Ashbourne Court Care Home

Ashbourne Court Care Home is a care home providing personal care over 2 floors to up to 16 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 15 people using the service.

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

The staff received training in the administration of medicines and had their competencies assessed. However, we found some staff did not always follow the provider’s medicines policy and procedures. We identified some shortfalls on the day of our inspection.

The process for learning from accidents and incidents to prevent these from happening again was inconsistent. Some accident records were incomplete and did not contain evidence of an analysis on what happened and how to prevent re-occurrence.

The provider had monitoring systems in place and took prompt action when any concerns were identified. However, their systems had not identified the concerns we found during our inspection. Following our feedback, the registered manager provided evidence they had taken appropriate action to make improvements.

Staff were recruited safely. There was enough staff on duty to meet people's needs and these were met in a timely manner. There was a calm and happy atmosphere. People told us the staff responded to calls and met their needs. The provider had contingency plans in place in the event of staff absence to help ensure continuity of care.

There were risk assessments in place for people who used the service and the environment which were regularly reviewed and updated. Safety checks were undertaken regularly including fire safety and environment checks.

A part-time activities coordinator provided people with a range of activities and people spoke highly of them.

Feedback indicated people using the service were happy with the care they received. We saw the staff were kind and friendly. Relatives thought people were well cared for and trusted the staff and management team.

The provider was suitably qualified and experienced. They worked with staff to ensure people’s needs were met in a person-centred way. There were appropriate systems for reviewing people's health and working with relevant health and social care professionals.

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.

Rating at last inspection

The last rating for this service was good (published 28 August 2019).

At our last inspection we recommended that the provider ensures sufficient staff are consistently deployed in order to provide people with safe, effective and responsive care. At this inspection, we found that improvements had been made.

Why we inspected

We received intelligence in relation to an increase in safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashbourne Court is a care home providing personal care to up to 16 older people. At the time of our inspection there were 12 people living at the service. Accommodation is provided over two floors which are accessible using a stair lift.

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

Feedback we received showed that staffing levels had varied over the past year. The registered manager told us these concerns had now been addressed. We have made a recommendation regarding the on-going monitoring of staff deployment to ensure there are sufficient staff available to meet people’s needs. Risks to people’s safety were assessed and monitored and people received their medicines in line with their prescriptions.

People had access to healthcare professionals and advice provided was followed. People’s nutritional needs and preferences were known to staff and people told us they enjoyed the food provided. 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. Staff received training and supervision to support them in their roles.

There was a positive and friendly atmosphere in the service. Staff treated people with kindness and respect and had a good knowledge of each person’s life history. A range of activities was available to people and staff spent time with people in their rooms where this was their preference. People’s independence was encouraged and support provided to maintain contact with those important to them.

The registered manager worked alongside staff which enabled continual monitoring of the service. Audits and surveys were undertaken to monitor quality and advice sought from external organisations. People, relative and staff were involved in the running of Ashbourne Court.

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 (published 23 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor 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.

Ashbourne Court Care Home is registered to provide accommodation with personal care for up to 16 people, some of whom may be living with dementia. At the time of our inspection there were 15 people living at the service, 3 of whom were staying at the service for a period of respite care.

We carried out an unannounced comprehensive inspection of this service on 9 December 2017. After that inspection we received concerns in relation to the staffing levels provided at night. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashbourne Court Care Home on our website at www.cqc.org.uk

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. The registered manager was not present during the inspection.

Sufficient staff were deployed to meet people’s needs safely. One staff member was working a waking night shift and had access to a second staff member should they require additional support.

People had risk management plans in place which gave guidance to staff on the support people required. Although staff knew the needs of permanent residents well, they were not always aware of the support people required who were staying at the service for a period of respite. The manager has assured us they are changing the system to enable staff to have a handover at the start of a night shift so they are aware of the needs and risks for people on respite.

Emergency protocols were in place to ensure that people would continue to receive a safe service in the event of an emergency. Staff understood the systems in place and were aware of evacuation procedures.

The service was last inspected on 9 December 2016 were no concerns were identified.

A registered manager was 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.

Ashbourne Court Care Home is registered to provide accommodation with personal care for up to 16 people. At the time of our inspection there were 14 people living at the service, some of whom were living with dementia.

During our inspection of January 2016 the provider was found to be in breach of five Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found there was insufficient staff to support people’s needs, effective infection control systems were not in place, lack of activities for people that reflected people’s needs and preferences, use of disproportionate restraint and records of people’s care were not accurate.

We carried out this fully comprehensive inspection to see what action the provider had taken in response to the shortfalls we had previously identified. We found during this inspection that the provider had made the improvements needed and was now meeting the regulations.

The Provider Information Return (PIR) we received from the provider contained limited information about the service. We have made a recommendation that the provider ensures the PIR is completed in full to provide all information in the five domains about how the service provides safe, effective, caring, responsive and well led care for people.

People and their relatives told us they felt the service was safe. Relatives told us that staff were very kind and they had no concerns in relation to the safety of their family member. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff commencing their duties undertook induction training that helped to prepare them for their roles.

There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred and discussed these with staff so lessons could be learnt.

The provider ensured that full recruitment checks had been carried out to help ensure that only suitable staff worked with people at Ashbourne Court.

Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them. People’s relatives and visitors were welcomed and there were no restrictions of times of visits.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded.

If an emergency occurred or the service had to close for a period of time, people’s care would not be interrupted as there were procedures in place. There was an on-call system for assistance outside of normal working hours.

A complaints procedure was available for any concerns. This was displayed at the service.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

People, relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular staff meetings took place.

Staff informed that they felt supported by the registered manager and they had an open door policy and were approachable.

The inspection took place on 13 January 2016 and was unannounced.

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.

The service did not deploy sufficient staff to meet people’s needs. People assessed as being at risk of falls were left unattended whilst staff carried out domestic tasks. Staff were not always available to offer reassurance to people and we observed people spent significant amounts of the day asleep. People were not provided with a range of activities which reflected their hobbies and interests.

Systems were not in place to ensure people were protected from the risks of infection control. Procedures to ensure adequate and appropriate cleaning equipment was available were not in place.

People’s legal rights were not always protected. Two people’s bedroom doors were locked at night with other rooms being locked during the day preventing them from re-entering them.

Staff did not always receive the appropriate training to ensure they had the relevant skills to meet people’s needs. Not all staff had received training in supporting people living with dementia and this was evident in their practice.

Regular audits of the service were not completed to monitor the quality and effectiveness of the service. There was a complaints procedure in place and we saw that complaints had been responded to in a timely manner. However, systems were not implemented to ensure that concerns raised did not reoccur. Staff and people were not routinely involved in decisions about how the home was run.

Records of the care people received were not always completed by the staff who had delivered the care. This meant that people were at risk of not receiving the care they required.

Medicines were managed safely. Staff took the time to explain to people about their medicines and where appropriate gave them choice about when to take them.

Appropriate recruitment checks were undertaken when new staff were employed to ensure they were suitable to work with people living in the service. Staff received regular supervision to support them in their role.

People were protected from the risk of harm or abuse as staff members understood their responsibilities in safeguarding people. A contingency plan was in place to ensure people’s care could continue safely in the event of an emergency.

People told us that the quality of food was good and that they were given choices at every meal. People were supported to maintain a healthy diet. However, staff were not always available to offer support and reassurance at mealtimes.

People were supported to maintain good health and had regular access to a range of healthcare professionals. People’s needs were assessed prior to them moving into the service and care plans reflected this information.

People and their relatives spoke highly of the registered manager and staff team. Relatives told us they were able to visit at any time and were always made to feel welcome.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found evidence in records and feedback from staff and senior management which suggested that robust actions had been taken to respond to the concerns that, people's privacy, dignity and independence had not always been met.

We found that, although people had choices about what they wanted to do and where they wanted to go, they did not always have choices at mealtimes. We saw that people were treated with dignity and respect by staff. One person told us 'Staff speak to me nicely.'

People and relatives we spoke with felt the staff were caring. One person told us 'Staff are so kind.' A relative told us 'My uncle is well looked after.'

We found that the home had effective infection control policies and procedures and that the home was clean and tidy at the time of our inspection.

All of the staff that we spoke with told us that they felt supported at the service. We saw that staff attended regular meetings and that a record was kept of these meetings. We saw that staff were kept up to date with the services mandatory training and had appropriate one to one supervision and appraisals.

The home had systems in place that monitored the quality of the service and to identify when things needed to be improved. We saw that this included auditing the health and safety of the home.

Review of the documentary evidence provided by the service manager demonstrated that improvements had been made as required.

Where people were unable to make decisions regarding the care and support they needed, a mental capacity assessment had been carried out as required by the Mental Health Act 2005. Following this assessment, decisions had been made in consultation with the person or their representative and after taking clinical advice into account.

We saw evidence in documents provided to us by the service manager that care was planned and delivered in accordance with the wishes of the person using the service and that they had been involved in the planning of their care and had agreed to it. In the case of a person using the service being unable to make a decision, the manager had carried out an assessment of their mental capacity and had planned their care in consultation with the person's representative and general practitioner and psychiatrist.

Relatives of people said staff consulted with them about the care and support of the person who used the service. Relatives signed the care plans on their relative's behalf. This meant that relatives were involved in deciding their relative's care and gave their consent for care to be carried out. Four people did not know if they had a care plan. This could be because they had forgotten, as we found up to date care plans for them. One relative said, 'My relative has a care plan which I sign on their behalf'.

Relatives told us the staff spoke to them in a polite way and addressed them in the way they preferred. A relative said, 'I know my relative has a care plan. I was asked to sign it on their behalf and I have signed it. I am very involved in my relative's care'. One person said, 'The food is very nice and nicely cooked . It is well done. They know what I like and do not like'. Another person said, 'I get enough food'.

We found the provider encouraged relatives to be involved in the care and welfare of people who used the service. Relatives were encouraged to express their views and were involved in making decisions about their relative's care, treatment and support. People were provided with suitable nutrition to maintain their wellbeing.