Asquith Hall provides nursing and personal care for up to 53 people with dementia and mental health needs. The service is divided into two units: Willow unit on the ground floor which accommodates 25 people living with dementia, and Meadow View on the first floor which accommodates 28 people with mental health needs. There were 53 people using the service when we inspected.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe. Staff understood how to identify and report potential abuse, and there was a good culture of reporting incidents as required.

There were enough staff to provide safe care.

People’s medicines were well managed and stored securely.

Maintenance of the premises and servicing of equipment and fittings were up to date.

People were confident staff had the skills to provide effective care, and we saw training was kept up to date. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support ed this practice.

We saw the lunchtime meal was a relaxed experience for people, who were promptly assisted when needed. People could choose what they ate and told us they enjoyed the food.

Feedback about the caring nature of staff was consistently good. People were involved in care planning and review, and we saw staff had training to ensure people’s diverse needs were met.

People had access to a range of activities including trips to the local community and further afield. People went into the garden whenever they wished.

Complaints were managed well. The provider considered lessons that could be learnt from these.

We received positive feedback about the registered manager. There were systems in place to monitor and improve quality in the service, and we saw people, their relatives and staff were involved in these processes.

Further information is in the detailed findings below

This inspection took place on 17 September 2015 and was unannounced. We previously carried out a comprehensive inspection in July 2014 and rated the home overall as good with a breach in regulation with regard to medicines. We inspected again in May 2015 when we looked solely at medicines to see if improvements had been made. Although we noted some improvements we found the regulation was not being met and we issued a warning notice which required improvements to be made by 3 July 2015. At this inspection we checked whether these improvements had been made.

Asquith Hall provides nursing and personal care for up to 53 people with dementia and mental health needs. The service is divided into two units – Willow Unit on the ground floor which accommodates 25 people living with dementia and Meadow View on the first floor which accommodates 28 people with mental health needs. The registered manager told us there were 53 people using the service on the day of our inspection.

The home has 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 found improvements had been made in the management of medicines which meant people received their medicines safely and when they needed them. There were a small number of discrepancies in the stock balances which we found was due to lapses in the auditing and recording systems.

People told us they felt safe. We found risks were managed well which meant people were kept safe and staff worked with people to ensure that any restrictions in place were lawful and the least restrictive option. Staff had a good understanding of safeguarding and knew how to report any suspected or actual abuse. Safeguarding incidents were reported to the Local Authority and the Commission as required, although there was one isolated occasion when this had not happened.

There were enough staff to meet people’s needs and keep them safe. Some people had one-to-one support which was provided sensitively to support the person and keep them and other people safe from harm. Recruitment processes were followed to make sure staff were safe and suitable to work in the service.

Staff received the training and support they needed to give them the skills and competencies required to meet people’s specialist needs. We found staff knew people well and good communication systems ensured they were aware of any changes in people’s needs.

The registered manager had a good understanding and knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), although we found the knowledge of the nursing staff varied. Some people had DoLS authorisations in place and for others applications had been made to the supervising authority.

Relatives were unanimous in their praise of the care and support provided and spoke highly of the staff team. Overall we found staff treated people with respect and ensured their dignity was maintained. Staff interactions were generally warm, caring and considerate.

People received the care and support they needed from staff and we saw some examples of person-centred care plans. However, other care plans were more generalised and required more specific detail to ensure people received consistent care from all staff.

There was a wide range of activities available in-house and people were supported to pursue their interests out in the community. People received a range of food and drinks and were supported by staff with their meals. We observed a difference in the dining experiences as lunchtime on Meadow View was calm and well organised which was not the case on Willow Unit. Although the registered manager told us immediate action had been taken following the inspection to address this.

There was a positive culture in the home. Staff told us they worked well together as a team and felt supported by management. There were a range of quality assurance systems in place, however these were not always effective as we found they had not identified or addressed the issues we identified in relation to the auditing of medicines, care plans and people’s dining experiences. We found this was a breach of regulation 17 which relates to good governance.

Although we acknowledge the registered manager took immediate action to act upon the feedback given at the end of the inspection to put these matters right, the quality assurance systems need to be robust to ensure these or similar lapses do not re-occur.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 15 July 2014 . A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the management of medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Asquith Hall provides nursing and personal care for up to 53 people with dementia and mental health needs. The service is divided into two units on separate floors. The manager told us there were 52 people using the service on the day of our inspection.

There was a registered manager at 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.

Although we observed some good practice in the management of medicines, we found there were occasions when people had not been protected against the risks associated with medicines. This included gaps in recording, medicines running out of stock and a lack of guidance for staff in how to administer 'when required' medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

At previous visits to the service in November 2013 and January 2014 we had found improvements were needed to ensure staff worked within the requirements of the Mental Capacity Act 2005 (MCA) when supporting people to make decisions about their care and treatment. We also found people were not always protected from the risks associated with medicines. In January 2014 we found the service had not been protecting people from abuse as staff had not followed multi-agency safeguarding procedures. This had led to safeguarding incidents not being reported to the local safeguarding authority. We issued compliance actions requiring the provider to make improvements. The provider sent us an action plan detailing the actions they would take to make necessary changes.

Asquith Hall provides nursing and personal care for up to 53 people with dementia and mental health issues. The service is divided into two units on separate floors. There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Although we found improvements in the management of medicines we found there were occasions when people had not been protected against the risks associated with medicines. This included gaps in recording and insufficient checks when people returned from hospital with changes to their prescriptions. This was a continued breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People were protected from harm and risks were managed to keep people safe. Where people’s freedom was restricted in order to keep them safe the provider had made Deprivation of Liberty Safeguards applications. Safeguarding concerns had been reported to the local safeguarding authority as required and CQC had been notified of these.

Staff were employed in sufficient numbers to keep people safe and meet their needs. Staff had received training to give them the knowledge and skills they needed to care for people who lived at the service. The provider monitored training to check this was up to date.

People were supported to have a balanced diet that met their nutritional needs. People told us they were satisfied with the food at the service. Risks to people’s nutrition were monitored and information was shared with those staff involved in supporting people with eating and drinking.

People had access to health professionals when they needed specific medical and health advice. The advice of health professionals was recorded and followed by staff in order to meet people’s health needs.

Staff were caring and knew the people they cared for well. Staff spoke positively about the people they supported. People and their relatives confirmed they were involved in care planning and care reviews allowing them to be involved in decisions about their care and treatment. We observed interactions between people and staff where people were treated kindly and their dignity was protected.

People received care that met their individual needs and preferences. Activities were meaningful and tailored to the individual.

The service encouraged people to express their views through consultations and surveys. We saw changes had been made to menus and staffing arrangements following feedback from surveys.

The registered manager was not present during our inspection. The service was led by a service manager who had a clear understanding of the service’s strengths and a plan for continued improvement.

Learning from incidents and feedback had resulted in changes to people’s care and staff practices where necessary. This had been managed positively. Staff told us they felt supported by the management systems in place.

Although people told us appropriate systems were in place to safeguard people we found the provider did not have suitable arrangements that ensured people were safeguarded against the risk of abuse. Where abuse or alleged abuse occurred the provider did not always report this to the local safeguarding authority. The provider did not have effective means to monitor and review safeguarding incidents and had not always taken reasonable steps to prevent abuse from occurring.

The provider did not always notify the Care Quality Commission (CQC) about incidents that affected people’s health, safety and welfare so that where needed, action could be taken.

People who used the service told us they could talk to staff if they had any problems and were complimentary about the staff who looked after them. One person said, “They are brilliant. I’ve never been happier” and “If you have a problem they will sort it out. If you don’t want the world to know they will talk to you in private.” Another person said, “They are all lovely. They talk to me when I want but don’t pester me when I don’t.” Another person said, “I feel very safe.”

Members of staff we spoke with all had a good understanding of safeguarding and could speak confidently about the various signs of abuse.

When we visited the home we spoke with a relative of a person who lived at the home. They told us they were very happy with how the home cared for their relative. They told us that their relative had settled in to the home very quickly. They said, “I’m glad I came here.” The relative said they felt involved in their relative’s care. They had recently not been able to visit for a short period and felt staff had looked after their relative well during their absence. We saw that people looked well cared for, people were dressed appropriately and their clothes were clean. There was a calm atmosphere in the home and although staff were busy, they did not appear rushed.

We spoke with two visitors who told us they were very satisfied with the care their relative was receiving. One relative told us they had been involved in their relatives care plan and staff always let them know what was going on. Another relative told us that their relative liked whisky and that the home had ensured that this was available for their relative. However, other evidence did not support this. We saw people did not look well cared for and were not treated with dignity and respect.

Many of the people at the home are living with dementia and we were not able to express their views about the home.

We received positive feedback from people. One person who used the service said, “It’s a good place and if I don’t like something to eat they offer me something else.” Another person said, “They are looking after me as best they can and their best is good enough for me.” A relative said, “I’m very happy with the way staff interact, I’m happy with communication. I’ve no concerns. The whole family are totally happy with the care.” Other agencies told us they did not have any concerns about the service.

At this inspection we found the provider had improved their arrangements for obtaining the consent of people who used the service in relation to the care and treatment provided for them. Further improvements were still required. We found people made day to day decisions about routine care but as the significance of decisions increased the provider did not always show why, when and how decisions were made.

We observed care being provided to people and noted staff used a consistent approach when they interacted with people and made efforts to offer people choice. When they spoke they used people’s names as they started talking to them. Staff made good efforts to communicate with people; they sat next or knelt beside people. When they assisted people with drinks they provided one to one support and gave people plenty of time and encouragement.

We looked at the arrangements for handling medicines and found improvements in the areas we previously identified. However we found the arrangements for the recording, safely administering and safe keeping of medicines were not fully effective.

We found the provider had introduced more effective systems to monitor quality and safety. People who used the service benefitted from a more varied and structured activity programme. More activity workers were being employed because the provider wanted to expand this aspect of care.

Since the last inspection, the current manager was registered with the Commission. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We found the provider had improved their record keeping so people were better protected against the risks of unsafe or inappropriate care.