Ardenlea Grove Care Home

We found the following examples of good practice.

¿ On arrival visitors were screened for symptoms of COVID-19. Their temperatures were recorded, and they were required to complete a lateral flow test. The checks helped to ensure visits took place safely in line with current guidance.

¿ A vising pod partitioned by a clear glass screen was in use. This meant people and their visitors were able to spend time together in a safe environment. An extra staff member was on duty to coordinate visits and clean the pod between use.

¿ Computer tablets had been purchased to support people keep in touch with others who were important to them via video calls. One person wore headphones during their video calls to aid communication.

¿ ‘Hot spot’ stickers had been placed on areas that were frequently touched within the home including light switches and door plates. The stickers reminded people to frequently wash their hands after contact to reduce the transmission of infection.

¿ Social activities were provided seven days a week and had been adapted during the pandemic. For example, some people enjoyed going to the pub so a mobile ‘mini bar’ had been created.

¿ Engagement champions cascaded information and updates from the senior leadership team to keep staff up to date with any changes. A confidential helpline and a bereavement counselling service was available for staff to seek advice and support during the pandemic.

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

People continued to feel safe living at Ardenlea Grove and they were protected from harm. Risks associated with people’s care had been assessed and were managed well. Staff were recruited safely and were trained and competent to carry out their roles effectively.

Medicines management was safe, and people had access to health professionals when required. The staff team worked in partnership with health and social care professionals to ensure people received effective care.

The environment met people’s needs and systems were in place to ensure the equipment used and the environment was safe. The provider's infection prevention and control measures were effective.

Staff were caring, and staff spoke fondly about people. The culture at the home was inclusive and people and staff were treated well. People's needs were assessed before they moved into the home. Where possible, people had been involved in planning and reviewing their care.

Staff knew people well and provided care in line with their wishes. Action was being taken to update people’s care plans to ensure care was always provided consistently. People’s right to privacy was respected and people received dignified care from staff who understood the importance of promoting their independence.

People enjoyed the food and had enough to eat and drink. People enjoyed the range of social activities provided. People were supported to maintain relationships that were important to them and visitors were welcome to visit at any time.

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 knew how to complain, and systems were in place to manage and respond to complaints in a timely way. Lessons were learnt when things had gone wrong.

Effective systems monitored and continually improved the quality and safety of the service provided. People and relatives spoke positively about the leadership of the service and told us they would recommend the home to others. Staff enjoyed their jobs and felt supported by their managers. People had opportunities to share feedback about the service they received, which had been used to support improvement.

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 26 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Ardenlea Grove nursing home provides nursing and residential care to a maximum of 60 people. On the day of our visit 50 people lived at the home. The home had three floors. The Emerald Unit (ground floor) provided care to people who lived with dementia. The Pearl Unit (first floor) which had provided temporary care to people discharged from hospital. The Ruby unit (first floor) provided care to people with nursing and palliative care needs; and the Sapphire unit (second floor) provided care to people with physical nursing needs.

The home had a registered manager. 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.

People felt safe living at Ardenlea Grove and thought staff were kind, considerate and caring. Staff told us they enjoyed working with people who lived at the home. They understood people’s needs, wants and preferences, and treated people with dignity and respect.

There were enough staff on duty to keep people safe. The provider’s recruitment practice reduced the risks of the home employing staff who were unsuitable to provide care. Staff understood how to safeguard people from harm.

People's risks were considered, managed and reviewed to keep people safe.

People thought staff had the experience and training to support them. Staff had received training to support them meet people’s health and safety needs, but more specialised dementia training had still not been provided since our last visit.

People were supported to have maximum 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.

People were offered a choice of meals and drinks throughout the day. Specific dietary needs were catered for, and appropriate support given to people who needed extra help with their eating and drinking.

Individual and group activities were provided to people who lived at Ardenlea Grove. There had been improvements since our last visit, although the activity worker acknowledged further improvements were needed. Visitors were welcomed at the home, and there were no restrictions on the length of time visitors could stay.

Medicines were managed safely and people received their medicines at the expected time. People were referred to other health and social care professionals when necessary and in a timely way.

There were systems to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to ensure people were kept safe.

People, relatives and staff thought the culture of management was open and transparent. The atmosphere in the home was happy and relaxed.

Ardenlea Grove nursing home provides nursing and residential care to a maximum of 60 people. On the day of our visit 52 people lived at the home. The home has three floors. The Emerald Unit (ground floor) provides care to people who live with dementia. The Pearl Unit (first floor) provides care to people who have been discharged from hospital and whose needs were being assessed to determine what their next steps would be. The Ruby unit (first floor) provides care to people with nursing and palliative care needs; and the Sapphire unit (second floor) provides care to people with physical nursing needs.

The home has a registered manager. 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.’

People told us that staff were not always available at the times they needed them. We were concerned that staffing levels during the evening and night time meant some people’s care needs were not responded to quickly. Some people told us their care needs were not always met in a timely way at busy times of the day. The recruitment process checked that staff were suitable to work in a care service.

Suitable arrangements were in place for ordering, storing and returning medicines. Medicines were mostly managed safely and securely.

Risks related to people’s care were mostly managed appropriately. Staff mostly had a good understanding of how to manage risks related to people’s health and welfare. The registered manager and staff understood the principles of the Mental Capacity Act and the registered manager had applied for Deprivation of Liberty safeguards for people whose freedoms were restricted.

People told us they felt safe at the home, and staff understood policies and procedures designed to protect people from the risk of abuse.

People received food and drink which met their nutritional needs. There were mixed opinions about the quality of the meals, and the meal time experience did not cater sufficiently to meet the needs of people who lived with dementia.

Staff sought the advice and guidance of other healthcare professionals to support people’s healthcare needs. These included the GP, dietician, tissue viability nurses and speech and language therapists.

Most people felt cared for by staff. Some people felt that staff did not spend enough time talking with them and engaging with them, and we observed this during our visit. Staff had received sufficient training and support to meet people’s care and nursing needs, but had not received training to provide a ‘specialist’ dementia care service.

Some organised activities and individual activities were available to people who lived at Ardenlea Grove. People enjoyed the activities but did not think there were sufficient to keep them occupied. The registered manager had recruited a new activity worker who would provide a further 20 hours of activity work per week. People who lived with dementia had very little stimulation or activities available to them.

There were systems in place to capture feedback from people and relatives who used the service. This included a formal complaints policy and procedure, customer feedback boxes, relatives meetings, and quality assurance questionnaires. Friends and relatives were able to visit the home when they wished.

People and their relatives felt the home was managed well. The registered manager worked with staff on the floor, and staff felt they were approachable and supportive. Not all the people we spoke with knew who the manager was, or felt comfortable in approaching them. The provider had quality assurance systems in place to support the registered manager in running the home.

At our last inspection we were concerned about people who were unable to eat food or take liquid via their mouth. These people needed to use a tube inserted into their stomach for nutrition (percutaneous endoscopic gastrostomy) and were not receiving appropriate mouth care to stop the mouth area from becoming dry and cracked. On this visit we noted systems had been put in place to ensure the mouth area was kept moist.

At our last inspection we noted the service was not sending the CQC notifications of people who had developed pressure ulcers classified as a grade three or above after admittance to Ardenlea Grove (grade one is the lowest severity of injury to skin and underlying tissue and grade four is the highest). Since our visit, the service has sent us notifications.

'Staff are kind',

'The staff are very respectful',

'It's different here but very nice, everyone is very helpful to you'.

We observed staff being kind and caring to people living at Ardenlea Grove.

We looked at whether people had adequate nutrition and hydration. We were satisfied people enjoyed a good menu which was adapted to suit individual needs.

We looked at how staff at Ardenlea Grove co-operated with other services. We saw there were good links with other services to promote the well-being of people living in the home.

We checked the safety, availability and suitability of equipment used at Ardenlea Grove. We were satisfied that there was sufficient equipment to meet the needs of people living at the home.

We looked at staffing levels and the skills and qualifications of staff working in the home. We were satisfied there were sufficient staff to support people living at Ardenlea Grove. Staff had appropriate training and qualifications to meet people's needs.

We looked at care and care records. We were satisfied that the majority of people living at Ardenlea Grove were receiving good care and treatment. We had concerns about some aspects of care and the recording of that care. These are detailed in the body of the report.

We saw good care and treatment provided to people living in the home. We were told by people 'I've been better since I've been here', 'the food here is good, it's too good for me because I eat it all', 'the staff are lovely, so nice and friendly'and we have entertainment'.

We spoke with one visiting relative who told us their loved one received 'excellent care' and the 'staff are lovely'

We looked at how the service managed medication. We were satisfied it was managed competently and people were safe. We noted some inconsistencies with the amount of stock in relation to the medication records of two people, however these did not put people at risk.

We saw good recruitment systems in place to ensure staff are safe to work with people. Staff told us it was a stable staff team with many having worked at Ardenlea Grove for a number of years. We noted some gaps in staff files of information required by Schedule 3 of the Health and Social Care 2008.

We looked at how the service responded to any formal and informal complaints and were satisfied that complaints were taken seriously and responded to in a timely way.