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Ash Court Care Centre - Camden Requires improvement

Reports


Inspection carried out on 11 September 2019

During a routine inspection

About the service

Ash Court Care Centre – Camden is a care home providing personal and nursing care for up to 62 people aged 65 and over. The accommodation is on three floors, with communal areas located on each floor and a patio garden on the ground floor. There were 60 people living in the home at the time of our visit.

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

People were not always protected from harm. Medicines were not managed safely. People had not always received their medicines, and safeguarding concerns associated with the lack of medicines were not identified by the service. Aspects of infection control and cleanliness of the environment needed to improve.

Care staff had not always received sufficient training on specific health conditions and clinical tasks. The service’s decoration and adaptation did not support the needs of people with dementia and orientation difficulties. Some outside areas of the service were not maintained to ensure they were pleasant and safe for those who used it.

Aspects of the management and leadership of the service needed to improve. There were gaps in the managerial oversight of the service provision. Some managerial and staff roles and expectations, and accountability related to these roles, were not always clear. Not all regulatory requirements had been met. This had impacted the safety and the quality of the service provided.

Some aspects of formal care planning needed to improve. This was to ensure that people’s voice was reflected and information about people’s history and end of life wishes were included in their care plans and personalised.

Risks related to people’s health and care needs had been assessed and reviewed. Regular checks of care equipment and fire safety had been carried out. Staff were recruited safely, and systems were in place to make sure there were enough staff on duty each shift to meet people’s needs.

Staff received induction and training that the provider considered mandatory. Staff received supervisions and yearly appraisal. They felt supported by nurses and managers.

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’s health and care needs had been assessed before they moved in to the service. Staff knew people’s needs well and people were happy with the care received. People were supported to eat and drink enough to maintain a balanced diet. Food provided met people’s dietary needs and cultural and personal preferences. Staff supported people to have access to external health professionals to ensure people’s health needs were met.

There was a welcoming and positive culture in the service. Staff and managers received consistently positive feedback from people, their relatives and external professionals. They thought staff were welcoming, kind and very considerate. People felt safe and comfortable with staff who supported them. Staff interactions with people were caring and attentive to their needs. People were encouraged to make decision about their everyday care and their dignity was protected. Equality and diversity amongst people living at the service had been considered. People were supported to maintain relationships with those who were important to them.

Relatives felt the management team were approachable and always willing to help. People and relatives were encouraged to provide feedback about the service they received. Staff enjoyed positive team work. Staff said they were well informed about people’s current needs and changes and developments within the service. The service worked in partnership with others to ensure people received care they wanted and needed.

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 (10 Mar

Inspection carried out on 18 January 2017

During a routine inspection

This inspection took place on 18 and 19 January 2017 and was unannounced. At our last inspection in October 2014 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Ash Court Care Centre provides accommodation, nursing and personal care for up to 62 older people over three floors. The home is in Kentish Town in Camden. There were 60 people staying at the home at the time of our visit.

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.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful and they were satisfied with the numbers of staff on duty at the home.

Staff understood, respected and responded to each person’s diverse needs in regard to their culture, gender, sexual orientation and spirituality in a caring and compassionate way.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

The home was clean and staff understood about the importance of infection control.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would always offer people choices about their care. People told us staff listened to them and respected their choices and decisions.

The service was following the appropriate procedures regarding Deprivation of Liberty Safeguards (DoLS).

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us they liked the food provided and menu choices were always available.

People using the service and staff were very positive about the registered manager and the management of the home.

People confirmed that they were asked about the quality of the service and had made comments about this. Quality assurance systems were in place in order that suggested improvements could be actioned and monitored.

The service had a number of quality and safety audits which were designed to ensure a safe environment was maintained.

Inspection carried out on 27 October 2014

During an inspection looking at part of the service

This inspection took place on 27 and 28 October 2014 and was unannounced. At our last inspection in December 2013 the service met all the regulations we looked at.

Ash Court Care Centre provides accommodation, nursing and personal care for up to 62 older people over three floors.

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 and associated Regulations about how the service is run.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were patient, kind and respectful.

People and their relatives said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance when they used the call bell.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought out and recorded how these risks could be minimised.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment. They told us that if the person could not make certain decisions then they would have to think about what was in that person’s “best interests” which would involve asking people close to the person as well as other professionals.

Food looked and smelt appetising and the chef was aware of any special diets people required either as a result of a clinical need or a cultural preference.

People and their relatives said they had good access to other healthcare professionals such as dentists, chiropodists and opticians. We met with the GP who visits the home every week.

People told us they liked the staff who supported them and that they were treated with warmth and kindness and that staff listened to them respected their choices and decisions.

A person we spoke with told us they had been involved in activities and their needs had been catered for.

People using the service, their relatives and friends were positive about the manager and management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. They felt the service took their views into account in order to improve service delivery.

Inspection carried out on 3, 9 December 2013

During a routine inspection

In this report there appears the name of a registered manager who was not in post and not managing the regulatory activities at the home at the time of the inspection. Their name appears because they were still registered manager on our register when the inspection was carried out. A new manager had recently started at the home. We spoke with them and other members of staff.

People we spoke with were generally happy with the service. Their comments included that they were "very happy" at the home and the the staff were "very nice and "very caring." We saw people being appropriately supported throughout both days of the inspection, at mealtimes and during group activities arranged by staff members and visiting volunteers. People's care records and other records relating to the service were detailed and up to date.

Staff felt they were properly supported in their roles, but we found that some ongoing training for staff was overdue. We also found that periodic background checks on staff members had not been carried out routinely by the provider. However, we were told that the checks would be undertaken under a revised procedure that had now been implemented.

The provider had effective systems to monitor the quality of the service and to address any complaints.

Inspection carried out on 19, 20 November 2012

During a routine inspection

Our inspection was carried out over two days. Two inspectors visited the home during the evening of the 19th November 2012 and one inspector returned the following day. We spoke with people using the service and visiting relatives and friends across the three floors in the home. We also spoke with the manager and five members of staff. On both days we observed care being provided. We looked at records relating to the care of people in the home as well as staffing records.

The people we spoke with were all very positive about the care being provided. A person using the service told us that �staff are friendly and kind� and were �never rude.� A relative told us the home �takes good care of my gran.� Another said the home was �welcoming.� Since the last inspection fifteen new nursing and care staff have started working in the home and we were told by people using the service and their relatives that these staff were working well and providing good care.

Two relatives mentioned they had concerns over staffing levels at night in the past. Two others said that there could be more activities provided for people, particularly in the evening.

Inspection carried out on 30, 31 July 2012

During an inspection looking at part of the service

We carried out an unannounced inspection visit on the evening of 30 July 2012 and during the day of 31 July 2012 to see whether the improvements we required following our last review had been implemented. Ash Court Care Centre was issued with two warning notices in May 2012 for failing to comply with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; Regulation 9 and Regulation 13. On 31 July 2012 the inspection team included a pharmacy inspector to review Outcome 9 relating to the safe management of medication.

We spoke in detail to three residents and their relatives. We also spoke in detail to four other residents and spoke briefly to most of the residents in their rooms. People living in the home told us the staff are �friendly, gentle and kind� and that the care is �really good�. One relative commented that the care is alright at the moment but there are staff changes and the main thing that needs to happen in the home is for the �staff team to settle down�. We also spoke with staff members at all levels including agency staff.

Inspection carried out on 4 April 2012

During an inspection looking at part of the service

We carried out an unannounced inspection visit on 4 April 2012 to see whether the improvements we required following our last review had been implemented and to assess whether the provider continued to meet the required standards. During our visit we spoke with people who use the services as well as their relatives and friends. The people we spoke with said they felt safe and well cared for in the home; their relatives and friends told us that they were happy with the standards of care provided by the home and its staff.

Following our visit on 4 April 2012 we received some information of concern regarding the care and welfare of people who use Ash Court Care Centre and the management of their medicines. We carried out further inspections to see whether Ash Court Care Centre was meeting the government�s standards of quality and safety. We carried out unannounced inspections through the night on the 3 May and in the early morning on the 4 May. During the course of these inspections we identified concerns around whether the delivery of care to the people that use the service was meeting their individual needs through the night. We then carried out an unannounced inspection in the early morning on the 9th May. During the course of this inspection we identified concerns around the management and administration of medicines to people who use the service.

Inspection carried out on 27 June 2011

During an inspection in response to concerns

We carried out two inspection visits to Ash Court, on 27 June and on 4 August 2011, in response to safeguarding concerns. On the first inspection visit, we looked at outcomes twelve, thirteen, fourteen and sixteen, and on the second visit, we looked at outcomes one, four, five, seven, thirteen, fourteen and sixteen.

During the first inspection visit, we spoke to many people who have used the service, and their relatives and friends. They told us that, generally, staff do their jobs well, are helpful, kind and approachable. They treat people with respect, observe their right to dignity, make them feel comfortable, equal and safe. There were enough staff to meet their needs.

They did not directly comment on the support staff receive or the quality assurance system. They did tell us that they found the manager and team to be open and approachable and they had daily contact with them. They also said that residents� meetings took place with questionnaire handed out beforehand.

On our second visit, we spent most of our time, from early morning until the evening, talking to people and observing care. We also looked at records. People told us that they felt safe and well care for in the home.

Reports under our old system of regulation (including those from before CQC was created)