Asher Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Improvements and changes had been made since the previous inspection. There was no registered manager in place, however a managerial team had been formed and had improved oversight. There were more effective quality assurance processes in place and where gaps had been found, action plans had been made to address these. These processes were new and required time to become embedded in everyday practice over time. Staff were receiving supervision and spoke positively about the support they had in their role. Regular team and resident meetings were being held to allow people and staff’s voices to be heard. There had been a shift in culture at the service which people, relatives and staff all told us had impacted positively. The service had worked hard to forge relationships with partners to drive the improvements which were needed.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There had been improvements in the day to day running of the home since the last inspection. Most areas of concern identified in the previous inspection had been addressed and there was an improved culture for learning and development. For those improvements still on-going, a plan was in place to address these. Staff and management felt that the improvements had been significant and meant that not only had people’s quality of life improved, but that the new systems and processes in place supported staff and made for a nicer working environment. Staff told us, “Previously [management] were not fully engaged with us as a staff team and morale became very low, things are much better now.”

There had been a shift in organisational culture and processes were in place to ensure the values of the service were upheld. Accident and incidents were being reported appropriately and the management team had oversight of these. The provider was transparent and acknowledged that things had deteriorated at our last visit but was receptive to the action taken and worked to make the improvements needed. Processes were in place to enable people to be more involved in the shaping of the home, to allow person-centred care which is inclusive. The provider and management team acknowledged that the change in culture will need time to embed.

The service did not have a registered manager in post at the time of the assessment. Recruitment to this position was on-going. An interim management team had been formed to progress the improvements needed. A previous compliance manager had returned to have oversight of improving the documentation and other tasks. Staff told us the management support had improved and staff were now working together as a team. A staff member told us, “There have been lots of ups and downs, but it’s definitely improved a lot in past 3-4 months. Staff have rallied round to make things better.”

Processes of oversight had improved. We discussed with the management team how it was vital that this does not decline again. Improvements needed to continue to become fully embedded and good governance implemented to ensure people were safe. Although there were plans in place to maintain governance, the provider understood the importance of recruiting a capable and compassionate leader that fit the service well to ensure learning was still facilitated going forward.

Staff received regular supervision. Management carrying out supervisions told us these were an opportunity for staff to discuss any issues or concerns be that personal or related to work. Staff felt supported and staff meetings had taken place. Staff were given the opportunity to discuss changes and share their views, confidence around doing this was growing.

Regular team meetings were in place to allow staff to raise any concerns and discuss any ideas they may have to drive improvement in the service. These were new to staff and encouragement was being given for attendance to be prioritised and improved. Staff also had regular supervision to discuss any individual concerns. The provider had a whistleblowing policy in place for staff to utilise should they need this. Confidence of staff to raise concerns was improving however some more embedding was needed to make sure this became regular practice.

Staff members did not have any concerns in relation to equality, diversity, and inclusion. They spoke positively about Asher being an open and respectful place to work. Staff who had expressed a lack of confidence in speaking to health professionals and visitors due to English not being their first language had been supported to access ways to improve this.

Policies were in place to ensure equality and inclusion across the workforce. There was an ethos at the service to allow people and staff to be who they wanted to be without fear of discrimination. The management team had a good understanding of the Equality Act 2010 and this was embedded in their equality and diversity policy. Systems were in place for staff to report any discriminatory behaviours which they be concerned about. Supervisions and team meetings were being embedded into regular practice to allow staff space to discuss any matters they wished.

Regular staff meetings were taking place to encourage information sharing. These were attended by a member of the current management team to allow oversight and learning. Staff told us that the management team were approachable and there is an ‘open-door’ policy. Spot checks for staff, where management could check to ensure best practice was being followed, were planned but had not yet been implemented. Staff and the management team had worked hard to make changes at the service, which now required embedding to ensure sustainability.

Governance and auditing processes had improved, and management oversight was now in place for the day to day running of the home. However, the service did not yet have a registered manager in post. Audit processes were more effective and the issues we identified, like improvements needed to daily records had been recognised by the management team. Plans were in place to address the concerns which remained, but further time was needed for improvement to embed and audits to become robust and effective. Visual aids were in place in the manager office to support with the oversight of practices, for example matrixes to monitor those under DoLS and when these needed review.

Not everyone was able to tell us about their experiences of living at Asher Nursing Home. We spoke to relatives and health professionals involved with the service, who said things had improved. Relatives told us that people were happy living at Asher. Health professionals were aware that things had not been good, and people had not been receiving person centred care, but felt work had taken place to improve and to work with individuals alongside other professionals to achieve positive outcomes.

Management was able to demonstrate how they were working more closely and collaboratively with health professionals. For example, people were supported to attend health appointments at hospital, and health professionals’ visits were supported to the home. This included mental health teams, chiropodists, and tissue viability nurses (TVNs).

Health professionals told us they felt that improvements had taken place, and that staff and management were making progress in how people’s care was provided and documented. Some concern was expressed that without the high level of oversight that has been put in place, things may return to how they were. There were also some concerns about people’s needs around wound care and pressure area monitoring not always being effectively met. Staff training was taking place to address this. External professionals did tell us that nurses and care staff are “open and engaging” and care documentation is now more holistic with referrals to falls and continence services being made when needed.

The service was working hard to improve and forge relationships with health professionals to ensure they worked together to improve people’s care. Following the last inspection, the service had worked with the local authority and CQC to support and review improvements. Measures were now in place to ensure information was shared with partners when needed, staff were gaining confidence in doing this.

Leaders had implemented a ‘Policy of the week’ system to encourage learning and development for staff. This involved staff reading one policy per week and signing to say they have read it. They are also given time to ask any questions should this be needed. Staff told us about the introduction of key workers for people which enabled them to get to know people better and share that learning with their colleagues. Both of these systems were new and staff were adapting to them. Staff and management had worked in conjunction with the local authority and CQC to promote learning and improvements.

Since the last inspection the provider has implemented a new system of auditing and assurance. This was still becoming embedded into practice. Vast work had been undertaken to make improvements, the provider and management team had been receptive to the feedback and was still working closely with external agencies to continue improvements. Oversight needed to be maintained by the provider to ensure it continued and became fully embedded into practice.