CQC report explained · a residential care home
What the CQC found at Ash Tree
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2019
Ash Tree was rated Good; inspectors found safe, kind and personalised care, with some handover and decoration improvements noted.
This was an unannounced inspection on 08 August 2019. One inspector spoke with one person using the home, a relative and four staff. They reviewed care and medicine records, staff recruitment and supervision files, and management records.
The home supports up to five people with learning disabilities, and all five places were in use. Inspectors found enough suitably recruited staff, safe medicines practice, detailed risk assessments and a clean, safe environment.
Care was described as kind, respectful and tailored to each person. People were supported with their choices, communication, activities, relationships and access to health services. The home had systems to check quality and make improvements.
The overall rating was Good, as were all five areas inspected: Safe, Effective, Caring, Responsive and Well-led. The overall rating remained Good from the previous inspection in 2016, while Effective improved from Requires Improvement to Good.
Kind and respectful care
Staff were patient and compassionate. Inspectors saw people being reassured and treated with dignity throughout the visit.
“People were treated to kind and compassionate care. We saw caring interactions between people and staff during the whole inspection.” from the report
Personalised support
Care plans included people's preferences, histories and communication needs. Staff understood how each person wanted to be supported.
“People had been involved in developing their plans of care and these were person centred.” from the report
Safe staffing and medicines
There were enough staff for people's assessed needs. Medicines were stored, recorded and given safely and on time.
“Medicines were managed safely, and people received their medicines on time.” from the report
Improved mental capacity practice
The home had addressed a concern from the previous inspection. Records showed that capacity was assessed and best-interest decisions were made when needed.
“Records showed people's capacity was always assessed, and where required, decisions were made in people's best interests.” from the report
Some decoration needed improvement
minorInspectors noted that parts of the home needed redecoration. This work had been identified and was ongoing during the visit.
“Some areas of the service needed improvement to the décor. These improvements had been identified and were ongoing at the time of our visit.” from the report
Handover records had been incomplete
needs fixingThe handover process had not recorded all events during each shift. The manager introduced a new policy and staff said information sharing had improved.
“It was identified the handover process was not robust as it was not detailing all the events during each shift.” from the report
- 01Has the redecoration work identified in the report been completed, and are any areas still awaiting improvement?
- 02How does the current handover system make sure all important events from each shift are recorded and shared?
- 03How are people involved in reviewing their care plans and making day-to-day choices?
- 04What activities and community opportunities are currently available for each person?
- 05How do you check that staff remain trained and competent to support people's individual needs?
This was an unannounced planned inspection that looked at the care home, the care provided and all five CQC questions; the previous overall rating was from 2016. This explanation was written from the published report of 21 September 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2016
Rated Good overall, but inspectors found the service was not consistently effective because mental capacity decisions were not properly assessed or recorded.
Inspectors visited the home without notice on 24 November 2016. They spoke with people, relatives, an advocate, staff and the manager. They also observed care and checked care records, medicines, staff files and quality checks.
People were found to be safe, treated kindly and supported to make choices. Staff knew people well, helped them stay independent and supported activities, health needs, food and medicines.
The main weakness was the use of the Mental Capacity Act. Where people might not have had capacity to make particular decisions, assessments had not been completed and best-interest decisions were not recorded. Some care and support plans also needed clearer and more detailed guidance for staff.
People felt safe
Inspectors found enough staff and saw that risks relating to people, the environment and equipment had been assessed. Medicines were stored, administered and checked safely.
“People were protected from avoidable risks.” from the report
Kind and respectful care
Staff knew people well and adapted communication and choices to each person. Inspectors saw warm interactions and support that respected people’s dignity.
“People were supported by staff who treated them with kindness.” from the report
Independence and activities
People were encouraged to do everyday tasks, make choices and follow hobbies and interests. Activities included community trips, horse-riding and vocational or educational opportunities.
“People's independence was promoted and supported.” from the report
Good health and nutrition support
People were offered food and drinks that met their needs, and staff contacted health professionals when concerns arose. Staff followed professional advice about people’s health.
“People were supported to maintain good health.” from the report
Open and improving management
The manager was available to people and staff, listened to concerns and used audits to identify improvements. The provider planned regular external audits and action plans.
“The provider demonstrated that they were committed to providing a high quality level of care and that there was a drive for improvement.” from the report
Mental capacity records
seriousThe home had not completed capacity assessments for people who might lack capacity to make decisions about their care. It had also not recorded best-interest decisions, creating a risk that people’s rights were not protected.
“We also saw that decisions made in people's best interests were not recorded as having taken place.” from the report
Care plans needed clearer guidance
needs fixingSome care plans were difficult for staff to follow and did not always match the guidance in risk assessments. Some behaviour support plans also lacked enough detail, which could lead to inconsistent support.
“Some support plans lacked detail which meant that there was a risk that people would receive inconsistent support when experiencing anxiety.” from the report
Safeguarding information was not accessible
minorThe safeguarding policy displayed for people was not in an accessible format and had not been updated to reflect changes in national guidance. The manager said this would be corrected.
“The policy that was on display on a communal notice board was not in an accessible format for people using the service” from the report
One activity needed further follow-up
minorOne person repeatedly asked for an activity they could no longer do because of declining health. Inspectors asked the manager to explore whether they could take part again or receive an equally enjoyable alternative.
“We asked the registered manager to further pursue ways of including this person in the activity that they had previously enjoyed or providing an equally enjoyable activity.” from the report
- 01How are mental capacity assessments completed for each person, and where can we see the records?
- 02How are best-interest decisions recorded and reviewed when someone cannot make a particular decision?
- 03What changes were made to care plans and behaviour support plans after inspectors said they lacked clear detail?
- 04How do you make safeguarding information understandable and accessible to people living here?
- 05What alternative activities are offered when a person can no longer do an activity they used to enjoy?
This was an unannounced inspection of all five key questions, including observations, discussions with people and others, and checks of care, medicines, staffing and management records. This explanation was written from the published report of 21 December 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ash Tree
2 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2015
Registered with the Care Quality Commission on 16 October 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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