Ash House is run by Age UK Somerset who have been contracted by the Somerset Partnership Foundation Trust to provide a toe nail cutting service for people in Somerset. People assessed by Somerset Podiatry service as not requiring health care intervention, but who cannot manage to cut their own toenails, have the option to receive that service from Age UK Somerset. This can be in clinics (which were not included in this inspection), or in their own home if they are housebound. The service is administered from Ash House and comprises a supervisor and team of toe nail cutters. 98 People were using the service at the time of this inspection.

Rating at last inspection

At our last inspection, we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good

Robust staff recruitment procedures protected people from harm. The service understood how to protect people from abuse and discrimination.

The staffing arrangements were flexible and the toe nail cutting assistants arranged appointments according to people’s individual needs, which promoted people’s comfort and safety.

People were protected from infection and cross contamination when receiving the toe nail cutting service.

Toe nail cutting assistants were trained to be alert to health conditions which might pose a risk to people, and make appropriate referrals. A podiatrist said that the referrals they received from toe nail cutting assistants were always appropriate.

Toe nail cutting assistants understood that people should consent to receiving the service and how to respond if consent was not provided.

People were treated with respect and dignity. Kind and friendly rapport helped people feel valued and people said how much the service helped them maintain their independence. One person’s family member said, “They help (the person) and me as well.” People’s views were sought through the service supervisor visits and feedback questionnaires. The one complaint relating to the toe nail service in people’s homes had led to positive change.

People, and toe nail cutting assistants, were protected through records of the care they received, and any issues which might pose a risk. The standard of record keeping, and information from the records, was monitored to improve the service, as was any incident which occurred.

Toe nail cutting assistants received observation supervision and there were plans to provide face to face supervision in a private setting, and a yearly appraisal. They said they felt supported and managers were always available to talk to.

The aims and objectives of the service, to improve the lives of people over 60, were uppermost in the culture and practice of the organisation.

Further information is in the detailed findings below.

This inspection took place on 06 January 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to talk with people receiving a service.

The service provided from Ash House is run by Age UK Somerset and is registered to provide a toe nail cutting service in clinics and people’s own homes. The Care Quality Commission regulates the toe nail cutting service provided to people in their own homes.

The last inspection of the service was carried out in September 2013. No concerns were identified with the service being provided to people at that inspection.

There is 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.

During our inspection we gained the views of people and staff employed by the organisation by talking to them over the telephone.

People told us they received a safe and reliable service from staff who were trained to provide a service that met their needs. The staff team was well established which meant people received a service from staff they knew and had been able to build up a relationship with. Appointments were made in advance so people were able to make their own choice about when and at what time the service was provided. Staff would ring and check they were still available just before they visited.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns, and people who lived at the home said they would be comfortable to discuss any worries or concerns with the manager.

People were protected from the risk of cross infection as they were all provided with their own nail clippers and files. Staff did not use generic equipment and there were clear guidelines on cleansing clippers after use. For those people who did not want to keep their clippers in their own home, a storage system with labelled bags was used to ensure people’s toes were only cut with their personal clippers.

Staff monitored people’s health and ensured they were referred to their GP for any condition they identified. Staff always checked people with diabetes had received their annual foot check. If this had not taken place they contacted the appropriate health care professionals to make sure an appointment was made.

Changes in people’s health and medication were responded to as the service could not be provided to people on specific medication. If this occurred they would be referred to the podiatry team for a reassessment of their care needs.

There were systems in place to monitor the service provided and action was taken when shortfalls were noted. For example the organisation had introduced a system to record the actions taken and issues discussed during one to one supervision with staff.

The service had a complaints policy and procedure which was available for people and family members. People said they were aware of how to raise a complaint and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

At the time of the inspection approximately 50 people received the toe nail cutting service in their own home. Many more people visited clinics across Somerset which were also run by Age UK Somerset and operated by the same toe nail cutting assistants.

The Care Quality Commission regulated the toe nail cutting service when it was delivered to people in their own homes.

During our inspection we gained views from people who used the service by telephoning them. We tried to gain the views of 20% of people. We were told some people were not able to talk to us on the telephone. Some people had dementia and the service administrators liaised with relatives and carers to support them. We spoke with two relatives who confirmed they were pleased with the way the staff spoke with and treated their family members.

We spoke to ten people who were satisfied with the service they received. Everyone who spoke with us said staff were polite and kind. They told us staff were well trained and always arrived on time.

The service administrators ensured people knew who was coming to see them. They communicated with carers and family members if people needed additional support during the visit. People told us they knew when their next appointment was and who they expected to come and see them.

We asked people if they felt staff were well trained and confident in the treatment they provided. People told us they were able to rely on the assistants who came to see them to deliver a good service. One person said “They are very good. Very cheerful. I feel at ease with them.” People told us the staff “knew what they were doing” and it was “an excellent service”.

We spoke to a sample of seven people who were very positive about the service that they received from the toe nail cutting assistants in their own homes. Everyone who spoke with us said that staff were polite and considerate. People were able to contact the office if they needed to change their appointments.

The service ensured that people receiving a service in their home knew who was coming to see them.

We asked people if they felt that the staff were well trained and confident in the treatment that they provided. We were told that they were “very good” and “very well trained.” One person said “I was amazed. She did my feet beautifully. I am very pleased with the results.”

We found the service to be well organised. Staff were supervised regularly to ensure that people's feet were treated safely and according to prescribed good practice.