Asher Care is a residential care home providing personal care for up to 25 people, some of whom are older people living with dementia and others have enduring mental health conditions. Nursing care is not provided at the home. This is provided by the community nursing service. At the time of our inspection there were 22 people living in Asher Care.

At the last inspection in January 2016 the service was rated Good overall. The ‘Responsive’ key question was rated ‘Requires Improvement’ due to lack stimulating activities available for people. We had made a recommendation to the provider for them to improve in this area. 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 ongoing monitoring that demonstrated serious risks or concerns. Action had been taken to improve people’s access to personalised, stimulating activities. 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.

Following our previous inspection in January 2016 action had been taken to improve the activities offered to people. People’s views were sought and staff ensured people had access to activities which met their personal needs and preferences. People were supported to remain independent and take part in activities such as flower picking and gardening.

The people who lived in Asher Care had a wide variety of needs and health conditions. People living in the home had been diagnosed with dementia, Korsakoff’s, mental health conditions such as bipolar disorder and alcohol abuse. The home was set over two floors, with bedrooms on each floor and two standalone flats in the rear of the building. These flats were used by people who were more independent but still needed staff support.

Staff received training in a number of areas and support from healthcare professionals. However, we identified that further improvements could be made with regards to providing training for staff relating to people’s individual mental health and needs relating to addiction. We made a recommendation for the provider to undertake a review of the training provided to ensure this met people’s complex needs.

The people who lived in Asher Care were provided with care that was person centred and met their individual needs. People made comments including, “I’m happy. I’m very happy” and “I can do what I want.”

People spoke highly of the staff who worked at Asher Care, with comments including; “They are marvellous”, “The staff are the best bit” and “They’re all wonderful.” Relatives made comments including, “They’re kind the staff” and “The staff are very lovely and very helpful.” Staff treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people spoke highly of the food at the home.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staffing numbers at the home were sufficient to meet people’s needs. Staff received regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put this into practice.

People who lived in Asher Care had a variety of needs and were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Where accidents and incidents had taken place, these had been reviewed and action had been

The Lindons is registered to provide personal care, without nursing care, for up to 25 adults. People living at the service are older and have physical and dementia care needs. During the inspection there were 20 people living at the service.

The inspection took place on 7, 19 and 20 January 2016 and the first day was unannounced. The service was last inspected on 25 November 2014 when it met the requirements relevant at that time.

There were two managers registered in respect of the service. 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 were told that one of the registered managers no longer worked at the service. The registered manager who was working at the service told us they would contact the other registered manager to remind them of the need to apply to deregister as manager.

Prior to the inspection we received concerns about the way infection control procedures at the home were affecting the health and welfare of people living at the home. There had been a fire in the laundry over the Christmas period and this had resulted in a change to the way laundry was managed at the home. There were also concerns that there was a lack of hot water in some bedrooms. Due to these concerns a scheduled comprehensive inspection was brought forward.

We discussed the situation with the registered manager, care staff and people living at the home. People told us they knew about the fire, but that it had not affected them in any way. Laundry was being taken to a local laundrette. Extra sheets and towels had been purchased to ensure there was a good supply. Staff told us there had never been a time when they had run out of either. Staff told us some items of personal clothing had been destroyed during the fire, but that these had now been replaced.

We had also received concerns that not all bedrooms had access to hot water. On the first day of our inspection we tested the water in all bedrooms and found that 15 of the 25 had either no hot water or the water was tepid. The registered manager told us they knew there was a problem and the heating engineer visited during our inspection. Staff told us that while some rooms had no hot water they had taken water from the bathroom to people’s rooms so that they could wash. They said people had still been able to have a shower or bath. Following the inspection the registered manager informed us the boiler had been replaced.

People did not benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. The was no regular programme of activities, but staff told us they did spend some time with people when not carrying out personal care tasks. The registered manager had already identified the lack of social activities and a staff member had been identified who was to increase the level of social interaction. They had begun to identify activities people might like. The reminiscence magazine ‘The Daily Sparkle’ was available for people to look at. A small ‘snug’ area had been redecorated and contained a small library. Plans were in place to use this area to hold film nights.

People’s needs were met by kind and caring staff. People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. One relative told us they thought staff provided “A good level of care”, and their relative “Always seems well cared for”.

Staff were responsive to people’s individual needs and gave them support at the time they needed it. One per

One inspector carried out this inspection. The focus of the inspection was to answer one key questions: is the service safe

We initially inspected The Lindons on 18 September 2014. We found concerns at this time in respect of how the home was meeting their requirements in relation to the management of medicines under the Health and Social Care Act 2008. We requested the provider send us a written action plan on how they were going to address the concerns raised. We also asked them to provide us with a date when they would have put these concerns right. They told us this would be by the 30 October 2014.

We inspected the home on the 25 November 2014 and looked at how the service had made improvements to the management of medicines at the home since the last inspection. We did not inspect any other outcomes during this inspection.

We spoke with one person who lived at the home and two of their relatives. We also spoke with the registered manager. A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Below is a summary of what we found. The summary is based on what we were told by the people we spoke with, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

The provider had made improvements to the management of medication and appropriate arrangements were in place to manage medicines safely since the last inspection. They had sent us an improvement plan clearly showing how the improvements had been made. The improvements had been made within the time schedule agreed between the providers and CQC. This meant that people were protected against the risks associated with medicines.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

There were 23 people living at The Lindons when we inspected, some of who were there for a short stay only. This was the service’s first inspection since the current provider was registered with us.

We looked around the home and spoke with nine people. We met five other people who spoke with us but who were not able to answer our questions fully because of their physical frailty or communication needs. We observed some of the support that people received from staff. We looked at care records, following up three people in more depth, and at records relating to the management or running of the home.

We spoke with the relative of another person who lived at the home, two visiting health professionals, six ancillary or care staff and the Registered Manager.

The manager was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Below is a summary of what we found. The summary is based on what we were told by the people we spoke with, including the staff, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

Care was planned and delivered in a way that was intended to ensure the safety and welfare of people who lived at the home. There was management of risks relating to individuals’ needs, such as to prevent malnutrition and falls, in part through the use of recognised assessment methods. People’s care was reviewed regularly, ensuring they continued to receive support they needed even if their needs changed. However, the provider did not have appropriate arrangements fully in place to manage medicines safely. This meant that people were not protected against the risks associated with medicines. A compliance action has been set for this, and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards. Relevant staff were trained to understand when an application should be made. People’s human rights were therefore properly recognised, respected and promoted.

Is the service effective?

People were positive about the support they received. One person commented, for example, “They talk to you and help with anything you want.” People looked content and at ease with the staff. The home’s annual quality assurance survey showed that the majority of respondents were satisfied with the support they received. We saw that staff received training, development and on going support, so that they could understand and meet people’s needs in the best way possible. Staff we spoke with evidenced that they understood people’s care and support needs, and that they knew them as individuals.

Is the service caring?

People told us that staff were respectful, listened to what they said, and treated them as individuals. One person added “You can have a laugh and a joke with them, which is nice.” Another said “The staff are quite fun. They do a good job.” A third commented “They’ve been very kind”, as other people reflected. People’s decisions about their daily activities were respected, such as where to spend their time. Their privacy and independence were supported, such as during personal care.

We observed that staff took time with people when approached by them or assisting them. They engaged with people in a friendly or calm way. The language in care records was appropriate, and reflected a caring attitude towards people and their needs.

Is the service responsive?

People’s needs had been assessed and reviewed, with care planned to meet their needs. Visiting health professionals told us that staff acted on their comments and followed their advice. We saw that people were given opportunities to discuss their care and care plan, which included their preferences, interests and diverse needs.

Records, our observations and conversations with people confirmed support had been provided that met their wishes. For example, people told us that staff responded quickly to call bells and to requests, such as for pain-relieving medication. Visitors were made welcome, enabling people to maintain relationships with their friends, relatives and others important in their lives.

Is the service well-led?

A variety of quality assurance processes were in place. Systems were also in place to identify and manage risks to the health and welfare of people living at the home and others. These included risk assessments and regular monitoring.

We saw that people had opportunities to give their views of the service through surveys and meetings. Action plans and our conversations with people or staff showed that people’s views were used to improve the service. People who had made complaints had been responded to, with action taken to address or rectify the issues they raised. Staff also told us that their views and suggestions were sought and listened to by senior staff.