Ash Grove

Ash Grove is a residential care home registered to provide accommodation and nursing care for 48 people. There were 32 people accommodated in the home at the time of the inspection. The home is set in its own grounds in a residential area of Burnley. Nursing care was not provided in the home at the time of the visit.

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

People told us they felt safe living in the home, and they were happy with the service provided. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. We found shortfalls in the recruitment of new staff. The provider and manager took immediate action to address these issues. Risk assessments enabled people to retain their independence and receive support with minimum risk to themselves or others. People were protected from the risks associated with the spread of infection. The premises had a satisfactory standard of cleanliness.

People received their medicines safely and were supported to maintain good nutrition and hydration. 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’s needs were assessed prior to them using the service. The provider had appropriate arrangements to ensure staff received training relevant to their role. New staff completed an induction training programme. Staff felt supported by the management team.

Management and staff had developed friendly, caring and respectful relationships with people living in the home. People were treated as individuals which helped protect their dignity. People's equality and diversity was respected, and care was tailored to their needs, routines and preferences. Staff knew people well.

People were happy with the way the service was managed and staff told us they enjoyed working at the home. The management team monitored the quality of the service provided to help ensure people received safe and effective care. People asked for more opportunities to provide feedback about the service. The manager therefore agreed to increase the frequency of residents’ meetings. The manager was supported by the provider.

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 8 January 2021).

Why we inspected

We received concerns about care practices and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Ash Grove on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Victoria Care Home is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

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

People told us they felt safe living in the home and staff were kind and caring. Staff understood how to safeguard people from abuse and report any concerns. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from the risks associated with the spread of infection. Medicines were managed safely in the home.

Effective systems were in place to ensure lessons were learnt from any incidents and the registered manager understood their responsibility to be open and honest when something went wrong.

All people had a care plan which detailed their needs and preferences. The registered manager had ensured all staff had ready access to up to date information about people’s needs. People were provided with appropriate activities and had access to a complaints procedure. Staff had good relationships with the people living in the home and we observed staff responding to people’s needs with kindness and respect.

The provider, registered manager and staff had worked hard to address the shortfalls found at previous inspections and were confident the improvements would be sustained. The registered manager carried out a number of audits to check the quality of the service. They provided clear leadership and took into account the views of people, their relatives and staff about the quality of care provided. The registered manager and staff used the feedback to make ongoing improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 March 2020) and there were two breaches of the regulations identified in relation to the management of medicines and the deployment of staff. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 17 and 18 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show how they intended to improve the service.

We undertook this focused inspection on 16 December 2020, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-Led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the all reports’ link for Victoria Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Victoria Care Home provides accommodation and personal care for up to 48 people. The home is set in a residential area in Burnley. Accommodation is provided in single rooms over three floors. A passenger lift provided ready access to all floors. At the time of the inspection, there were 23 people accommodated in the home. The third floor was not in operation.

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

People told us they felt comfortable and safe living in the home. The staff understood their responsibilities to raise concerns and report incidents or allegations of abuse and had received training. However, there had been a seven day delay in reporting one allegation of abuse to the local authority. While staff had carried out risk assessments, we noted risk assessments had not been carried out in respect of risks posed by one person’s distressed behaviours. The provider operated an effective recruitment procedure, however, there were not always enough staff on duty to meet people’s needs. The nominated individual assured us the staffing levels would be reviewed. Staff were not provided with adequate documentation or training to ensure medicines were managed safely. Cleanliness and hygiene were maintained throughout the home, which reduced the risk of infection.

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. The provider had appropriate arrangements to ensure all staff received training relevant to their role. However, one new member of staff, who was working unsupervised had not completed any induction training. We also noted two agency staff members had not completed the provider’s induction training for visiting staff. The nominated individual addressed this issue during the inspection. People’s needs were assessed prior to them moving into the home. People were provided with a nutritionally balanced diet. People were supported to maintain their health and two visiting healthcare professionals provided positive feedback about the staff team and their management of healthcare needs.

Staff treated people with kindness and respect and spent time getting to know them and their specific needs and wishes. Our observations during the inspection, were of positive interactions between staff and people who lived in the home.

All people had a care plan which detailed their needs and preferences. Whilst established staff knew people well, there was a delay of seven days before a plan was developed for one person with complex physical and communication needs. The staff did not have ready access to some care plans and none of the care staff had read the plans. We have therefore made a recommendation about ensuring staff are fully aware of people's care plans. People were provided with appropriate activities. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.

The provider’s systems to review the quality of care were not always effective. We found various shortfalls in the operation of the service. Audits were completed by the registered manager and representatives of the provider. Action plans had been drawn up to respond to any shortfalls. The nominated individual made immediate arrangements to address the issues identified during the inspection.

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 requires improvement (published 21 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the rating.

Enforcement

We have identified breaches in the regulations in relation to the management of medicines and the level of staffing. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Victoria Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection, all people were accommodated on the ground floor. There were 20 people accommodated in the home.

The manager was appointed in October 2018 and was in the very early stages of registration with CQC, to become the 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.

We carried out the last comprehensive inspection on 20 and 21 November 2017 and assessed the service as overall ‘requires improvement’. We identified four breaches of the regulations in respect of the management of medicines and complaints, the implementation of the Mental Capacity Act and the lack of effective quality assurance systems. We issued two warning notices in relation to the management of medicines and the governance systems. At this inspection, we found the provider had made the necessary improvements and they were compliant with the requirements of the notices.

This is the fourth time the service has been rated as requires improvement. However, there was an upward trend at the service and there were clear improvements since the last inspection. The provider was no longer in breach of the regulations. At this inspection, we have made two recommendations about improving people’s dining experiences and ensuring people are fully involved in the development and review of their care plan.

People using the service told us they felt safe and staff treated them with respect. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Risks related to people's lives and wellbeing were assessed, monitored and reviewed to support people's safety. Risk assessments were detailed and contained information to help staff understand and manage any identified hazards. There were sufficient numbers of staff deployed to meet people's needs. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work with vulnerable adults. People received their medicines when they needed them from staff who had been trained and had their competency checked.

Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and were up to date with the provider's mandatory training. 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’s healthcare needs were monitored as appropriate and staff worked closely with social and healthcare professionals.

People were provided a varied nutritious diet and were offered a choice of food. However, the staff did not always provide effective supervision and there was limited social interaction. The manager had also identified the meal time arrangements as an area for development.

Staff treated people in a respectful and dignified manner and people's privacy was respected. We observed people were happy, comfortable and relaxed with staff. Individual care plans and risk assessments were reviewed on a regular basis; however, people were not always consulted about their care and were not involved in the reviews. People were encouraged to remain as independent as possible and were supported to participate in a variety of daily activities. People were also offered the opportunity to go on regular trips in the community.

The manager had established systems and processes to monitor the quality of the service. However, these need to be fully implemented and sustained over a period of time.

The Victoria Residential Home 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. The care home accommodates up to 48 people on three floors. At the time of the inspection, there were 26 people accommodated in the home. There were no people accommodated on the top floor. The first floor of the home specialised in providing care and support for people living with dementia.

At the time of our inspection, the service did not have 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. The previous registered manager had left the service in August 2017. The current manager had been in post since 25 September 2017.

At the last inspection on 6 and 7 June 2017, we asked the provider to take action to make improvements to management of medicines, the levels of cleanliness and the maintenance of people’s records. We also issued a warning notice in respect of the deployment of staff. Following the inspection, the provider sent us an action plan and told us they would make the necessary improvements by 31 October 2017.

During this inspection, we found the level of cleanliness had improved, the staffing levels had been increased and there had been some improvements in the maintenance of people’s care records. However, we identified there was a continued shortfall in the management of medicines and found two further breaches of the regulations in respect to the management of complaints and the governance systems to assess, monitor and improve the service. We also repeated our recommendation in respect to the implementation of the Mental Capacity Act 2005.

The home was rated as inadequate in February 2015 and requires improvement in June 2015 and June 2017. This is therefore the fourth occasion the provider has failed to meet the regulations.

People told us they felt safe and comfortable in the home. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. However, we saw no evidence of safeguarding investigations. Staffing levels had been increased and according to the rotas the level of staff was consistent across the week and weekend. However, on the first day of the inspection the senior staff allocated to the first floor was given other duties and was therefore not able to supervise the staff. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

People’s medicines were not managed safely.

All areas of the home seen had a satisfactory level of cleanliness and there were arrangements in place for the maintenance and upkeep of the premises.

There was a system in place for recording accidents and incidents. However, there were no records seen for June, July and August 2017 and there was no analysis seen of incidents, which occurred during this time. Further to this, the provider sent us copies of monthly analysis forms for this period on 10 January 2018. We were also informed the manager was analysing the data for any potential trends.

Staff told us they were provided with appropriate training, however, the staff training matrix was not up to date. This meant it was difficult to determine what training staff had completed. Staff felt supported by the manager; however, some staff had not received a supervision since our last inspection.

People had choice and control over their lives and staff supported them to be independent in the least restrictive way possible. We found some mental capacity assessments had been carried out to assess people’s capacity to make specific decisions. However, there were some files where these assessments were not evident. The manager was unaware of the number of DoLS applications submitted and we noted there had been no action taken to meet the conditions associated with one person’s DoLS authorisation.

People were satisfied with the food provided and had access to healthcare services as necessary.

People told us the staff were kind and caring. People were relaxed in the company of staff and the home had a warm, friendly atmosphere. There were no restrictions placed on visitors. All people had an individual care plan, which was supported by risk assessments. Whilst some people’s plans had not been reviewed in line with the provider’s policy, we did not determine any negative impact on people’s care. People had access to a variety of activities both inside and outside the home. People spoken with told us they enjoyed the activities particularly the trips to places of interest.

There was a complaints procedure in place and people and their relatives felt confident in raising any concerns. However, the provider had failed to manage complaints in an effective manner.

Whilst the manager, told us they were committed to making improvements, the provider had failed to assess, monitor and evaluate the quality of the service.

The Victoria Residential Home is registered to provide accommodation and personal care for up to 48 older people. The home is a converted hospital set in its own grounds within a close distance of Burnley town centre. Accommodation is provided on three floors, however at the time of the visit there was no one living on the top floor. The ground floor provides personal care for older people and the first floor provides care for people living with dementia. The home is spacious and has car parking facilities at the front of the building. At the time of the inspection there were 32 people living in the home.

The service was managed by 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.

On our last inspection on 14 and 15 July 2015, we found one breach of the regulations. This was because the information in people’s care plans was brief and lacked detail. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulation. During this inspection, we found some improvements had been made and the registered manager had implemented a new care planning system. However, we also found a number of shortfalls in the management of medicines, the deployment of staff, the levels of cleanliness and the maintenance of records. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concern found during inspections is added to reports after any representations and appeals have concluded. We also made recommendations about the implementation of the Mental Capacity Act 2005, improving some aspects of the internal and external environment and ensuring evidence is available to demonstrate the quality monitoring checks undertaken by the provider.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. Individual risks had been assessed and documented; however, we found information from the risk assessments was not always reflected in people’s care plans. This is important to ensure staff have accurate information about people’s current needs. Since our last inspection, the registered manager had introduced a new care planning system. We noted that wherever possible people had been involved in planning their care.

There were shortfalls in the management of medicines. We noted medicines were not always stored, administered and disposed of appropriately.

We noted there were insufficient staff deployed on the ground floor in order to meet people’s needs in a timely manner. The provider followed a robust recruitment procedure for the appointment of new staff. Staff were supported in their roles via a system of training, supervision and appraisal. All staff had the opportunity to attend meetings and provide feedback on the service. Staff spoken with told us they were well supported and had confidence in the registered manager.

Mental capacity assessments had been carried out and the registered manager had submitted Deprivation of Liberty Safeguard applications to the supervisory body. However, we found the assessments were not always person centred and lacked information about specific decisions.

Some areas of the premises and equipment did not have an acceptable level of cleanliness.

We observed people did not always receive appropriate support at meal times and people had mixed views on the quality of the food. The meal served on the day of the inspection looked hot and the portions were ample. People were asked if they wanted second helpings.

Staff adopted a kind and caring approach to people and respected their rights to privacy. People were supported to build and maintain their independence skills. There were no restrictions placed on visitors and they were made welcome in the home.

There was a complaints process in place and people were confident their concerns would be listened to and acted upon.

The registered manager used a number of ways to assess and monitor the quality of the service, which included feedback from people, their relatives and staff; however we found a number of shortfalls across the operation of the service. The nominated individual supported the registered manager and visited the home on a frequent basis. However, we saw no evidence to demonstrate what assessment and monitoring had been carried out by the nominated individual or his representative during their visits to ensure the service was meeting regulatory requirements. The registered manager was forward thinking and told us she was committed to making improvements to the service.

People spoken with were satisfied with the service provided, one person told us, 'I feel very well looked after and have no worries at all'. A relative spoken with was also complimentary about the service.

People's care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments. A new care plan format had been implemented, which provided more information for staff on people's needs and preferences.

People were provided with a variety of suitable and nutritious meals. People were given a choice each mealtime and we noted drinks and snacks were served throughout the day as well as other times on request.

The provider had notified the commission as necessary in line with the current regulations.

We found the refurbished areas met with regulatory requirements and the manager explained the safety arrangements in place for the planned refurbishment of the ground floor. People had been consulted about moving from the ground to the first floor.

Prior to the inspection, we received a report from the fire authority to confirm the fire safety arrangements were satisfactory. During the visit we looked at safety certificates for the electrical installations and the call system.

Having seen the safety documentation and viewed the first floor accommodation, we had no objections to the 11 people accommodated in the home moving to the first floor.

During the inspection, it was established there was a waste pipe from the kitchen discharging water into the cellar and an infestation of vermin in the same area. There had been no sightings of vermin in the main building.

Whilst arrangements were made to rectify these problems, we were concerned we had not been notified of these events in line with the Regulations. This is essential so we can ensure the provider has taken appropriate action to safeguard the people living in the home.

This was our first inspection of the home following a change of ownership. Over the last six months there has been significant building work to improve and refurbish the home. We found appropriate arrangements were in place to minimise any disruption to the current residents.

People told us they were generally satisfied with the service provided. One person said, 'I think this is a lovely place' and another person commented, 'I don't have any complaints'.

Each person had a plan of care which was designed to provide guidance for staff on how best to meet people's needs. Staff spoken with told us the plans were easy to follow. However, we found not all aspects of need were covered in the care plans.

People told us the food was generally 'alright' and said they enjoyed their meal on the day of our visit. However, we found there were limited communication systems between the cook and the staff, which meant the cook may not have been fully aware of people's dietary needs and preferences. We also found the menus sometimes offered limited choices. The manager informed us the menus were due to be reviewed and she was working on improving the kitchen arrangements.

Staff were provided with appropriate training opportunities and received regular supervision. Staff told us they were well supported in their role.

There were systems in place to monitor and assess the quality of the service, which included gathering the views of people living in the home.