About the service:

Asra House Residential Care Home providing care and support for up to 42 older adults living an Asian lifestyle. At the time of the inspection there were 42 people using the service.

Rating at last inspection:

Our last inspection report for this service was published on 22 June 2016 and the rating was ‘Good’.

Why we inspected:

This was a scheduled inspection based on the service’s previous rating.

People’s experience of using this service:

People benefitted from an outstanding responsive and well-led service. Care and support was tailored to meet people’s needs and to ensure flexibility, choice and continuity of care. People were involved in and consulted about all aspects of their care and support. People told us that staff had an excellent understanding of their social and cultural diversity, values and beliefs and how these might influence their decisions on how they wanted to receive care and support.

The home promoted understanding and a positive attitude towards different types of disability. Staff had opportunities for learning, development and reflective practice on equality and diversity, both individually and in teams, which influenced how the home was developed.

Arrangements for social activities were innovative, met people’s individual needs, and followed best practice guidance so people could live as full a life as possible. People organised events at the home themselves. Photographs throughout the home showed people taking part in a wide range of activities, events and celebrations throughout the year. The home had a key role in the local community and links with other community organisations which provided information and support to people.

The culture in the home focused high-quality, person-centred care. In 2018 the home won a major Department of Health sponsored care award for ‘outstanding excellence within their field of work’. Staff put people at the heart of the service and their views were at the core of home’s quality monitoring and assurance arrangements. Staff were motivated by and proud of the home. Continuous learning was embedded in the home’s culture.

People felt safe at the home and there were the systems and processes in place to safeguard them. People had risk assessments so staff knew how to keep them safe. The premises were safe for people. Regular safety checks were carried out on the environment and on the equipment used. There were enough suitable staff on duty to meet people’s needs. People were provided with their medicines in a safe way. All areas of the home were clean, fresh, and tidy. The provider and registered manager ensured lessons were learnt and improvements made when things went wrong.

People’s social care, healthcare and cultural needs were assessed prior to them moving into the home. They told us staff supported them to access health care services when they needed to. The staff team were well-trained and knew how to meet people’s individual needs. People told us they liked the food served. The kitchen catered for a range of dietary and cultural needs including vegetarian, halal, and diabetic. The home was purpose-built and provided people with spacious and accessible accommodation including a range of communal areas. Staff understood the importance of people consenting to their care and support.

The atmosphere in the home was warm and friendly. People experienced positive caring relationships with the staff team. Care workers assisted people in a kind and reassuring manner. People were encouraged to express their views and make decisions about their daily routines. They said staff helped them to maintain their independence. Staff treated people with dignity and respect. People were supported to maintain relationships with relatives and friends. Visitors were made welcome by staff and invited to events and celebrations.

For more information please see Detailed Findings below.

Follow up:

We will continue to monitor this service and plan t

We carried out an announced comprehensive inspection of this service in May 2016. No breaches of legal requirements were found and the service was rated as ‘Good’. We then received concerns relating to the ‘Safe’ and Well-led’ areas of this service. In response we carried out this focused inspection on 13 October 2016 to check the provider continued to meet their legal requirements in order to provide a ‘Safe’ and ‘Well-led’ service.

This report only covers our findings in relation to ‘Safe’ and ‘Well-led’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Asra House on our website at www.cqc.org.uk.

Asra House Residential Care Home provides care and support for up to 40 older adults from the Asian communities. The service caters for people living with dementia, physical disabilities, and sensory impairments. It is situated in the city of Leicester close to a range of local amenities including the city’s ‘Golden Mile’ of shops and restaurants.

The service had a registered manager. This 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.

All the people we spoke with said they felt safe using the service. They told us the continual presence of staff and their caring approach made them feel safe. There were enough staff on duty to keep people safe and meet their needs. They assisted people calmly, allowing them to take they time to move about the premises, receive personal care, and have their meals.

Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. They knew how to meet people’s needs safely using the correct equipment and techniques where necessary to protect people from harm. Staff were safely recruited to ensure they were suitable to work at the service.

Medicines were safely managed and stored. Staff gave out medicines at the right time and explained to people what their medicines were for to involve them in the medicines process. Staff were trained to administer medicines safely and were knowledgeable about their purpose and if they had any side-effects.

All the people and relatives we spoke with reported high levels of satisfaction with all aspects of the service. They praised the staff, the quality of the care, the environment, the activities, and the management. They also told us they liked the culture of the service as it encouraged people to make choices about all aspects of their lives.

The atmosphere at the service was positive and inclusive. People and relatives told us the service catered for those from a variety of Asian communities. The food, decor, entertainment, and care and support reflected different Asian lifestyles and beliefs. The service was integrated into the local community and had links with schools, places of worship, and neighbourhood groups.

The provider carried out regular quality audits centring on the views and experiences of the people and their relatives so people could have their say about Asra House.

The service was continually improving. Since we last inspected the refurbishment of the premises had begun, people using the service were taking it in turns to chair meetings, and ‘resident of the month’ award had been introduced.

This was an unannounced inspection that took place on 5 May 2016.

Asra House Residential Care Home provides care and support for up to 40 older adults from the Asian communities. The service caters for people living with dementia, physical disabilities, and sensory impairments. It is situated in the city of Leicester close to a range of local amenities including the city’s ‘Golden Mile’ of shops and restaurants.

Although the service has a registered manager they were no longer working at Asra House and had left the provider’s employment, although they had not yet cancelled their registration with CQC. This matter was being addressed by CQC. A new manager was in post and told us they had submitted their application to become the next 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.

Asra House had a happy atmosphere and we saw many positive interactions between staff, the people using the service, and relatives, who were all involved in communal life at the service. People using the service told us they were satisfied with the care they were receiving, their life at the service, and the way staff members treated them.

During our inspection we saw many examples of staff being positive, warm, and friendly towards the people using service. For example, we saw them discussing the day’s meal with people, talking to them about their families, and encouraging them to take part in activities.

The staff respected the varied Asian faiths and cultures of the people living there and fostered a lifestyle in keeping with these. The way the home was decorated, the food, and the activities provided were also designed to meet people’s cultural needs

People told us they felt safe at Asra House. During the inspection we observed that people using the service were relaxed and comfortable with the staff and happy to approach them at any time.

Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people they supported.

People told us there were enough staff on duty to meet their needs and we observed that people who needed assistance did not have to wait long. The staff we spoke with understood people’s individual needs and were able to support them in the way they wanted. They were knowledgeable about providing people with effective, personalised care.

All the people we spoke with praised the food. During our inspection lunch was served in the restaurant-style dining room. The tables were well-presented and set with tablecloths, cutlery, cruets, glasses for drinks, and trays of Indian pickles. The menu was written in both English and Guajarati and people told us the chef served a range of traditional Asian and English food in line with their preferences. If people needed one-to-one assistance with their meals this was provided.

Activities were a big part of life at Asra House. The service had developed close links with the local community. An older person’s support group visited the service, day trips were organised to places of interest, local cultural singing and dance groups were invited into the service, and cultural festivals were celebrated. On the morning of our inspection people joined in both indoor and outdoor activities including painting, ball games, and singing bhajans [Hindu devotional songs]. In the afternoon pupils from a local primary school visited to talk with the people using the service and find out about their lives for a school project.

The manager was knowledgeable about the care and support needs of all the people who used the service. She was supportive of her staff team and keen to develop their skills through training and practical experience. Staf

Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what the people who used the service, relatives, and the staff told us. During our inspection we talked with 13 of the people who used the service, three relatives, and seven members of staff. Some of the people who lived at the home were not able to give their views due to their mental health needs.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and well-cared for at Asra House. One person said, “The carers look after me well”. Another commented, “This is a very good place and I am very happy here.” Relatives told us the staff mostly provided 'good, safe care'. And a care worker said, “I look after the residents as if there were members of my own family.”

At our last inspection the home did not have suitable arrangements in place for acting in the best interests of the people who used the service. At this inspection action had been taken to address this issue and the home was following the key principles of the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS) to ensure people's legal rights were upheld.

Is the service effective?

Since we last inspected staff had had additional training in ‘person-centred care’ (individualised care that promotes independence and choice). This had helped to ensure people were given the opportunity to consent to their care and make changes to how it was given.

The home’s dining room was ‘open’ all day so people could get together and socialise. Between meals this area was run like a café with people coming in and out for drinks and snacks. There were pictures of various foods were on the walls to tempt people’s appetites. Here people could sit and relax, chat to each other and staff, and enjoy the aroma of food being cooked in the adjoining kitchen. This gave people a further communal area to use in addition to the lounges.

During our inspection the home’s activity co-ordinator organised a painting activity in the gardens, and a local religious organisation came in to sing religious songs with a group of people who used the service. The home’s activity co-ordinator told us recent activities had included a canal trip, comedy shows, a zoo trip, and visits to places of worship including temples and mosques.

Is the service caring?

We saw staff providing care in a kind and compassionate manner. We observed one carer talking with a person and explaining what they were doing while hoisting them. We saw another care worker comforting a person who was distressed and speaking soothingly. In these ways staff were able to reassure the people who used the service and involve them in their care.

The staff team was multilingual and could speak a range of local languages. They had a good understanding of the various cultural needs of the people they cared for and a commitment to the multi-faith ethos of Asra House. This helped to ensure they could communicate effectively with the people who used the service and help them follow their individual religious and cultural practices.

Is the service responsive?

We were told how staff involved one person in their care plan by writing the person’s life history with them. This revealed the person loved Indian music, so a Bollywood group was invited to perform at the home. The person in question ‘absolutely loved this’ which showed how good care planning had a positive impact on their life.

The home catered for people from a variety of religious and cultural backgrounds and their care plans took account of this. People were supported in following their particular traditions if this was what they wanted. This showed the home was active in helping to ensure people’s religious and cultural needs were met.

People told us the manager was approachable and took action when they raised issued with her. One visitor said, “After raising my concerns, I am being kept aware by the management of some of the changes planned and being involved in care planning for my family member”.

Is the service well-led?

We met with the new manager, a registered nurse, and her deputy manager. They discussed their vision for the home which was to make it more person-centred and homely. Work had already begun on the premises which were being refurbished. The people who used the service had been involved in choosing wallpapers and colour schemes for various bedrooms and communal areas.

The manager told she had introduced a new activity to the home. Every day everyone who lived and worked at Asra House was invited to come together in one of the lounges to clap and sing along to a popular song. The manager said this get-together had proved to be popular and helped to bring a sense of unity and togetherness to the home.

The manager had instigated a series of ‘residents and relatives’ meetings and those attending had formed a committee. The committee met regularly with the manager to share their views on the service and make suggestions for changes and improvements. This helped to ensure that the people who used the service and their relatives had a say in how the home was run.

We spoke with three people who used the service, one relative, the four care workers who were on duty at the time of our inspection and the senior carer who was in charge of running the home on the day of our inspection. We also observed people in the communal areas throughout the day. Our specialist advisor observed staff carrying out moving and handling techniques during the visit.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. We found that people were confident approaching staff and that carers were responsive to people’s needs. The staff team were representative of the people who used the service and carers were able to communicate with people in their own language.

We saw that people had a choice about whether to spend their time in their room or in the communal areas. People were engaged in reading, playing games or singing in the main living room and staff participated in these activities. We observed one leaving to visit the temple during our visit. People’s individual preferences, religious and cultural needs had been catered for. The lunchtime meal had been freshly prepared and was appetising.

We looked at the records of five people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.

However, we found that the home did not have suitable arrangements in place for acting in accordance with the best interests of the person when they were unable to consent to the care and treatment being provided.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

People said the food was very good and like ‘home style cooking’. A visiting relative told us “everyone here is happy and helpful, [relative] is very well looked after and she has communicated to us her care is good”.

People we spoke with were all positive about their experiences. People said “couldn’t get better” and “good food, good company, good living”.

In the home’s compliments book, one person had written:

“The Asra House was surprisingly clean and had a very warm environment. I thoroughly enjoyed my stay here. With food just like home and carers attending to me as if they were my daughter. The Asra House felt like a second home”.

People said the staff were very good. In a recent customer service questionnaire, one person had written “all staff are very helpful and friendly and I have been looked after very well”.