Archived: Ashgrove House Nursing Home

We found the following examples of good practice.

In order to reduce the risk of infection, the service introduced zoning into Covid-19 and non-Covid areas. Staff were assigned to work in specific zones only to reduce spread of the pandemic. Staff working in the Covid-19 area was issued with masks, gloves, aprons, face shields, hair caps, sleeve covers and overshoes.

The service used IT equipment in order to reduce direct contact between members of staff working in different zones. An intelligent personal assistant, a sort of cloud-based voice service, was used for staff in different zones to communicate between them, the kitchen and the management team. This reduced the possibility of cross-infection and spread of Covid-19.

The service used whiteboards with people who needed to read lips to communicate and were unable to do it due to staff wearing face masks.

Staff used the most up-to-date guidance and best practice regarding the pandemic. This was shared through a live document that was updated according to the newest guidance published by Public Health England. The document was shared in the electronic form on a closed social media group and hard copies were given to all members of staff.

The service provider used fast-testing on top of regular tests to obtain faster test results when concerned about staff or people displaying symptoms of Covid-19. Test results were communicated to staff and the provider which resulted in positive outcomes. For example, the provider was able to obtain test results and to send home an infected member of staff who was working their shift.

There were appropriate arrangements for waste managements from all the zones with separate paths used for disposal of waste.

Staff maintained social distancing and the provider installed screens in the smoking area to protect staff from cross-infection. Perspex dividers had been fitted between seating spaces in the smoking shelter.

Meals for all the zones were covered, sealed and served from different areas of the kitchen.

Staff were using separate changing facilities provided to reduce the risk of infection.

Prior to the lockdown, the service was booking visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Outdoor visits took place and visitors were also provided with an infection prevention pack on arrival, including a mask, a face shield and disinfection gel. End of life visits were available for relatives in full personal protective equipment (PPE) for the length of 15 minutes.

The company vehicle was used with the driver in full PPE for hospital appointments. The vehicle was ventilated and disinfected after each use.

Further information is in the detailed findings below.

Ashgrove House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 35 persons who require personal care. On the day of our inspection 34 people were living at the service.

At the last inspection, the service was rated Outstanding in the Caring, Responsive and Well led domains and Outstanding overall. At this inspection we found the service had continued to meet the characteristics of outstanding in Caring, Responsive and Well-led domains, they had also improved in the Effective domain from good to outstanding. The overall rating continues to be Outstanding.

People were at the heart of Ashgrove House Nursing Home. We saw examples of staff wanting to make a positive difference to people’s quality of life. This reflected the values that staff held and the culture of the service ‘being more than a job’.

Without exception people said and gave examples of where staff had gone ‘the extra mile’ to make their lives special. They told us they felt well cared for and were offered emotional support when needed. Relatives were enthusiastic about the support they received. They said they felt encouraged to continue to play an important part in their relatives lives and told us the service provided a holistic approach to care, which included them even after their loved ones had left the service. People’s dignity was always respected and people were able to build meaningful, caring relationships with staff.

The service was led by a registered manager who promoted a service that put people at the forefront of all the service did. 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 registered manager was very passionate about working with people and their aim was to ensure the service met people’s physical and emotional needs. There was a culture of positive teamwork and empowering staff in line with the provider’s values. There was a very high level of confidence in the leadership and management of the service expressed by people, relatives and staff.

The registered manager was supported by an owner and organisation that was committed to providing high quality, innovative care. There continued to be a culture of putting people first which was evident all the way through the service from the provider to the care staff.

The owner and registered manager worked proactively with other organisations to develop training and support which provided enhanced support for the people living at Ashgrove House Nursing Home.

The team worked closely with other agencies and promoted an open and transparent culture that promoted a strong emphasis on continually striving to improve the service. There were effective systems in place to monitor the quality of the service provided and appropriate action was taken promptly when required.

The atmosphere at Ashgrove House Nursing Home was one of caring, happiness and positivity. This enabled staff to embed a strong culture that valued people, relatives and staff and promoted a caring ethos.

People received exceptional care and support from staff who were skilled and knowledgeable and supported them on an individual basis. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People remained safe living in the home. There were robust staffing levels to meet people's needs and staff had time to spend with people. Risk assessments were carried out and these promoted positive risk taking which enable people to live their lives as they chose. People received their medicines safely. There was a robust recruitment process, which involved people as part of the decision making process.

The provider and staff continued to recognise the importance of a range of activities to support people to maintain their interests and wellbeing through mental and physical stimulation.

Staff knew people very well and continued to be sensitive and responsive to people’s changing needs. Care plans continued to be comprehensive, detailed and well written. They continued to reflect people’s individuality and personal preferences.

The registered manager saw feedback and concerns as a learning opportunity and complaints were managed in line with the provider’s policy.

We saw that people's health and welfare needs were being met and the support they received was appropriate to their needs. Experienced staff were available in enough numbers to be able to provide the care and support that people required.

We found that people were being well treated and there were systems in place to protect them from possible abuse.

The quality of the service was being monitored and systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

A relative told us that the staff were very good and caring and were always polite and respectful. They said that the staff "go the extra mile." They told us that they visited at different times of the day and people always seemed to be very happy and comfortable in the home. They were very pleased with the care and support for their relatives.

We saw staff speaking to people with respect and responding sensitively to their needs. We found that there was a clear system of care planning so that people's needs would be met. The plans were person centred so that people could continue to live the life they chose.

People were protected from abuse because staff had the right training and knowledge about prevention of abuse. People told us that they felt safe in the home. Staff had the right training, qualifications and support to meet people's needs. The provider had comprehensive systems to assess and monitor the quality of the service and to manage risks to people.