This inspection took place on 31 October 2018 and was unannounced. This means no-one connected to the home knew we were visiting that day.

Ash House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ash House is registered to provide accommodation and personal care for up to 40 older people, some of whom are living with dementia. At the time of the inspection there were 27 people living at the home. The service is a detached building in its own grounds and divided into two units. Beech Walk unit specialises in care for people living with dementia. Beech View unit is a residential unit. There are two double and 36 single rooms. Communal lounges and dining rooms are provided on both units.

Our last inspection at Ash House Residential Home took place on 14 September 2017 and we rated the service requires improvement overall. We found the service was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents. When we completed our previous inspection in September 2017 we found the registered manager was not always submitting notifications to the CQC every time a significant incident had taken place. At this inspection we found the service had made sufficient improvements to meet compliance with this regulation. However, other aspects of the service provision had deteriorated since the previous inspection and we found two breaches of regulation and the rating remains requires improvement. We have also made three recommendations to the provider where we expect improvements.

There was a manager at the service who had been in post since June 2018. The manager informed us it was their intention to be registered with the CQC. 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 and associated Regulations about how the service is run.

People living at the service told us they felt safe. Staff were aware of their responsibilities in protecting people from abuse. We found systems were in place to make sure people received their medicines safely so their health needs were met. Regular checks and audits to medicines management were undertaken to make sure full and safe procedures were adhered to. On the day of the inspection we found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. However, we have had asked the provider to make improvements to the consistency of staff at the home.

The service worked collaboratively with external health services to promote people's wellbeing. People’s care records contained detailed information and reflected the care and support being given. All staff told us they enjoyed working at the service and had received support and supervision to help them to carry out their support role effectively. However, we found gaps in some care staff members training records, which meant we could not see clear evidence they had the right skills and knowledge for the role. 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 support this practice. We found people’s nutritional needs were met.

During the inspection we observed staff treated people with respect and dignity, and staff supported them in a way which met their needs. We received mixed feedback about the quality of the activities provided and people said there were limited opportunities for meaningful social opportunities.

There were systems in place to monitor and improve the qu

Ash House is registered to provide personal care and accommodation for up to forty older people. The home is a detached building in its own grounds. The home is divided into two units. Beech Walk unit, which cares for people living with dementia and Beech View unit, which is the residential unit. There are two double and thirty six single rooms. Communal lounges and dining rooms are provided on both units. An outside seating area overlooking the grounds is provided. It is in the Dore area of Sheffield. At the time of the inspection the home was providing care for 33 people, some of whom were living with dementia.

At the time of our inspection the home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Our last inspection at Ash House took place on 5 and 9 September 2016. The home was rated Requires Improvement overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of these regulations.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Seven Hills Nursing Home on our website at ‘www.cqc.org.uk’.

This inspection took place on 14 September 2017 and was unannounced. This meant the people who lived at Ash House and the staff who worked there did not know we were coming.

People spoken with were very positive about their experience of living at Ash House. They told us they were happy, felt safe and were respected.

We found systems were in place to make sure people received their medicines safely so their health was looked after. PRN (as and when needed) medicine protocols were in place to ensure staff knew when PRN medicine was required. However, we found stocks of expired prescribed nutritional supplements had not been disposed of appropriately.

Staff recruitment procedures ensured people’s safety was promoted. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment.

We saw the service had a general fire evacuation plan in place. Individual support needs to evacuate the building safely had not been identified to make sure risks to people’s safety had been mitigated.

Staff were provided with relevant training, which gave them the skills they needed to undertake their role. We found staff were receiving regular supervision and appraisal at the frequency stated in the registered providers own procedures.

Sufficient numbers of staff were provided to meet people’s needs. We saw staff responded in a timely way when people required assistance. However, we found during busier periods, such as lunch, staff were not always deployed effectively.

People’s individual needs were not currently met by the design, adaptation and decoration of the service. However, we saw a refurbishment plan was in place and work had already commenced at the service. The plan included things like improvements to the lighting in the Beech Walk lounge so it was more dementia friendly, which would be completed by October 2017. Other actions included the replacement of existing carpets in bedrooms on the residential unit and replacement of bedroom flooring on Beech Walk unit with cushion flooring. This plan was over an 18 month period and all actions would be completed by March 2019.

We looked at care records and found they contained detailed information and reflected the care and support being given.

The inspection took place on 5 and 9 September 2016 and was unannounced on the first day, which meant the provider did not know we were coming. We last inspected the service in July 2014 when it was found to be meeting the regulations we assessed.

Ash House provides personal care and accommodation for up to forty older people. The service was divided into two units. Beech Walk unit, which cared for people living with dementia and Beech View unit, which was classed as the residential unit. There were two double and thirty six single rooms. Communal lounge and dining rooms were provided on both units. An outside seating area overlooking the grounds is provided. The home is a detached building in its own grounds. It is situated in the Dore area of Sheffield. At the time of the inspection the home was providing care for 36 people, some of whom had a diagnosis of dementia.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The current registered manager is in a temporary position since February 2016 until a new manager is recruited.

People told us they felt the home was a safe place to live. Systems were in place to protect people from the risk of harm. Staff were knowledgeable about safeguarding people from abuse, and were able to explain the procedures to follow should there be any concerns of this kind.

At the time of our inspection we found there were adequate staff on duty to meet people’s care needs in a timely manner. Although staff told us that at weekends and at night it could be busy. They said during the week they had the assistance of the registered manager and the activity coordinator, who did not work at weekends.

The registered manager told us they did not have or use a staffing dependency tool. This would determine people’s so they were assured there were adequate staff on duty at all times to meet people’s needs based upon their level of dependency. Some of the care records we saw lacked detail, were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where there was no care plans in place, so staff were not aware of people’s needs and how to meet them safely.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. However, we found these systems were not always followed and people did not always receive their medication as prescribed.

The manager was aware of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. We found some improvements were still required to ensure mental capacity assessments and best interest decision records were more individualised and decision specific.

We found staff approached people in a kind and caring way. However, some of the interactions we observed were task orientated. Signage around the home was not dementia friendly. Notice boards were not kept up to date and menus were not always displayed.

People were supported appropriately to eat and drink sufficient to maintain a balanced diet and adequate hydration. However we found the meal time experience was not as pleasant an experience for people who were living with dementia, as it was for others.

We saw the provider followed safe recruitment procedures to ensure people employed to work with vulnerable people were fit to do so. However, we found staff had not received supervision in line with the provider’s policies.

The company’s complaints policy was available to people using or visiting the service a

On the day of the inspection an adult social care inspector visited the home. There were thirty two people living at the home. The home has a residential unit and a dementia unit. We spoke with five people and four relatives during the inspection. We also spoke with the registered manager, five care workers and a member of the kitchen staff. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found-

Is the service safe?

People spoken with told us staff treated them with dignity and respect. People told us they felt “safe” and did not have any concerns.

Staff were clear about what their roles and responsibilities were and the action they would take if they saw or suspected any abuse. We found the service had a copy of the local protocols and followed them to safeguard people from harm.

The manager operated an effective recruitment procedure and carried out the relevant checks when they employed staff.

The home had access online to the proper policies and procedures in relation the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager told us the local authority was providing further training and guidance. To ensure the home only deprived someone of their liberty in a safe and correct way and that this was only done when it was in the best interests of the person.

Is the service effective?

People’s health and care needs were assessed with them and/or their representative and where able they were involved in writing their care plans.

People’s relatives and representatives were kept informed of their family member’s wellbeing and invited to attend care plan and GP reviews. We saw evidence on people’s care records that they had been referred to other health professionals when needed.

Is the service caring?

During the inspection we were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Therefore we used a formal method to observe people in two of the lounge areas. Staff treated people in a caring and supportive way. In the dementia unit we observed some people finding comfort stroking toys, cuddling dolls and undoing knitting. We also observed staff using these items to interact with people and to provide comfort.

People told us they were satisfied with the quality of care they had received. Their comments included: “the staff are not bad at all, can’t grumble”, “the staff notify the GP if you are not well” and “they [the staff] are caring people”. People told us they were encouraged to come and have their meals in the dining area and they were given a choice about what they would like to eat.

Relatives were satisfied with the quality of care their family member had received. They also made positive comments about the staff. Their comments included: “the staff are fabulous”, “staff are very friendly”, and “very happy with the quality of the care”.

Is the service responsive?

A copy of the service’s complaints procedure was displayed in the reception area of the home. People and/or their representatives told us if they had any concerns they would raise these with the manager.

People told us staff responded promptly when they used their call buzzer’s to call for assistance during the day or night.

Relatives spoken with told us staff kept them fully informed when there were changes in their family member’s wellbeing.

Is the service well led?

We saw there was a range of quality monitoring checks in place to make sure the manager and staff learned from the findings of checks.

Staff training was being monitored and a comprehensive system was in place to highlight when staff refresher training was due.

The home held regular resident meetings and completed relative’s surveys. This showed the home actively sought the views of people or their representatives to improve the quality of service provided.

The home had a happy, relaxed and pleasant atmosphere. We found the bedrooms, toilets, bathrooms, lounge and dining area clean and tidy and free from any unpleasant odours.

Comments from relatives included “The place is always spotless” and “There are no smells which is important”. We found the people using the service happy and well cared for. Comments included “It’s a lovely place” and “the staff are extremely good to us” and that they could not wish for better care.

We observed that people were treated with respect and dignity and the staff were kind and considerate in their conversations with service users. The staff knew people well and were aware of how to respond to them. We saw that any requests made by service users about their welfare were accommodated where possible.

People using the service told us of the various activities they were involved in. These included listening to music and playing board games and chatting to other residents. One service user told us that if they asked the staff they would take them out. Another commented “The staff will not let us go out on our own; they like to be with us”.

We observed that the home had recently celebrated Remembrance Day which people using the service told us they had enjoyed very much.

People told us that their opinions were sought so that they were involved in decisions and that they had choice. Where people were able to they had signed the consent form in their care plan.

The three relatives and the advocate we spoke with told us they were very satisfied with the quality of care at the home. Their comments included: “It’s really, really good.” “It’s marvellous, the manager, the staff are excellent.”

We observed staff providing reassurance and care to people. People we spoke with made positive comments about their care and the staff. Their comments included: “Staff are very respectful.” “Staff do understand when people have their ups and downs”

We saw that people in the home benefited from equipment that was comfortable and met their needs.

We found that the home had appropriate staffing levels and could respond to unexpected absences. We spoke with two district nurses who had no concerns regarding the staffing levels in the home. Their comments included: “On the whole the staffing levels are good.” “The care here is superb.”

We found that staff had received training and were supervised but that some staff training in safeguarding was overdue. We saw evidence that staff had the opportunity to develop and improve their skills.

We also saw that the home had provided people with information about how to complain. All the people we spoke with told us that if they had a concern they would speak to staff or a relative.

People told us that they were happy living at the home and satisfied with the care and support provided. Their comments included:

“It’s not bad here compared to some places.”

“They (the staff) leave you in peace. They don’t go on at you all the time.”

“There is always enough staff to help. They are all very nice. I can’t grumble.”

People told us that they were happy living at the home and satisfied with the care and support provided. Their comments included:

“It’s not bad here compared to some places.”

“They (the staff) leave you in peace. They don’t go on at you all the time.”

“There is always enough staff to help. They are all very nice. I can’t grumble.”

A number of people who lived at Ash House have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. People that were able told us that overall they were happy living at the home and satisfied with the level of service provided.

Individual comments included

“the food was lovely”.

“there is plenty to eat and we always have a choice”

“the rooms are comfortable and there is everything in them that I need”

“the home feels very homely”

“I get my tablets every morning”

“If I need tablets for pain they bring them straight away”.

When asked residents said that they had enjoyed their lunch.

Relatives spoken to said that they were pleased with the care provided. Individual comments included

“I feel as though I can go and talk to the staff or manager at any time”

“the food is fantastic”.

Some concerns were raised by staff that on a number of occasions there was not enough staff on duty at the home, which affected the levels of care they could provide to the people using the service. Staff also commented that they thought that the environment of the home needed upgrading.