Ascot House

Updated 31 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 7 and 8 January 2019. The inspection team consisted of an adult social care inspector and an assistant inspector on both days. An expert by experience attended the first day of the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The provider had completed a Provider Information Return (PIR) prior to our inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service, including notifications. A notification is information about important events which the service is required to send us by law.

We contacted the local authority commissioning and safeguarding teams as well as the local Healthwatch board and infection control service. They did not raise any concerns about Ascot House prior to the inspection. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. All of the comments and feedback received was reviewed and used to assist and inform our inspection.

During the inspection we spoke with seven people currently receiving care and support at Ascot House and two relatives. We spoke with the registered manager, a physiotherapist, six care staff, a social care support worker, and the cook. We looked at four staff recruitment records and four people’s care files. We observed people in the communal areas and at lunch time. We viewed information relating to the health and safety of the premises, records of staff supervision and meetings, policies and procedures, compliments and complaints and quality assurance systems.

Updated 31 January 2019

The inspection took place on 7 and 8 January 2019 and was announced. We announced the inspection as we inspected the Ascot House Care at Home service as part of the same inspection. This was to allow us to see how the service supports people with rehabilitation and follow up care received from the care at home service. We also needed to ensure there was someone available to facilitate the inspection.

Ascot House is an intermediate care service provided by Trafford Council and Pennine Care. It provides therapy led rehabilitation for adults. Intermediate care is a service which helps people to recover from illness or an accident, to regain independence and to remain in their own homes. Ascot House is registered to provide accommodation for persons who require nursing or personal care, for up to 45 people. There are 45 single rooms across five individual units. Nine of the rooms are used as step-down beds for people waiting for residential care or additional care and support packages at home. There are lounge and kitchen facilities within each unit and areas for rehabilitation and exercise to be undertaken. The service aims to provide a 21-day turnaround for rehabilitation to enable people to return to their own home. At the time of inspection, the service was supporting 26 people for rehabilitation and nine people in the step-down beds.

At out last inspection, we rated the service overall requires improvement, as medication was not always safely managed and there was a lack of supervision for staff. At this inspection, we found there had been improvements made and the service is now rated as good in all of our key questions.

A registered manager was 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.

People felt safe being supported at the service. Staff had received training in safeguarding vulnerable people from abuse and were confident any concerns they raised would be listened to and acted up on. People felt comfortable to raise any concerns they had with the staff team.

Staff were recruited safely. Appropriate checks were in place to ensure staff were suitable to support vulnerable people.

People had the risks they presented assessed and reviewed, when there were changes. People were supported with equipment to help them reduce levels of risk and as their mobility improved.

The safety of the premises was monitored both internally and externally. Regular checks were in place for fire safety, gas, electric, the passenger lift, equipment and legionella.

People were assessed to ensure they were suitable to receive rehabilitation at the service. Assessments ensured people were fit for discharge from the hospital and could understand what would be required from them in terms of regular exercise plans with the therapy team. Staff were able to read information about people before they arrived at Ascot House and could arrange equipment to be ready for their arrival.

Health needs were still met when people stayed at Ascot House. People were registered with a local GP service to monitor their health and make referrals to other services if necessary. Weekly multi-disciplinary meetings were held to discuss people’s progress and plan for returning home. District nurses worked in the service to complete nursing roles, such as to administer insulin or attend to dressings.

Staff received training appropriate to their job role. Staff enjoyed the training and were able to complete additional qualifications to enhance their knowledge. Staff received an induction into the service which accompanied the training. Many of the staff had work for the organisation for many years.

People had their nutritional needs catered for and monitored while staying at the service. Meals were healthy and nutritious and there was plenty of choice on the menu. If people did not like what was on the menu, an alternative meal would be offered. Meal times were relaxed and a social event.

The building was accessible for people with mobility concerns. There was adequate space for rehabilitation exercises to taken place in and for people to be mobile in. Sensors could be fitted to chairs and beds to alert staff when people might be at risk of falling.

People felt cared for and we observed caring interactions between staff and people who used the service. Staff told us they were happy knowing they had assisted people to improve their mobility and independence to enable them to return back to their home.

We saw examples of dignity and respect as staff knocked and people’s doors and gained permission to enter. Staff explained to people what they were doing, such as personal care.

Personal information relating to people was kept securely locked away. Confidential conversations were held in private.

Care plans captured people’s needs and identified the support needed to improve people’s mobility. Care plans gave goals for people to work towards. Goals were agreed with people on admission and reviewed as progress was made.

Discharge planning ensured people’s properties were safe for them to return home to. Referrals were made where people required support in their own home and follow up calls were made to ensure people had settled in, once they had returned home. The Ascot House – Care at Home service could be requested to follow up people for a short period once they had left Ascot House.

People told us they knew who to complain to if they had any concerns. Complaints were responded to in a timely manner and outcomes shared.

Staff felt supported by the registered manager. The registered manager was supported by the head of service and had responsibility for managing the manager of the care at home service as well as the Ascot House staff team.

Staff from other services that supported Ascot House felt the teams worked well together.

There were audits in place to monitor and improve the service. Improvements has been made to the auditing of medicines to ensure they were safely managed.

People and staff felt that Ascot House provided a valued service which enabled people to return to their own home.

Feedback from people who used the service stated that people were likely or very likely to recommend the service to others.