About the service:

Ash Tree House is a purpose-built facility in Hindley, Wigan. The service cares for people who have a dementia type illness and those who require only residential support and has the capacity for a maximum of 60 people to live there. At the time of the inspection there were 57 people using the service.

People’s experience of using this service:

Systems and processes regarding safeguarding were in place and staff continued to receive appropriate training.

Risk assessments were in place, reviewed and updated regularly and risks were well managed at the home. The service encouraged positive risk taking, supporting people to be as independent as possible.

The premises were safe and well maintained and medicines systems were safe.

There were robust recruitment procedures in place and staffing levels were sufficient to ensure people’s needs were met.

The premises were exceptionally clean and infection prevention and control measures were in place.

Initial assessments prior to admission were comprehensive. Care plans were complete and up to date.

Staff had a thorough staff induction programme, on-going training and refreshers and were knowledgeable and competent.

People told us they enjoyed the food and there were lots of choices. The mealtime was calm and unhurried and was a very happy, relaxed and enjoyable experience. Where diet and fluids needed to be monitored, this was done.

The premises were bright, airy and decorated to a high standard. The building was well-maintained and well-lit, there were coloured doors and some signage for ease of recognition and access.

Verbal consent was sought by staff when offering support and assistance. Consent was referred to within care plans.

The service worked within the legal requirements of the Mental Capacity Act (2008) (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Equality and Diversity was embedded within the service’s induction programme and individuals were treated in a fair and equitable way.

There was evidence within the care files that people were fully involved in the planning of their care and support, where they were able.

People were treated with dignity and respect. The service was aware of the legal requirements of the General Data Protection Regulation (GDPR) and the need for confidentiality.

People were given full choice and control over their lives where possible.

Activities at the home were chosen by people who used the service in consultation with the lifestyle manager and there was a huge range of activities and outings on offer.

The complaints procedure was made available to everyone in the home and was on public display in the reception area of the home. Complaints and concerns were dealt with appropriately and we saw a number of compliments.

End of life wishes, where these had been expressed, were recorded within people’s care records and the service was committed to building staff skills in specialist areas, including end of life care.

People felt the service was high quality and person-centred. Staff felt well supported in their roles and told us training was plentiful and professional development was encouraged and supported.

The service had a registered manager in place, as required. CQC notifications of significant events that the service is required to tell us about, were sent in as required.

Staff felt the registered manager was very approachable and hands on.

Quality assurance systems were in place, regular audits completed, and any actions and lessons learned noted.

The service worked well with other professionals. There was an all-inclusive policy at the home, meaning that no additional costs were required for extra services.

Rating at last inspection:

Our last inspection of Ash Tree House was in August 2016. The overall rating was Good, and this report was published on 21 September 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to chec

We carried out an unannounced inspection of Ash Tree House on 02 and 04 August 2016.

The home was last inspected on 10 September 2014 when the service was found to be meeting all regulatory requirements.

Ash Tree House is a purpose built facility in Hindley, Wigan and can accommodate up to 60 people. The service cares for people who have a dementia type illness and also those who require only residential support. It is well furnished to a high standard over three floors, serviced by passenger lifts, with each bedroom having en-suite shower facilities. Additionally there are suitably adapted bathrooms, a hairdressing salon, ‘pub themed’ social room, socialising lounges and quieter areas.

At the time of the inspection the home 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.’

We saw that the home was clean with appropriate infection control processes in place.

All the people we spoke with told us they felt safe. We saw that the home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Staff we spoke with reported that there were not enough staff deployed at night to keep people safe. We were told that five staff were required to meet people’s needs, however staff told us that on occasions only four had been allocated. We were informed by the registered manager that this had only occurred due to sickness. We have made a recommendation that the service reviews staffing levels at night.

Both the registered manager and staff we spoke to had knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their own best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the provider had followed the requirements in the DoLS and that related assessments and decisions had been properly taken.

Robust recruitment checks were in place to ensure staff working at the home had met the required standards. This included everyone having a Disclosure and Barring Service (DB S) check, full documented work history and three references on file.

We saw that medicines were managed and administered appropriately. We saw that the home had systems in place for the safe storage, administration and recording of medicines. We saw that staff who gave out medicines had their competency assessed before being able to do so and regular medicines audits were carried out.

Staff reported that they received a good level of training to carry out their role. We saw that all staff completed an induction training programme when they first started and that on-going training was provided to ensure skills and knowledge were up to date.

Staff also told us that they felt supported through completion of regular supervision meetings and team meetings which they were encouraged to attend and were held for all levels of staff.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. The feedback we received from both people who used the service and relatives was complimentary about the standard of care provided.

We looked at seven care files, which contained detailed information about the p

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

We asked the following five questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

The people who lived in the home were pleased with the care provided and felt their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One person said: "I do feel safe. It’s a quiet place.”

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults. Staff could identify potential abuse and knew how to report any suspected incidents of abuse. One person who lived in the home said: “I’ve never seen any unkindness.”

Is the service effective?

People told us they were happy with the care they received and their care records were up to date and signed by them where appropriate. One relative said: "She’s improved a lot since she came here. She’s blossomed." Care records confirmed people's preferences and needs had been recorded and care and support had been provided in accordance with people's wishes. One person said: "We can please ourselves. We are not dictated to."

We heard from staff information was shared effectively. Several ways of sharing information were used including staff meetings, handovers, the handover book, daily records and monthly reviews.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and encouragement when supporting people. One person said: "It’s my home. I really love it." Another person said: “Nothing is too much trouble.”

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs for support and treatment were carefully described so care workers knew exactly what tasks to undertake. Changes in people's care needs were reported to the deputy manager and they briefed care staff. A person who lived in the home said: "I’ve never waited for more than 30 seconds if I use the buzzer.”

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. We saw the results of customer satisfaction surveys completed over the last few months and we saw evidence that feedback from meetings had been acted upon. One person said: “I can’t praise it enough.”

Staff told us they were clear about their roles and responsibilities and were well supported. One said: "They are very responsive to our requests. She lets you get on with it but she’s there in the background if we have any problems." Another member of staff told us: “I’m very happy in my job. It’s a lovely environment.”