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.