Ash Court Care Centre - Camden

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 58 people living in the home at the time of our visit.

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

Since our last inspection, the management team at the home had taken effective action on improvement. Newly introduced monitoring systems and processes led to an improved managerial overview of the service delivery. This led to meeting a warning notice about medicines management and meeting breaches in relation to protecting people from abuse, staff training, reporting on notifiable events and appropriate maintenance of equipment.

Further improvements were still needed to fully meet the requirements of the Regulations. This related to aspects of the management of medicines and their monitoring.

People were protected from harm and abuse from others. Overall, risks to people’s health and wellbeing had been assessed. There were appropriate infection prevention and control measures in place. Recruitment procedures were safe, and people were supported by suitably selected staff. There were enough staff on each shift to support people safely. Staff and the managers followed the procedures related to the effective management of accidents, incidents and safeguarding concerns at the home.

Staff received training to help to support people effectively and safely. Formal staff one to one supervisions during the last 12 months have been reduced due to demands related to the Coronavirus pandemic. Nevertheless, staff said they felt supported as they received emotional and practical help from the managers, colleagues and when appropriate the local authority.

People’s care plans were personalised and included information about their cultural background, religion, disability, age, end of life wishes, important relationships and personal preferences. This helped staff to understand people’s specific needs and provide effective care. End of life care plans needed further development to ensure they specified when the end of life care pathway would be implemented. The managers assured us this would be looked into.

Overall the managers at the home received positive feedback from staff, people, their relatives and external professionals. They all said the managers were kind, attentive and willing to take improvement action when gaps in the service delivery were identified. Some family members told us, they were not always updated on the outcomes of the actions agreed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 05 November 2019) and there were multiple breaches of regulation. A warning notice was issued in relation to the management of medicines. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made however more improvements were needed and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 and 12 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led domain and additional checks on breaches and recommendations from the effective and responsive domain.

The ratings from the previous comprehensive inspection for those key questions we did not fully look at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ash Court Care Centre Camden on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of medicines and governance of the service at this inspection. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will continue to monitor the 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.

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 March 2017).

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: At this inspection we have found evidence that the provider needs to make improvements. We have identified breaches in relation to safe care and treatment, safeguarding, premises and equipment, training, submitting statutory notifications and good governance at this inspection. We have made two recommendations related to person centred care planning and end of life support. Please see the safe, effective, responsive and well led domain sections of this full report.

We issued the warning notice about the Regulation 12 (Safe care and treatment). You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires Improvement. This is based on the findings at this inspection. Full information about Care Quality Commission’s (CQC) regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

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.