This comprehensive unannounced inspection was carried out on 9 and 10 August 2018. At the last inspection on 25 September 2015, the service was rated as ‘Good'. At this inspection we found the service was in Breach of Regulations 11, 12 and 17 and has been rated as ‘Requires improvement’.

Asher House 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 service is registered to support up to 20 older people, some of whom may be living with dementia. At the time of our inspection, 14 people were being supported at the service.

Asher House provides accommodation on two floors with access via a stair lift. It is situated in a quiet residential area in Walton on the Naze.

The service required, and did have, 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.

Risk assessments had been completed but we found they were incomplete, confusing and not sufficiently detailed to ensure staff knew how to deal with risks to people appropriately.

Medicines were not administered to people in a safe way. The medicines were handled in a way which did not follow good practice. Appropriate hygiene measures were not used when dispensing and giving medicines to people.

People’s capacity to make their own decisions and consent to their care and support was not always assessed and recorded. Systems to protect people’s human rights were not always in place.

Staff recruitment systems were in place. However, we found gaps in three staff members employment which needed to be verified to ensure they were safe to work with people at the service.

Staff undertook training in their roles and responsibilities but it was not always effective.

There was an infection control process in place. Despite staff not using protective gloves whilst administering medicines, staff used aprons and gloves and followed processes to minimise the risks from the spread of infection.

There were systems in place to regularly assess and monitor the quality of the service. However, not all areas of the service were checked and monitored in line with required legislation.

People, relatives, staff and health care professionals spoke positively about the service and the care provided. People and their relatives told us the service was a safe place to live.

Staff had received training in safeguarding adults from abuse and understood their responsibilities and the actions they should take if concerns were identified.

There were sufficient numbers of staff deployed to meet the care and support needs of people.

People had sufficient food and drink and were provided with choices at mealtimes. Where required, people were supported to access health care services to maintain their health and well-being.

People were treated with kindness, compassion and courtesy. Staff knew people well and were sensitive to their needs. People's independence was promoted and people were encouraged to do as much as they could for themselves. People were treated with dignity and respect and staff ensured people's privacy was maintained at all times.

People received a responsive service. The content and design of the care plans had been reviewed. The service was in the process of updating and completing them to make them more person centred which reflected people's current care and support needs.

The involvement and feedback from people and their relatives was actively encouraged. Social and leisure activities were individually tailored to people’s needs and people from the community provided

Asher House provides care for up to 20 older people who may be elderly and or have a physical disability. Some people are living with dementia. There were 12 people living in the service when we inspected on 24 September 2015.

The service 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.

People felt safe living at Asher House and spoke positively about the care provided to them. Staff were employed in sufficient numbers to meet the needs of people. Staff knew people well and treated people with kindness, dignity and respect. Relatives and friends were welcomed and visitors spoken with were positive about the service being provided and said they could visit at any time. They spoke about the relaxed and homely atmosphere and this was evident on the day we visited.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

Appropriate recruitment checks took place before staff started work. Staff received training and on-going support to help them perform their allocated job role.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to take their medicines as prescribed and were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People enjoyed their meals as a social occasion, and had access to a varied diet that took into account people’s preferences and any individual needs associated with health conditions or poor nutrition

People received care that was based on their needs as an individual. Efforts were made to identify people’s preferences in a wide range of areas and arrange care so as to meet those needs

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

The manager had created an open culture within the service, where people who used the service, and staff felt able to express their views about the service. There were systems in place to help ensure the safety and quality of the service provided.

Our inspection team was made up of one inspector who answered our five questions. Below is a summary of what we found. The summary is based on our conversations with the manager, two staff, three people who used the service, two relatives and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Staff had undergone a thorough recruitment and induction process and had also received appropriate training and guidance.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training in administering medication. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One relative said, "I feel that my relative is safe here, the staff treat my relative with respect."

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well. People we spoke with told us that, "Staff are well trained, polite and caring."

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One person who used the service said, "The staff always listen to me and respond positively if I have any concerns."

Is the service responsive?

The manager told us that they had regular contact with the relatives of people who used the service. Relatives we spoke with were very positive about the communication with them by the manager and the staff.

A visiting district nurse told us, “People who have tissue viability issues have healed very well because they received good nutrition and regular fluid intake.”

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw that the home ensured that the relevant health care professionals had been involved in assessing, planning and meeting people’s changing health needs.

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they had received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

During our inspection we used different methods to help us understand the experiences of people who used the service. If people were unable to tell us about their experiences, we used observation and noted people’s responses to staff. We saw that people appeared calm and relaxed.

People told us that they had been given the opportunity to visit the service prior to admission. Their consent had been obtained before any care or treatment had been given.

During our inspection we saw that staff were knowledgeable about people needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. One person who used the service told us: “The staff are lovely, they listen to me and take notice of me".

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service. Staff told us about the training they had received to enable them to carry out their roles in supporting people. Staff told us they felt supported by the manager.

We saw that regular audits of health and safety, medication and care plans and risk assessments had taken place and action was taken to address any concerns. An annual customer, stakeholder and staff survey takes place and the information is used to improve the service. The providers director carries out monthly audits and talks with the people who use the service to gain their views.

As part of this inspection we checked on the standards that were not met at our last inspection in June 2012. The areas needing improvements were care records, staff training, staff supervision and quality assurance. We found that the provider had made improvements since our last inspection. Additional staff training had been given, care records were improving and systems for auditing standards had been introduced. As a result we found that these standards were now met.

As part of our inspection of Asher House we had conversations of various lengths with five people living in the home and with three relatives, who were visiting at the time of our inspection. People and the relatives we spoke with during our inspection told us that they were happy with the standards of care and support provided. One person told us “They make you feel welcome and happy.” A relative said “This is a fantastic home. They can’t do enough for residents. It’s not regimented, it’s like a home.” People told us they appreciated the fact that staff supported them to maintain their independence. They liked the food and said that there were choices and alternatives if they did not like what was on the menu. They told us the home was kept very clean. One person said “I liked the home straight away when I first visited. The staff are very good, they give me help in the way that I like it. I’ve never had any concerns.”