The inspection took place on 2 June 2017 and was unannounced. At the last inspection on 11 June 2015 the registered provider was rated ‘Good’ and was compliant in all areas we assessed.
Ash Lodge Care Home is situated on a main road into Hull city centre. It is close to local amenities including shops, pubs, library, swimming baths and a park. The home is owned by a partnership and offers support up to 22 adults who have mental health needs. At the time of the inspection, there were 20 people using the service.
The service had a registered manager. 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. The registered manager also managed another service within the organisation. This meant they divided their time during the week between the two services.
During this inspection we had concerns about some aspects of the environment caused by domestic shortages and overall governance.
The dining room and some bedrooms required cleaning. External areas leading from both ends of the dining room required sweeping and tidying and more bins were required for the disposal of cigarettes ends. We found domestic and catering hours were insufficient.
There was no structured quality monitoring system. Some checks were carried out, for example on medication, everyday maintenance jobs, and care plans, which had been checked during their input into a new computer system. However, there had not been any environmental checks recorded and no evidence the registered manager and registered provider were aware of the issues we found with cleanliness and specific furniture. The environment was suitable for people’s needs, however some items of furniture needed replacement. This related to two settees, some bed bases and mattresses, a wardrobe and a dining table; these were ordered on the day of inspection. There had not been any questionnaires to people in 2016 apart from to four relatives and there was no action plan to record negative comments so it was difficult to see if they had been addressed.
You can see what action we have asked the registered provider to take regarding staffing and governance in the full version of this report.
We found staff knew how to keep people safe from the risk of harm and abuse. The registered provider had policies and procedures to guide staff and they had completed safeguarding training. Staff completed risk assessments for people and there were plans in place to help minimise risk whilst still ensuring people had control of their lives.
The recruitment process had some shortfalls in regards to ensuring people had references in place prior to the start of employment. The registered provider told us they would address this straight away. Other employment checks were carried out appropriately.
Staff supported people to be independent and ensured they gained consent prior to carrying out tasks. People who used the service all had the capacity to make their own decisions. Staff were aware of mental capacity legislation and had completed training in this.
Staff supported people to access community health professionals and monitored their general and mental health, offering advice when required and an escort to appointments.
People’s nutritional needs were met. Menus provided people with a nutritious diet with choices and alternatives. Drinks and snacks were served throughout the day and people who used the service could help themselves to hot and cold drinks in the dining room.
People’s needs were assessed prior to admission and the registered manager formulated a care plan for each person. These helped to guide staff in supporting people in the way they preferred to be cared for. Some minor amendments were required to ensure all the information was included in care plans; this was mentioned to the registered manager to address. As they were in the process of transferring paper records to computerised ones, they told us this would be completed straight away. One of the directors of the organisation is an approved mental health practitioner and told us they were supporting the registered manager with updating the care plans.
People told us the staff treated them well and had a caring approach. We observed staff had developed good professional relationships with people who used the service. There were activities for people to participate in and staff encouraged people to pursue their own hobbies and interests; staff supported people to access community facilities. An enablement co-ordinator was employed two and a half days a week to support people with activities of daily living and to help prepare them for a move to more independent accommodation.
We saw staff had access to training, supervision and on-going support. This enabled them to feel confident when supporting the people who used the service.