White Ash Brook

We found the following examples of good practice:

Staff wore appropriate personal protective equipment (PPE) to ensure people were protected as much as possible from the risk of cross infection. There were a number of PPE stations located around the home and used PPE was disposed of safely. Staff had received training on how to put on and take off PPE safely. Enhanced cleaning was being completed to ensure the home remained clean and the risk of cross infection was reduced. Regular checks of cleanliness and infection control were being completed to ensure appropriate standards were being maintained.

There were safe processes in place for people visiting the service. Visitors were screened for Covid 19 symptoms on arrival and were required to wash their hands before entering the home, wear appropriate PPE and maintain social distancing during their visit. At the time of our visit, due to the national lockdown, visiting was restricted to window visits and visits for people who were receiving end of life care. In addition, staff were supporting people to stay in contact with family and friends through regular video calls and telephone calls.

The provider had installed a visiting 'pod' with a floor to ceiling screen. This meant that, when visiting restrictions were relaxed, people could see and talk with their visitors, while being protected from the risk of infection. The Government has advised that, from 8 March 2021, people can nominate one visitor and can hold hands with them during the visit. The provider and manager understood the importance of visits to people and had created a visiting room, where people and their friends and family could enjoy these types of visits.

White Ash Brook is a residential care home providing personal care and support to up to 53 people. This includes older people, younger adults, people with a physical disability, mental health support needs and people living with dementia. The home has two units, with one unit specifically for people living with dementia. At the time of the inspection, 33 people were living at the home.

People’s experience of using this service and what we found

People told us there were enough staff available to meet their needs. They were happy with levels of hygiene at the home. The provider recruited staff safely and staff knew how to protect people from abuse and avoidable harm. The service managed people’s medicines safely and completed regular safety checks of the home environment.

Staff completed an effective induction and the training needed to support people well. Staff supported people effectively with their nutrition, hydration and healthcare needs. They referred people for specialist support when appropriate, to ensure they received the support they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People liked the staff who supported them. They told us staff were kind and helpful. Staff respected people's right to privacy and dignity and encouraged people to be independent when it was safe to do so. They considered people's diversity. Staff involved people and their relatives in decisions about their care. The service provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

Staff provided people with care that reflected their needs and preferences. People told us staff offered them choices and encouraged them to make decisions about their care. The registered manager managed people’s concerns and complaints appropriately. People were happy with the activities and entertainment provided at the home.

Staff and management were clear about their roles and responsibilities and provided care which resulted in good outcomes for people. They worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was being managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 January 2017).

Why we inspected

This was a planned inspection based on the rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the inspection of White ash Brook meetings had been held with the registered persons, Care Quality Commission (CQC), the safeguarding team and commissioners of services. Quality Improvement Planning meetings had continued to discuss and monitor progress made and to also provide support and guidance on how to improve the service people received. After the last inspection we took enforcement action to stop any admissions to the service without prior consent from CQC. This was to ensure best practice was firmly embedded into the service. The provider agreed to this decision. As a result of this inspection we have written to the provider of our intention to remove this condition we imposed.

During this inspection we found improvements had been made and the service was meeting the current regulations.

White Ash Brook is a purpose built home registered to provide accommodation, nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms located on the ground floor. Communal lounges and dining rooms are also on the ground floor. The gardens are easily accessible to people using the service. The home is situated in the small town of Oswaldtwistle and close to local amenities. There is a car park for visitors and staff. At the time of this inspection there were 15 people resident at the home.

There was a manager in post who was registered with the Care Quality Commission. A 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.

All the people, their relatives, and a visiting professional we spoke with told us the service provided a good level of care and support that placed people at the heart of their care. We found people’s rights to privacy, dignity, and freedom of choice was embedded into the culture of the home and people’s diversity was embraced.

People living in the home told us they felt safe and very well cared for. They considered staff were always available to support them when they needed any help.

Recruitment processes and procedures that were followed ensured new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively at all times.

Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. Staff was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.

Risks to people’s health, welfare and safety were managed well. Risk assessments relating to people’s care were good and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Charts used to monitor people at risk were being used effectively.

There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines. Staff responsible for administering medicines had been trained.

All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately. Staff felt confident in their roles because they were well trained and were supported by the registered manager to gain further skills and qualifications relevant to their work. They were motivated and committed to provide a high quality of care.

Training was being provided to support the staff to deliver safe and effective care and support. Staff training needs was being routinely assessed and planned for, and staff received regular supervision.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People told us they enjoyed the meals. They were provided with a nutritionally balanced diet that catered for their dietary needs. Staff worked closely with healthcare professionals to ensure people’s dietary needs were met.

People we spoke with considered staff were kind and caring. We found staff were very respectful to people, attentive to their needs and treated them with kindness in their day to day care. We observed people’s dignity and privacy was being respected. Staff had a good understanding of people’s personal values and needs and had been trained to ensure people’s right to privacy, dignity, independence, choice and rights was central to their care.

People had a plan of care that covered all aspects of their daily lives and embraced their diverse needs such as faith and gender issues. Care plans were complimented by an ‘All about Me’ booklet that provided staff with guidance and direction on how best to support people and to be mindful of what was important in people’s lives when providing their support.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

Communication between all staff was good. People's care and support needs were discussed on a daily basis.

Activities were varied and meaningful and people benefitted from individual and group sessions that provided stimulation. There was a happy atmosphere observed in the home and Christmas activities were on-going. People told us they had enjoyed a ‘turkey and tinsel’ party and were enjoying the festive activities taking place.

The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. Complaints raised were taken seriously and action taken to bring about resolution.

People using the service, relatives, health care professionals and staff considered the management of the service was good and they had confidence in the registered manager.

There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being. We found regular quality audits and checks were completed to ensure any improvements needed within the service had been considered and action taken.

At this inspection we found the provider had taken action to improve staffing levels, infection control, dignity and respect, training and supporting staff, care planning and making sure staff knew how to support people properly and quality assurance processes. However further improvements were needed to ensure the provider was fully compliant with regulations.

White Ash Brook Nursing Home is a purpose built home registered to provide nursing and personal care for up to 53 people. Accommodation is provided in single en-suite rooms located on the ground floor. Communal lounges and dining rooms are also on the ground floor. The gardens are easily accessible to people using the service. The home is situated in the small town of Oswaldtwistle and close to local amenities. There is a car park for visitors and staff. At the time of this inspection there were 39 people resident at the home.

There was a manager in post who had submitted an application to the Care Quality Commission to be registered as the manager for the service. A 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 with the ordering and disposal of medicines. We identified some issues we saw on our previous inspection had not improved. You can see what action we have asked the provider to take at the end of the full version of this report.

Quality assurance systems were being formalised to support the manager to assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service and others. However further improvements were needed to ensure these systems were more robust.

Risk assessments relating to people’s care had improved and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Further improvements were needed to ensure a more robust approach was taken in managing risk.

People received a balanced diet and special diets were catered for. People unable to swallow had their nutrition given through a PEG (percutaneous endoscopic gastrostomy) by nursing staff assessed and trained as competent to undertake this. However charts used to monitor people’s nutritional and hydration intake were not being used effectively and this resulted in people being at risk not having their nutritional needs consistently met.

Information sharing between staff had improved but we found records used by staff to review people’s needs were not always completed. Specific issues such as nail care and physiotherapy exercises were not effectively planned for and we have made a recommendation about this.

There had been an increase in staffing levels and people using the service, relatives and staff told us this had been beneficial to them. People did not have to wait for assistance when they needed staff support.

Infection control within the service was good and infection control measures had been introduced. The home was clean and odour free and there had been an increase in domestic hours to maintain cleanliness.

Training was being provided to support the staff to deliver safe and effective care and support. Staff training needs was being routinely assessed and planned for, and staff received regular supervision.

Staff we spoke with were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safe Guards (DOLS) and best interests decisions. The manager was familiar with the process to follow and had taken action to apply for DoLS following people’s capacity assessments and in their best interest.

People we spoke with considered staff were kind and caring. We observed people’s dignity and privacy was being respected and relatives commented they had seen a big improvement in the amount of individual attention people received. Staff were observed carrying out welfare checks to attend to people being cared for in bed.

People had a plan of care that covered all aspects of their daily lives and staff were familiar with these. These were complimented by an ‘All about Me’ booklets that had been completed. These gave staff direction on how best to support people and to be mindful of what was important in people’s lives.

Communication between all staff was good when they discussed people’s care at the beginning and end of their shift. Staff took notes and this helped to ensure important information in relation to people’s care and support other staff would need to know was not missed.

Activities were varied and people benefitted from individual and group sessions that provided stimulation. One person had a special chair to enable them to leave their room and benefit from social interaction with other people and take part in activities.

The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. Complaints raised were taken seriously and action taken to bring about resolution.