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Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 January 2019

This inspection took place on 7 November 2018 and continued on 12 November 2018. We previously inspected Ashmeadows in January 2018 and rated it overall as requires improvement. There were no breaches of regulation found.

Ashmeadows Care Home provides residential care for up to 17 people. At the time of our inspection, 15 people were living at Ashmeadows. Ashmeadows 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.

At the time of our inspection, Ashmeadows did not have a registered manager in post. A home manager started working at the home in August 2018 and they had started their application to become registered. Following our inspection, we were able to confirm the application process had completed and they had become registered with the Care Quality Commission.

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.

Individual risks to people were not consistently well managed. Certificates relating to gas, electricity and lifting equipment showed maintenance had been regularly carried out. However, the home manager who was checking hot water temperatures had not tested this in people’s own rooms.

Quality assurance audits had identified care plans needed refreshing which the home manager had started. People, relatives and staff were involved in this process. New care plans were found to be easier to use and contained better detail. We found some gaps in other care plans we reviewed. End of life care records required improvement.

The registered provider had a dependency tool, although this was not being used to calculate staffing levels. People told us staff responded to them quickly. Regular agency staff were used as needed on night shifts and permanent night staff were being recruited.

Safe recruitment procedures were followed. The registered provider used a risk assessment and character reference to assess the level of risk in one case where they were unable to access a reference.

The administration and storage of medicines was safe. People received their medicines as prescribed and protocols for ‘as required’ medicines were in place. The home manager was in the process of completing medication competency checks for all staff.

People told us they felt safe and protected from harm. Staff received safeguarding training and knew how to report abuse. Weekly and monthly fire safety checks were carried out. Each person had an up-to-date evacuation plan for staff to follow.

The home was found to be clean and the lounge area had been refurbished with new carpet and had been redecorated.

Activities were being provided, although feedback we received indicated this could be better. The operations manager was looking to invite befriender volunteers to visit people in the home. The home manager said they wanted to have a singer visit monthly.

There were systems in place to ensure people and their relatives knew how to complain if they were dissatisfied. Complaint records provided evidence to show how these matters had been resolved.

People’s equality, diversity and human rights were respected. People’s religious needs were supported. Staff were seen to be caring and knew people’s needs well. Staff were able to explain how they supported people to maintain their privacy and dignity.

Staff training completion rates were found to be high. Staff received supervision support and the home manager had scheduled staff appraisals for January 2019.

People were supported to have maximum choice and control of their lives and staff supported them in the least restri

Inspection areas

Safe

Requires improvement

Updated 17 January 2019

The service was not consistently safe.

A dependency was in place, although this had not been used to calculate staffing hours needed.

Risks to people had not been consistently identified and assessed. Lessons were learned from events which did not go as planned.

People felt safe. Medicines and recruitment had been safely managed.

Effective

Good

Updated 17 January 2019

The service was effective.

People were supported to have maximum choice and control of their lives.

People were supported to access healthcare services.

Staff training showed high levels of completion. Supervision sessions had commenced under the home manager and appraisals were scheduled.

Caring

Good

Updated 17 January 2019

The service was caring.

Staff knew people’s needs well and demonstrated positive interactions with people.

People’s privacy and dignity was protected along with their equality, diversity and human rights.

Responsive

Requires improvement

Updated 17 January 2019

The service was not consistently responsive.

Care plans were being reviewed to make them more reflective of people’s needs. End of life care needs contained limited recording.

Activities were provided, although feedback we received indicated this could be improved.

People knew how to complain and complaints we looked at were suitably managed.

Well-led

Requires improvement

Updated 17 January 2019

The service was not consistently well-led.

Staff gave mixed responses about the support they received from the management team.

Surveys and meetings had been held with people, relatives and staff to capture their views.

There was sufficient oversight of the home through senior management visits and home manager audits.