21 January 2016
During a routine inspection
At the last inspection on 19 September 2014 we found the service to be compliant with all regulations we assessed at that time.
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.
Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. The service took into account people's needs and their dependency level, using a dependency level tool. People we spoke with living at Ashwood and visitors told us they thought there were sufficient numbers of staff to meet their needs
We looked at five staff personnel files and there was evidence of robust recruitment procedures.
There was an up to date safeguarding policy in place, which referenced legislation and local protocols. We spoke with three care staff who demonstrated an awareness of safeguarding and were able to describe how they would make a safeguarding referral. The home had a whistleblowing policy in place.
We looked at how the service managed the administration of medicines and looked at medication administration records (MARs). We observed staff administering medicines and saw that people were given their medicines as required. Staff who administered medicines had all completed appropriate training in the safe handling of medicines. Records of medicines administration had been completed consistently and accurately. We saw some people were prescribed medicines ‘when required’ (PRN). We saw PRN protocols were in place for these medicines.
Accidents and incidents were recorded correctly including a record of the accident or incident, whether or not it was reportable under RIDDOR, a summary chart and action plan
We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition.
We saw the home was clean and free from any malodours. We saw that bathrooms and toilets had been fitted with aids and adaptations to assist people with limited mobility. Peoples’ changing care needs which required the support of other appropriate professionals were responded to promptly. People’s care plans contained records of visits by other health professionals.
We looked at how the service managed the control of infectious diseases. We saw that monthly infection control audits were in place and included areas such as beds and mattresses, furniture, bedrooms and the general environment and equipment. Staff were aware of precautions to take to help prevent the spread of infection.
There was an up to date a fire policy and procedure. Fire safety and fire risk assessments were in place. The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use.
There was a staff supervision schedule in place which identified meetings during the year. Annual appraisals had either taken place or where scheduled for after the date of the inspection. Staff were subject to a formal induction process and probationary period. Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role.
The service was working within the principles of the MCA. Staff told us they had received training in the MCA and DoLS and most were able to explain the principles of this legislation to us. Staff were aware of how to seek consent from people before providing care or support.
The service had achieved a food hygiene rating score (FHRS) of five. There was a three week rolling menu cycle, which was nutritionally balanced. Special diets were catered for, food allergies were recorded and people had nutrition and hydration care plans in place.
We saw there were some adaptions to the environment, which included pictorial signs on some doors which would assist people living with a dementia.
We saw staff showed patience and encouragement when supporting people. We observed people were treated with kindness and dignity during the inspection. Staff spoken to had a good understanding of how to ensure dignity and respect when providing care and support and people we spoke with confirmed that they felt staff respected their privacy and dignity. We saw that the care staff knocked on people’s bedroom doors and waited for a response before entering. Throughout the course of the inspection we heard lots of laughter between staff and people and there was a positive atmosphere within the home.
People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this. Staff told us they involved families when developing care plans or carrying out assessments. The people we spoke with living at the home and visitors to the service confirmed this was the case.
We looked at records of residents and relatives meetings which were held regularly. Records were kept of each meeting and notes were given to people and their relatives. We found the service aimed to embed equality and human rights though good person-centred care planning.
Care files were well organised and contained care plans that covered a range of health and social care support needs. We saw detailed personal profiles in the care records which included people's life story, a list of priorities about their care and quality of life, their memories, risk assessments and relationships. We saw people had a choice of activities to stimulate them.
People’s care files identified that individuals and their relatives were involved in the planning of their care, and personal preferences were discussed. The care records showed regular visits form relevant other professionals such as a GP, an optician, a chiropodist and advanced nurse practitioners.
We looked at how the service managed complaints and we found that the home had procedures in place to receive and respond to complaints. There was a complaints policy and procedure in use and this was up to date
People told us they could make choices such as when they went to bed or were supported with bathing. Staff we spoke with confirmed this was the case.
Each person using the service had an allocated key worker who consulted them about their preferences and listened to any concerns they had. Staff reviewed the weights of people who lived in the home on a weekly basis.
Staff said they liked working at the home. They told us they thought the home was well led and said that the registered manager was approachable and fair.
There were a variety of systems in place which helped the service to monitor the quality of care provided to the people who lived in the home. The service undertook a range of audits, which were competed according to different schedules and these included areas such as the environment and equipment.
We found that residents’ meetings had been held regularly. Records of these meetings were detailed and showed that various issues had been discussed.
The service had a business continuity plan that was recently reviewed in October 2015 A ‘sister home’ buddying system was in operation which identified another local care home who had a reciprocal arrangement with Ashwood in the event of the need to evacuate the premises for an extended period of time.
There was a full range of policies and procedures in place which were available in paper copy format and electronically.
There was evidence in minutes of staff team meetings that findings from audits were communicated to staff and actions taken. There was a monthly staff supervision schedule in operation.
Accident and incident forms were completed correctly and included the action taken to resolve the issue. The service appropriately submitted Statutory Notifications to the Care Quality Commission (CQC) as required and had notified the CQC of all significant events, which had occurred in line with their legal responsibilities.