Ashbourne House - Stockport

We found the following examples of good practice

¿ The service had implemented a safe procedure for outside visiting. The service had been innovative in ensuring people had the best possible experience when a friend or relative wished to visit. The service had set up a specific room with a large, sealed window and installed an intercom system to facilitate safe window visits by appointment. This room and intercom was sanitised after each visit.

¿ The service ensured people were supported to keep in contact with friends and family through the use of telephone and video calls. The service also streamed exercise classes and concerts through video conferencing applications. The registered manager told us they had kept the residents and families up-to-date with the current situation at the home through regular meetings, letters and phone calls.

¿ The service had comprehensive contingency plans in place to cohort and zone areas in the event of an outbreak. The service was already supporting people in small groups to include those people who liked to sit together in the lounge and dining room. These groups were kept together as much as possible and specific staff members were allocated to support those groups.

¿ There was a clear policy in place for new admissions to the home; this applied whether it was a new person from the community or someone returning from a hospital stay. The registered manager ensured Covid-19 test results had been confirmed for new admissions and people were tested regularly after admission. These people were required to self-isolate in their room for 14 days and extra infection control measures were put in place. The service had made the isolation room as pleasant as possible and staff ensured regular interaction to offer extra support to people during their isolation.

¿ The service had made provision for a designated room for staff to change into and out of their uniform and safely use the required personal protective equipment (PPE). Staff were able to place their uniforms straight into the laundry and a staff shower was to be installed. Sanitisation and PPE stations were placed around the building. Staff had made pictures of famous people and artwork where they had added PPE as a fun way of introducing the use of PPE at the home. The service ensured they had sufficient stocks of PPE and had purchased extra supplies.

¿ Regular testing was carried out at the home of both staff and people who used the service. There was a clear and detailed action plan in place in the event of a positive Covid-19 test. All staff and people had been risk assessed for their level of vulnerability and anyone identified as particularly vulnerable had an individual risk management plan in place. The home had a regime in place for regularly checking people's current health to quickly identify if someone was showing signs of being unwell.

¿ The home was very clean. A strong emphasis had been placed on current cleaning schedules and extra twice-daily cleaning regimes had been introduced. These were to ensure all contact points were cleaned with anti-bacterial sprays specifically designed to kill Covid-19. Deep cleans were also regularly carried out. The service had purchased a UV air purifier to remove bacteria and viruses that may be in the air; this was an extra measure to ensure the home was as clean as possible.

¿ The home did not use agency staff. However, the registered manager had arranged a pre-emptive contingency plan with a local agency to ensure access to single, exclusive agency staff in the event of staff shortages due to an outbreak. Staff had received additional training in infection prevention and control from the public health teams alongside additional internal training. Guidance posters on good infection control and the use of PPE were displayed throughout the home and in the staff changing room.

¿ The service had a detailed and comprehensive Covid-19 policy and contingency plan. This was kept fully up to date and had been reviewed just two days before our inspection. All information was detailed, contemporaneous, easy to understand and included links to current guidelines and Government policies.

Ashbourne House- Stockport is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. The home provides care and accommodation for up to 23 people. At the time of the inspection there were 20 people living at the home.

People’s experience of using this service:

At this inspection we found the evidence continued to support the continued overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

People felt safe living at the home. Risks were well managed. Medicines were managed safely. Staff helped people to stay healthy and people had access to a range of health care professionals.

Staff received the training and support they needed to carry out their roles effectively. Staff members had been safely recruited and there were enough staff to provide people with the person-centred support they needed.

The home was clean and well maintained.

People were involved in decisions about their care and support. The provider was working within the principles of the MCA.

Staff interacted with people in a kind and sensitive manner. People seemed relaxed and comfortable in the company of staff.

Staff and managers knew people really well and showed genuine empathy and understanding for the people who lived at the home. People spoke with fondness about the staff and the homely nature of the service.

Care records were person-centred and were reviewed regularly. They gave sufficient information to staff to guide them on the care and support people needed.

There was a range of activities on offer, both in the home and in the community to help prevent people becoming socially isolated and to keep people active.

Everyone was very positive about the registered manager and the way the service was organised and run.

Audits of the service, company policies and procedures and staff practice all helped to evidence how the service was meeting the regulations. The quality assurance records that we saw demonstrated how the registered manager maintained good oversight of the service.

Rating at last inspection:

At our last inspection, published in November 2016, we rated the service as good.

Why we inspected:

This was a planned inspection based on the last inspection rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The home’s last inspection report was published on 17 September 2014 and at this time the standard entitled ‘quality and suitability of management’ was not met. This judgement was made because a copy of the home’s Statement of Purpose had not been sent to CQC and could not be located on the day of the inspection. At this inspection on 18 October 2016 the home produced a Statement of Purposes that was current and described the service.

Ashbourne House - Stockport is a care home without nursing registered to provide care and accommodation for up to twenty-three older people. There are four lounges and a large dining room, which opens onto an enclosed garden area. At the time of the inspection there were 22 people living at the home.

The home has a registered manager. 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 who used the service told us they felt safe and well supported by staff. Staff had received training in safeguarding. We found staff understood what actions to take if they thought people were unsafe.

Appropriate systems were in place for the management of medicines so that people received their

medicines safely. Medicines were stored in a safe manner. We witnessed staff administering medicines in a safe and correct way.

The premises were clean and well maintained. We saw that equipment was in place to maintain the health and safety of people and staff, and were checked both by the service and approved contractors when required.

There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of recruitment checks to ensure they were suitable to work in the service. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff told us they felt well supported by the registered manager and had received support through supervision and appraisal to enable them to care for people, although we found supervisions were not always formally documented.

Staff told us they felt they had the training and skills to respond to people’s care needs. Training records demonstrated good levels of training and training had been planned to address any gaps in training undertaken.

We saw that people had person centred support plans that reflected their needs. These were reviewed regularly. Support plans reflected the person’s needs and preferences.

Individual support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.

The care records showed us that people’s health was monitored and health care professionals where involved where necessary for example: their GP, district nurse or social worker.

We saw a compliment and complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.

People also had access to advocacy services and safeguarding contact details if they needed it.

People told us the service was caring and that they felt well supported.

The service adhered to the requirements of the Mental Capacity Act. This meant people’s capacity to make decisions had been assessed. Where required we found decisions had been made in people’s best interests involving their family members and other professionals.

We found people who used the service, their representatives and healthcare professionals regularly asked for their views about the service.

There were quality assurance systems in place to ensure the effective running of the service, however we found that action plans could be clearer and more focused.

We found that the management and staff had a clear view of the ethos and purpose of the home.

We considered the evidence collected under this outcome and addressed the following question, is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service well led?

During this inspection we saw that the home had improved the way it monitored the effectiveness of the infection prevention and control measures in place. We also saw that a more comprehensive medication audit was in place and the home's medication policy had been updated.

A formal audit system had been introduced covering key areas of the service. Checks were carried out and recorded on a daily, monthly and annual basis. This meant that there was a system in place to identify and respond to shortfalls or concerns with the service provided, in a timely way.

We saw that the home's complaints policy had been updated to provide clearer guidance on how to make a complaint and improvements had been made to the way that feedback was obtained from people who used the service.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

The people we spoke with who lived at the home or were a visiting relative, all made positive comments about the service, they told us they had no concerns about people's safety or the care provided. One person living at the home told us 'Staff are wonderful, it doesn't matter what you ask them, they do their upmost to help'. A visiting relative told us 'I feel she's safe, that's the most important thing and that she's happy'. We also spoke with four members of staff who all told us they thought people were well looked after.

We saw that there were systems in place to manage people's medication. Medication was appropriately and securely stored and records were generally up to date and appeared appropriately kept. We did note an error in the recording of a controlled drug, where medication received by the home had not been recorded. However this medication was appropriately stored, was unused and there was no indication of any resulting harm from this error. We saw that this medication was also returned to the pharmacy following our inspection. The member of staff we spoke with who assisted people with their medication told us they had received training in this role.

We saw that the premises were well maintained and provided a pleasant environment for people using the service and their visitors. We saw that the environment was generally free from any obvious hazards, although we did observe the presence of toiletries in the communal bathrooms. People should have usage of their own personal toiletries to minimise the risk of cross infection. We also saw that the access to the cellar, which housed hazardous areas and items, was not as secure as it could have been. However there was no indication of any harm having occurred from inappropriate access to this area. We saw a selection of maintenance records for the utilities and equipment at the home. These included the gas safety check, fire equipment and emergency lighting checks and tests on the homes call bell system. We also saw that a 5 year electrical safety inspection had been carried out. Although the report found the electrical system to be unsatisfactory, it advised that remedial work was taking place.

Is the service effective?

People's care plans were person centred and provided clear guidance for staff in how to deliver people's care. We did find some examples where people's care records were not as complete as they could have been; however there was no indication that people were receiving poor care.

We saw that people were able to spend their time as they wished and move freely about the home. There were organised activities for people to take part in, with a strong emphasis on family involvement at the home. We saw that the independence of people who used the service was encouraged by staff. One person we spoke with told us 'Staff let you be independent'. The people we spoke with told us that people received the care and support that they needed. Staff felt they understood people's needs and preferences. They told us they had access to the information and guidance they needed to support people effectively.

We saw that staff received training and support to enable them to carry out their role and develop their practise. The staff members we spoke with told us they felt supported and that the management team was approachable. We saw that staff received regular supervision sessions and annual appraisals.

Is the service caring?

We found the atmosphere in the home to be friendly and relaxed. We observed a warm and caring approach from staff and saw that people were treated with dignity and respect. However we did observe an occasion when a member of staff appeared abrupt and off hand in their manner when assisting someone living at the home. We also received comments of a similar nature from the people we spoke with. Although staff were considered to be 'nice' and 'helpful', and people had no concerns about the care or welfare of people living at the home, we were told a small number of staff had been 'sharp' or overly assertive in their tone on occasion. Staff should treat people using the service and their relatives with dignity and respect at all times.

Is the service responsive?

We saw that reviews of people's care were carried out and people's preferences and preferred routines considered. We saw that people's independence was also encouraged.

We saw that there was a complaints process in place. All the people we spoke with told us they had had no cause to complain, but would feel comfortable in doing so if needed. The views of people who used the service, visiting relatives and other professionals, were sought to monitor the quality of the service and capture concerns or suggestions to improve the quality of the service. We saw that these opinions had been carefully considered and responded to.

Is the service well led?

We saw that there was a daily management presence in the home and that staff felt supported. The people we spoke with found the management team to be approachable and responsive. People told us they felt comfortable in raising concerns with the management team, who would put things right.

However we saw that the home did not have effective, robust systems in place to monitor the quality and the safety of the service that people received. This meant that the service was unable to reliably identify and respond to shortfalls in the service.

During our inspection we were told about two recent incidents that had occurred at the home, one of which was a safeguarding allegation that had been made against a member of staff. Appropriate action had been taken by the service in both instances and the safeguarding allegations were found to be unsubstantiated, however the registered manager had not notified us prior to our inspection. The provider is required to formally notify us in certain circumstances, such as a person using the service sustaining a serious injury or disclosing safeguarding allegations.

All the people who used the service we spoke to thought the home was very clean and tidy, but one person who used the service said they had problems with the plumbing in their room and it could be 'a bit chilly'. During our tour of the building with the manager, we noticed that the attic room was chilly. Although alternative heating was available in the room it was not switched on. We had some minor concerns that some people who used the service were being exposed to an inconsistent ambient temperature.

One person who used the service said "I am cared for very well' and another person thought it was 'a happy home', whilst another described the home as having more of a 'routine' than they would have liked. The home operated a key worker carer system and the carers were responsible for updating the care plans. We observed that the carers were friendly when undertaking their work and had a good relationship with the people who lived at the home.

We spoke to the visitor who said they visited the home regularly during the week to see their relative. They said they were 'very happy with the home' and had a good relationship with the manager and felt that the staff looked after their relative very well.

The permanent staff told us that they had worked at the home for a long time and that they were all qualified to undertake their respective roles. Although they had all received an annual appraisal, they told us they had not received any supervision. On the day we visited we had health and safety concerns regarding the potential hazard of the inappropriate footwear and jewellery worn by some carers in relation to moving and handling vulnerable people.

We spoke to five people who live in the home they all said they liked living there and all commented on how good the staff were. One person we spoke to said 'its lovely here they take the weight off your shoulders and sort out your problems'. Two people said 'the manager and the staff are lovely'. Another person said 'I can't explain it really it's just lovely here and staff are lovely'.

We spoke to two people visiting the home and they both said they were always consulted regarding their relatives care and knew all the staff's names. One person said 'I have no problems, everyone is so good, and they always ring me and check things out with me'. Another person said 'staff are very caring'.

One person visiting the home said 'I know mum is happy'.

Another visitor said 'I feel like it's a real home'.