to carry out their job properly. They also said they had plenty of time to get to know the needs of the people who used the service. They said they were able to go through people's care records and become familiar with how the records worked. One staff member did not feel they got enough support when they first started work at the home. They said they did not have enough time to get to know how to care for people who used the service.
Some staff said they had received training in dementia awareness and others said they knew they had this training coming up. Staff were able to describe how their training had influenced their practice and the care they gave. They spoke of the need for clear, consistent communication and how they treated people as individuals.
We noted only four out of twenty four staff had completed training on the MCA and DoLS. The training administrator said there was an on-line course available for staff and she was in the process of allocating time slots to staff to ensure this was completed by all staff.
People who used the service or their relatives said they were involved in the development and on-going review of their care plans and risk assessments. They spoke about how staff discussed their care records with them and documented any changes. Relatives of people who used the service said they were always kept up to date on the welfare of their family member. People who used the service said they felt involved in decisions about their care. One said, 'They are always there to give the help you ask for.
Is the service caring?
People who lived in the home said they were pleased with the care and support they received. They said they were happy living at the home and all the staff were kind and caring. Comments included: 'It's all very nice here; a very good service.' 'You get all the help you need.' 'Can't fault them, they are giving all the time, work flat out and they are so patient with everyone.'
All the relatives we spoke with commented on how kind and patient the staff were. Other comments we received included: 'Staff are amazing and so kind.' '(name of person) always likes to wear a hat and staff make sure he has one every day.' 'Mum is always well presented and I feel she is well regarded by all the staff.'
We observed during lunch and found it to be a very pleasant and sociable experience. Staff were attentive to people's needs and were interacting with people whilst serving them their lunch. People were given choice and explanations of food. People who needed assistance were offered it in a sensitive way that met their individual needs.
Is the service responsive?
We asked people who used the service if staff responded promptly when they used their call bells. Everyone we spoke with said staff were always prompt and they never had to wait long when they needed assistance from staff. One person said it was common to wait a bit longer for assistance at busy times such as meal times and added that they thought the home would benefit from more staff at these times.
People who used the service said they had enough to do. They said they enjoyed the activities in the home. We sat in on the morning activities and could see people were occupied and joining in at their own pace and choice. There was a lively positive atmosphere.
Is the service well led?
Staff and people who used the service told us they thought the home was well managed and they had confidence in the Registered Manager and Provider. Staff said the Registered Manager and Provider were approachable and kept them informed of issues affecting the home.
However, two staff told us they were not always confident that issues brought to the Registered Manager were acted upon, for example, length of staff breaks, errors made with medication. We saw in staff meeting minutes that medication errors had been discussed and the Registered Manager had highlighted where improvements needed to be made.
We looked at records of staff meetings that had been held recently. These showed staff were given the opportunity to get together to discuss feedback from people who used the service and/or their representatives, care and support issues and any information updates from the organisation.