Asher Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Improvements had been made since the previous inspection. People and staff spoke positively about the changes that had been made. Policies and procedures were in place. Accidents and incidents were being appropriately reported by staff, and the management team had oversight of these to highlight any learning points. Fire safety had improved, a new smoking policy was in place to minimise risk of people smoking in their rooms. We saw evidence of this being used effectively. The cleanliness of the home was much better and infection prevention and control (IPC) measures were much improved. There were some gaps in the detail in cleaning rotas but our feedback regarding this was well received by the management team. Although many improvements had been made, the new processes and policies needed time for staff to adapt to them and these become embedded in everyday practice.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt there had been marked improvements over recent weeks and months. People were grateful for the action taken and that things had improved. People told us they were happy. Relatives told us people felt that Asher was their home, and they were happy living there. People’s comments included, "I like it here very much" and "I’m happy here at the moment".

Staff had worked hard to make improvements and staff spoke of working together as a team. They spoke of their being a shift in the culture at the service and feeling more confident in reporting matters. One staff member said, “Before there was no real learning from when things went wrong. I believe in a learning culture not a blame culture. Now we learn, we pass things on”. Staff told us they were happy and felt supported and listened to in their roles.

Policies and procedures were in place to support people’s safety and ensure lessons are learnt when things went wrong. Management had better oversight over accidents and incidents, and staff confidence in documenting these was improving. The procedures for staff to report accidents and incidents, and management to then develop learning from this, was new and required time to embed to ensure it becomes regular practice.

People spoke more positively about systems and pathways. One person said, “It’s like a new place, it’s so much better, I am so grateful for the changes that have been made. Not so many people here now who just do not fit, there were too many bad issues before and now it’s so much calmer, we all get on and no one fights anymore.” The provider had sought feedback from people through resident meetings and surveys. People had been involved in improvements and felt this had impacted positively on the home.

Staff were more confident in sharing information to ensure good continuity of care for people. Memos and staff meetings had been implemented to ensure staff were aware of people’s needs and how to complete documentation appropriately. Referrals to external agencies were being made appropriately for people. More time was needed for staff to be fully confident with the new systems in place.

External professionals told us that the improvements at Asher were evident. They stated that care planning for people was more holistic, and referrals were being made more proactively to ensure people received good, safe care. One professional told us, “The changes the senior leadership team have made are hugely beneficial to patient care. The care planning is now much more holistic, patient centred and all the remaining patients have significant improvements in their assessments and plans. For example, Asher are now referring patients proactively to falls prevention and continence services.” Professionals did report that multi-disciplinary meetings are now occurring more regularly, and concerns are reported appropriately. All professionals we spoke with did express some concern that improvements may slow if oversight does not remain. The provider was receptive to the feedback and provided assurances around systems going forward. There is more detail about this in the well-led section.

Processes were in place to ensure people could keep up to date with their appointments and care needs. Staff were able to support people to attend appointments where needed and the management team were working closely with external bodies to drive improvement at the service. Policies and procedures around information sharing had improved but this was ongoing, and audits had identified further review of records was needed. A new page had been implemented in care plans to provide an immediate instruction list for when a person became in mental health crisis. This included who to contact for external support to ensure safe transition to other services if required.

People told us they felt safe living at Asher Nursing Home. People were comfortable with staff and there was a relaxed atmosphere throughout the home. Relatives spoke positively about the recent changes at the home and confirmed they felt their loved ones were safe. One relative told us, “The staff generally are very kind and caring. This is manifest in the fact that [Person] doesn’t want to be anywhere else, he regards Asher as his home. I am happy that current initiatives are forcing improvements.”

Staff had completed training and demonstrated a good understanding of safeguarding. Staff told us they would report any issues or concerns to the management team. Comments included, "I would go to [senior] with anything, they are very approachable”. Another staff member told us, “I’ve never had to report one, the only thing I’ve had to report was a fall that happened yesterday. But I know what to do and who to talk to. [Senior] would always listen. I know about whistleblowing and would definitely use it if I felt I needed to. People being safe is important”. Whilst staff knowledge had improved, processes of reporting still need time to embed.

We observed staff interacting with people in a positive manner, responding promptly when people became distressed or upset. Staff displayed a good working knowledge of safeguarding, some were more confident in this area than others. We saw that referrals had been completed appropriately when incidents had occurred. Staff told us that they were more confident about matters being followed up appropriately.

Policies in relation to safeguarding were in place, up to date and relevant to the service. These provided guidance to staff regarding safeguarding, how to identify possible abuse and when to report it. Mental capacity assessments had been completed and where necessary applications of Deprivation of Liberty Safeguards (DoLS) has been made. Processes to monitor and review safeguarding concerns, accidents and incidents had been implemented and enabled better oversight of these for management to act where needed. These processes were highlighted to staff and had started to become embedded in day-to-day practice. Further development was needed to ensure the processes were effective in identifying and addressing patterns and themes.

People had been involved in discussions around their care and support needs, this included discussing any risks and how to minimise these. People felt their independence was supported and were encouraged to take positive risks rather than being restricted. People who were safe to go out alone were supported to do so. We saw people going out during the inspection. There was a key code entry system to the front and rear of the home. People who were independently going out were aware of the code and able to use these.

Staff told us the home and day to day provision of care had improved since the last inspection. Although there was no registered manager, staff spoke of a better management team and improved sharing of information. Documentation had improved the way risk was being managed. Care plans and risk assessments provided staff with guidance in how to best support people whilst minimise risk as far as possible. Staff had regular handovers and staff meetings to enable robust information sharing, especially regarding risks. One staff member told us, “Things are reported now and it’s better now. We get the chance to learn.” A member of management would attend each handover to ensure anything that had happened, or any new risks, were passed on to the incoming staff.

We observed staff providing support and responding to people promptly. Some interaction was task focused however the culture shift at the service was working to improve this. When one person became agitated staff responded quickly and used the distraction techniques detailed in their care plan to alleviate their anxiety. One person was known to become focused on specific subjects, staff were prompt to close any discussions which may lead to the person escalating these thoughts and steer conversation onto other subjects.

Risk assessments were in place and provided guidance to staff to minimise risks where possible. Management oversight of risk had improved since the previous inspection and managers were regularly attending handover meetings to ensure messages were being communicated effectively. Daily notes which we reviewed were not always detailed, and although staff were now reporting new risks appropriately, this was not always done immediately following incidents. Management told us that these are both areas which they had identified and were working to improve with staff. We did not see any evidence of this having negative impact on people.

The environment was much improved, and people told us of the positive impact this had on them. People’s rooms which had previously been very cluttered and dirty were clean and tidy. Support was in place to encourage people who were prone to hoarding to reduce the number of items in their rooms to enable them to be kept clean and hygienic. A relative told us that it could be difficult for staff to get into their loved one’s room to support them, but staff were doing what they could to promote [Person’s] safety.

Staff and management told us about the improvements which had taken place and were planned for the service. Redecoration, including new flooring and painting had been completed. The environment felt much more welcoming. Staff told us that the biggest improvement had been the cleanliness which they felt was a positive improvement. The service had an allocated maintenance person who was responsible for undertaking the relevant checks on equipment. Some works were not yet complete in bedrooms and communal areas but there was a plan to address this.

At the previous inspection there had been significant concerns regarding fire safety, and we had seen evidence of people smoking in their rooms. This had stopped and we found no evidence of people smoking in their rooms. New ‘no smoking’ signs and other fire notices had been placed throughout the home. A grab and go bag with up to date and detailed personal emergency evacuation plans (PEEPs) was available for staff. People’s beds were made, and fresh linen was now available. The environment was clean and tidy.

Processes in relation to the overall safety and environment were greatly improved. Checks were completed and overseen by management to ensure standards continue to improve and maintained to a good level. An updated policy regarding people smoking in their rooms had been produced and was being utilised effectively by staff to prevent this. We saw evidence that any incidents of people smoking in their rooms had been addressed and action taken to prevent this happening again. Mattress audits had also been introduced to ensure these were clean and covered. Management had oversight of the improvements which were still needed, and a plan was in place to address these.

People and relatives spoke positively about staff. Feedback from people included that they felt there were enough staff to help them when needed and that staff were good. One person stated that he was much happier at Asher with staff than where he had lived before. Another said, “Staff are quite good, it is so much better here now”.

Staffing levels appeared adequate but most of the staff we spoke with described feeling stretched and very busy at times. Staff levels were adjusted dependent on how many people where living at the service and what their needs were. Management acknowledged the need to potentially increase levels as people needs increase or when more people are admitted. Staff spoke positively about the training they had been offered and felt this was relevant to their role. There were a number of new training sessions planned to increase staff confidence.

Our observations confirmed safe staffing levels. Whilst we were present only one call bell sounded which was answered promptly. People were able to ask for support when they needed it, and staff were responsive to requests. We saw staff and people interacting, it was clear people responded positively to staff and were comfortable in their presence. Staff were able to tell us about people and their needs, and had the correct skill set to be able to support people at the service.

Where people required one to one support, it had not always been clearly documented that this was given or a reason if it was not. We discussed during the inspection that this needs to be more accurately recorded to demonstrate people are getting the support they need. Management used a dependency tool to ensure that enough staff with the right mix of skills were on shift to support people safely. Regular supervision was taking place and new staff completed a probation period before working alone. Recruitment of staff was done safely in line with the provider’s policy.

People told us that the cleanliness in the service was much improved. People’s rooms and communal areas were clean and there was no odour detected in the building. Feedback from people included, “Its much nicer here now”. One relative told us, “[Person] doesn’t lend to a tidy room, he is a bit of a hoarder, but I do know that the home does its best to keep on top of his stuff. There has been a marked improvement in presentation and cleanliness”.

Staff spoke positively about the changes regarding infection prevention and control (IPC) and cleanliness in the home. One staff member told us, “It’s so much cleaner. People and staff all wash their hands regularly, the infection control is much better”. The home had recruited a new housekeeper who people and staff spoke positively about. A second cleaner worked part time and management had implemented one day a week where both housekeeping staff worked to carry out deep cleans.

The home was markedly improved with regard to cleanliness and IPC practices. Personal protective equipment (PPE) and hand gel was available on stands around the building. The laundry room was clean with separate containers for people’s clothes and a linen stock cupboard had been implemented which was locked but neat and clean inside. Cleaning staff were seen to be busy throughout the time of the site visit. All staff were seen to be using PPE appropriately and washing their hands when needed.

Management had introduced new infection prevention and control (IPC) processes including cleaning checklists and audits. A deep clean schedule was also in place. There were some gaps in relation to the cleaning rota, but this had already been identified and had been addressed in team meetings. Management had oversight of the checklist to ensure these were being followed. We discussed the importance of also completing regular walk-arounds at the service to ensure IPC processes were being followed. Work was also on-going to develop a more robust way to build rapport with people who are reluctant to let staff enter their rooms, so they can monitor any environmental and IPC needs more closely.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.