Ashford House

Ashford House is a residential care home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection, some of these people are living with dementia. The service can support up to 54 people.

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

People were kept safe by systems and policies in the home. Safeguarding incidents were managed, and referrals were made to relevant professionals. Staff received safeguarding training regularly to ensure they could identify different types of abuse.

Risks to people were identified, assessed and managed in a timely way. Action was recorded so staff had guidance to refer to for each person’s individual risks.

The home had responded to the COVID-19 pandemic and additional measures had been implemented.

To ensure people’s mental wellbeing during periods of “lockdown” where visits were not possible, additional video and phone calls for all residents were organised. When visits were permitted there was a booking in procedure implemented to ensure people were kept safe. This included a health questionnaire, temperature check and testing for in house visitors.

Separate entrances for different parts of the home had been utilised to ensure the least amount of foot traffic through the home occurred. Staff had access to a plentiful supply of personal protective equipment (PPE) and social distancing was encouraged through separate break times to ensure all government guidance was complied with.

Additional cleaning had been introduced in the home to ensure high touch areas were regularly cleaned and other areas that may increase risk of the spread of infection.

Social distancing had been encouraged by staff moving furniture to allow for a more spacious communal area. People living with dementia were reminded of the risks related to the pandemic on a regular basis by staff to ensure people received the appropriate support based on their needs.

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 19 March 2020).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The inspection was prompted in part due to concerns received about recent safeguarding referrals and the home experiencing a recent outbreak of COVID-19. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this report.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same.

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

Follow up

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

Ashford House is a residential care home providing personal and nursing care for up to 54 people with needs associated with dementia. Some people living at the home had other complex medical and care needs. At the time of our inspection 49 people were living at the home.

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

People told us they felt safe and staff were kind to them. Family members confirmed that people received safe care.

At our previous inspection of Ashford House we identified risks in relation to staffing levels and safe moving and handling of people. At this inspection we found that the registered manager had taken action to ensure that these risks were reduced. The provider recruited staff carefully to ensure that staff were suitable for their role. Staffing numbers were flexible and decided by the home’s evaluation of people’s needs.

At our previous inspection of Ashford House we had found that some staff were using unsafe techniques when supporting people to move. At this inspection we observed that staff followed good practice in moving and handling. All staff had received training in safe practice.

Staff knew what their responsibilities were in relation to keeping people safe. They understood the importance of reporting any concerns they had about people's safety and how to protect them from harm or abuse.

Staff provided people with personalised care that met their needs and preferences. They understood people’s needs and responded promptly and appropriately when they required support.

People's care plans and risk assessments were up to date and personalised. Guidance was provided for staff to ensure people received the care and support they required. Care plans and care records were handwritten and not always easy to read. The provider was piloting an ‘on-line’ system that would improve the accessibility of care records.

Staff were caring and treated people with dignity and respect. People’s differences including cultural, religious and relationship needs and preferences were understood and respected by staff.

People were supported to maintain good health and to eat and drink well. People were supported to access healthcare services when they required.

People’s independence was promoted and supported by staff. Staff recognised and respected people’s abilities. Staff engaged in a friendly way with people and supported them to participate in a range of activities. We observed staff engaging with people in dementia-friendly activities. However, people’s care records did not always reflect the supports that people living with dementia received.

Staff had the skills and knowledge to provide people with the care and support that they needed. They received the training and support that they required to enable them to carry out their roles and responsibilities effectively.

People had opportunities to participate in a wide range of social and leisure activities. People were supported to maintain relationships with family and friends.

People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible. People’s care plans and the policies and systems in the service supported this practice.

The home was clean and safely maintained. Staff ensured that refurbishment works that were taking place during this inspection did not impact negatively on people’s wellbeing.

The registered manager showed effective leadership and the home was well run. Staff felt supported. Systems were in place to assess and monitor the quality and delivery of care to people and drive improvement. Actions had been taken to ensure that concerns arising from quality monitoring were acted on and addressed.

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. (Report published 12 May 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

Ashford House is a nursing home providing support to up to 54 people. At the time of our inspection there were 47 people living at the home. Most people at the home were living with dementia. Some people also had complex physical health needs.

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. 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.

Our last inspection was in January 2016 where we identified concerns with medicines management. At this inspection we found actions had been taken to ensure this regulation had been met but we identified one other breach of regulation regarding staff deployment and made a recommendation that communications be improved with people and relatives.

People were not cared for by sufficient numbers of staff. Staff deployment across units meant that on one unit staff were rushed and unable to spend time with people apart from meeting their personal care needs. People waited longer for support and staff were rushed. We observed inappropriate moving and handling techniques used by staff on this unit, despite staff having been trained in these techniques.

People’s medicines were administered safely by trained staff. Improvements had been made to record keeping and staff demonstrated competence in handling and administering medicines. Staff worked alongside healthcare professionals to ensure that people’s healthcare needs were met.

People were kept safe from abuse as staff understood their role in safeguarding people. Risks to people were assessed and plans were in place to minimise risks to people. Where incidents had occurred, measures were taken to prevent a reoccurrence.

People had access to a wide range of activities, although not everyone we spoke to agreed there was enough to do. The provider was in the process of implementing changes to how activities were provided to people living with advanced dementia. People were provided with a choice of food that matched their dietary requirements.

People were supported by kind and committed staff. People were encouraged to make their own choices and decisions. People’s cultural and religious needs were supported by staff. Where people were not able to make decisions, their rights were protected as staff worked in accordance with the Mental Capacity Act 2005.

Staff had input into how the home was run and regular staff meetings took place. People and relatives also had regular meetings so they could discuss the running of the home. The provider maintained up to date records. People’s feedback was regularly sought and where complaints were raised these were dealt with.

Appropriate checks were undertaken to ensure that staff were appropriate for their roles. Staff had access to a range of training and received regular supervision. Clinical staff were supported to keep up to date with good practice.

Systems were in place to reduce the risk of fire and to ensure people’s health and safety. A plan was in place to ensure that people’s needs would continue to be met in the event of an emergency.

Ashford House is registered to provide accommodation with nursing care for up to 54 people. At the time of our visit, there were 38 older people living at the home. The majority of the people who lived at the home were living with dementia, some have complex needs and the home also provided end of life care. The accommodation is provided over two floors that were accessible by stairs and a lift.

The home did not have a registered manager in place. ‘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.’ The provider had arranged temporary management coverage at the home. We have been informed that a new manager for the home had been recruited and they would then submit an application to be registered as manager with Care Quality Commission (CQC).

At our previous inspection on 6 and 7 May 2015 we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the standards of cleanliness, infection control, management of medicines, dignity and respect, assessing and monitoring the quality of the service provided. Where the regulations were not being met, we took enforcement action. The provider sent us an action plan on 18 August 2015 and provided timescales by which the regulations would be met. The provider also sent us the updates in relation to progress they had made.

The home had also been placed in ‘Special measures’ by the Care Quality Commission. As this was the second time the home has been rated inadequate for one of the five key questions.

At this inspection we found that some improvements had been made. However, there was still a breach of the regulations. They had not met the requirements regarding the management of medicines.

People were at risk because the arrangements in place to manage medicines were not followed correctly. Medicines administration records (MARs) were not always accurately completed when verified against medicines in stock. The provider was not able to demonstrate when a medicine is correctly administered in line with the instructions provided. People were at risk of not receiving their PRN [to be taken as required] medicines in a consistent way. Documentation was not always completed in line with current legislation.

Staff were up to date with current guidance to support people to make decisions. However where people did not have capacity, not all of the records were completed and did not contain information about who could make certain decisions on their behalf. We made a recommendation that the provider ensures that the contents of their documentation is in line with current legislation.

Improvements had been made to the systems and arrangements in place to regularly assess and monitor the quality of the home, however they were still not effective enough to minimise risk or correct poor practice.

People’s needs were assessed when they entered the home and on a continuous basis to reflect changings in their needs. However there was some discrepancies between information provided by healthcare professionals was not always integrated into practice. We made a recommendation that the provider ensures that the contents of their documentation is in line with people’s current care and support needs.

Medicines were stored safely. Any changes to people’s medicines were prescribed by the person’s GP and administered appropriately.

The standard of cleanliness had improved and staff were following the provider’s Infection control policies and procedures.

People were safe at Ashford House. A relative told us, “People are safe because staff are always patient. I have never seen them rush anything or show any irritation.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There was sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff started work. Staff worked within best practice guidelines to ensure people’s care and support promoted well-being and independence.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The home had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding and power cuts.

Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

The provider ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People were encouraged to voice their concerns or complaints about the home and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the home.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the home had in place. There were a range of activities available within the home and community.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the home.

People’s care and welfare was monitored regularly to ensure their needs were met within a safe environment.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our visit we saw that staff treated people with respect, dignity and kindness. People told us that they thought the staff were “wonderful” and “kind”. We saw that people were cared for in a way that promoted their independence and that people were encouraged to make choices.

We looked at people’s care files and saw that each person had an initial assessment, a care plan and risk assessments. These were up to date and reviewed at least once a month or after changes in people’s care needs.

We spoke to three people who were visiting who told us that they thought their relatives were well cared for and safe. One relative told us “It’s not easy looking after my relative. The staff do an amazing job”.

We saw that staffing levels throughout the day and evening were sufficient to meet people's needs. Relatives confirmed that they did not have any concerns. One relative told us, "There is a lot to do but staff do a good job”.

We saw that the provider had a complaints policy and saw examples of some of the complaints that had been received. These had been investigated and that in each case the complainant had been informed of the outcome.

We looked at the provider’s statutory notifications as we had noted that there had been delays in reporting of incidents to the Commission. We saw that recent notifications were dated and submitted within appropriate timescales.