Archived: Ashfield House - Leominister

Ashfield House is a care home providing personal and nursing care to up to 25 people. The service is registered to support older people, people living with dementia, physical disabilities and sensory impairments. At the time of our inspection there were 21 people using the service.

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

Since our last inspection improvements had been made in how safeguarding concerns were reported to the appropriate authorities. Staff understood safeguarding and described how they would identify and report any concerns of possible abuse. Incidents and accidents were recorded and reviewed, and any measures put in place to prevent these from happening again.

On the day of our inspection the home was experiencing their first COVID-19 outbreak. This was being managed safely. Staff were wearing PPE appropriately for the task being carried out. Infection, control and prevention procedures had improved and helped to protect people from the risk of infection.

People’s medicines were managed and administered safely, and regular audits were completed.

People’s needs and choices had been assessed. Care provided was personalised and considered people’s preferences and wishes.

There was enough staff to meet people’s needs. Staff knew what was expected of them. Staff received appropriate training and support to enable them to perform their role safely and effectively.

People were supported to eat and drink enough to maintain a balanced diet. People’s dietary needs were met in accordance with their needs and preferences.

Staff recognised changes in people’s health, and sought professional advice appropriately.

Systems to asses, monitor and mitigate risks to people’s safety and well-being had improved. Improvements of the governance systems ensured better oversight of performance and quality. A range of audits were used to effectively monitor the service. Areas for improvement were identified and responded to so the service was continuously learning and developing.

People and their relatives were encouraged to provide feedback in the form of questionnaires. Information was used to drive through improvements.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 05 September 2019) and there were breaches of regulations. The provider sent us a monthly action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care and management of the service. We also wanted assurances the provider had followed their action plan and to confirm they now met legal requirements. As a result, we undertook a focused inspection to review the key questions safe, effective and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashfield House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service: People and their relatives were positive about the service and the care provided.

The service was not always safe. Systems to ensure people were safeguarded from abuse were not always effective. Concerns were not always reported to the Local Authority to protect people from the risk of abuse. People were at risk from infection, systems to protect people were not always completed or effective to identify and manage these risks.

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient, knowledgeable staff were available to meet people's needs. People told us when they needed assistance, staff responded promptly. People received their medicines regularly and systems were in place for the safe management and supply of medicines.

The service was effective. People's needs were assessed, and care was planned and delivered to

meet people’s needs. Care was delivered by staff who were well trained and knowledgeable about people's care and support needs. People had a nutritious diet, and they enjoyed the food offered. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People were cared for by staff who were kind and compassionate. The atmosphere within the home was warm and welcoming. Staff were calm and considerate towards the people they cared for. People and their relatives felt involved and supported in decision making. People's privacy was respected, and their dignity maintained.

Staff were responsive to people's needs and wishes and were knowledgeable about each person. Relatives confirmed staff knew their family members well. The management team had identified they needed more support to ensure people had more interesting things to do and were recruiting additional staff. People had access to some entertainment they enjoyed. People's concerns were listened to and action was taken to improve the service as a result.

The service was not always well led. There continued to be a breach in regulations around good governance.

Safeguarding systems to ensure service users were protected from the risk of abuse and improper treatment were not effective. Through system failure or lack of registered manager understanding and knowledge the systems in place had not been effective to ensure incidents were reported for review by the Local Safeguarding teams. Systems to protect people from the risk of infection were not always effective and new systems were not reviewed to ensure they were effective.

The registered manager and her staff team were open and focussed on providing person centred care. The management team and staff engaged well with other organisations and had developed positive relationships.

Rating at last inspection: Comprehensive inspection completed May 2018. Effective and well-led were rated as requires improvement. The overall rating was requires improvement. There were breaches in regulation that continue not to be met and sufficient progress to improve people’s care had not been made.

Why we inspected: This was a planned inspection based on previous rating of requires improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our methodology. If any concerning information is received, we may inspect sooner.

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

Ashfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides accommodation and personal or nursing care for up to 25 people. However, at the time of our inspection, the provider did not have anyone living at the home with nursing needs. There were 17 people living at the home at the time of our inspection, all of whom received residential care.

There was a registered manager in post, who was present during our inspection. 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.

At the time of our last inspection undertaken in October 2017, we rated the service as Requires Improvement. Breaches of Regulation were identified in relation to person-centred care; staffing; good governance; and failure to notify. At this inspection, we found some improvements had been made and the provider was no longer in breach of the Regulations regarding person-centred care, staffing and failure to notify. However, we found the provider remained in breach of the Regulation regarding good governance. We also identified an additional breach in regard to a failure to display the current rating.

Records associated with people's care were not always complete or accurate. Gaps were identified in records in regard to people's skin health monitoring and their dietary preferences. Although care plan audits had been carried out by the provider, these shortfalls had not been identified.

Where people had been identified as losing weight, it was not clear what, if any, action had been taken.

The provider had not ensured the current CQC rating for Ashfield House was visibly displayed for people and visitors. The previous rating was displayed, which was not reflective of the service's current position.

People received their medicines in line with their current prescriptions. Medicines were stored securely. Prescribed creams contained their opening dates, so staff could monitor these and ensure they were within their shelf-life.

There were enough staff to safely meet people's needs. The provider followed safe recruitment practice when appointing new staff.

Staff understood their roles and responsibilities in regard to protecting people from abuse and harm.

Staff received ongoing training and development in their roles, and they understood key legislation underpinning their practice.

People were able to navigate their way around their home and the environment was dementia-friendly.

People enjoyed positive and respectful relationships with staff. People's dignity was maintained. People's independence was promoted as much as possible.

There were in-house, and some external, social and leisure opportunities for people to enjoy.

People's care plans captured their preferences, wishes, needs and interests, and staff used these to inform their practice. There was a system in place for responding to and acting on feedback, complaints and suggestions.

Staff felt supported and motivated in their roles. Links had been established with the local community for the benefit of people living at Ashfield House.

We previously inspected this service on 17 August 2015 and the rating was Good. At this inspection, we identified breaches of Regulation. These were in relation to person-centred care, dignity and respect and good governance. You can see what action we asked the provider to take at the end of this report.

The inspection took place on 30 October 2017 and was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People's medicines were not always stored in accordance with the prescriber's directions, or in accordance with current best practice. People's medicines were not always signed for by staff, which made it difficult to know whether some medicines had been given.

Staff were deployed as cleaners as well as carers, which sometimes impacted upon the care they were able to provide. People were not always treated with dignity and respect.

People could not always enjoy their individual hobbies and interests. People were not able to go out for day trips when they wanted to, unless taken out by family members. People's care plans were not always reflective of their individual preferences, likes, dislikes and interests.

Quality assurance measures were in place, but these were not effective in identifying shortfalls in the service. Care records were sometimes inaccurate or had not been completed.

People were protected from harm and abuse. Risk assessments were in place in regard to individuals' needs and these were known and followed by staff.

People's weight was monitored and where there were concerns, appropriate action was taken. People had access to healthcare professionals, and their changing needs were responded to. People enjoyed the meals provided.

There was a system in place for capturing and acting on complaints and feedback. Staff felt valued and supported in their roles.

We observed that the staff supported people in a friendly and polite way. The staff showed people respect and made sure their dignity was maintained. We saw that the staff spent time supporting people who needed assistance.

We spoke with six of the thirteen people who lived at Ashfield House. They told us that they were very comfortable and the staff looked after them well. They said they were happy with the food provided and said that the cook was 'wonderful'. Another person told us, "The food is excellent and I really enjoy it". Two of the people we spoke with said they preferred to stay in their rooms. When they wanted to go downstairs they said that they only had to call and someone would be there to help them.

We spoke with three members of staff and the registered manager during our visit. The staff we spoke with demonstrated that they were very proud of the standards of care they provided. They said that it was very important to them to ensure the home was clean and that the people had choice in their food and daily living.

Staff provided health and social care support well. Community services were accessed to support people when necessary.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People's relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said that they 'The girls are very, very good' and another said, 'Yes, it's very nice'.

People we talked with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The home's management held regular meetings with the people to find out what they thought about how their care was delivered.