Ashgrove Care Home - Humberstone

Ashgrove Care Home - Humberstone is a residential care home providing personal care to up to 56 people aged 65 and over, some of whom may be living with dementia. The service was supporting 27 people at the time of the inspection.

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

People and their relatives were happy with the care being provided and told us they felt safe. There were enough staff to meet people’s needs and safe recruitment and selection processes were followed.

The registered manager focused on continuous improvement and had made changes since being in post. All staff we spoke with felt the changes were having a positive impact on the quality of care provided. People and their relatives felt the manager was approachable and would act on their feedback. The management team had good oversight of the service.

There were systems in place to ensure the safe management of medicines. Staff knew how to report allegations and concerns of abuse and understood their roles clearly and what was expected of them.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 1 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

Ashgrove Care Home provides care and support for up to 56 people who require personal care. The service has communal areas and has opened up an extension, which provides en-suite bathroom facilities in people's bedrooms and access to patio gardens. It offers care and support to people, some of whom are living with dementia.

Ashgrove 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 last inspection of this service we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations, 2014 for Regulation12, safe care and treatment and Regulation 17, good governance.

There were a variety of shortfalls within people's care records, which meant staff, did not always understand or deliver the care and support people required in a timely way. Audits were undertaken; however, they had not always found the shortfalls in the service relating to people's care records. Monitoring of the mealtime service at tea time required improvement along with a further review of pressure area care for people living at the service. The staff team had changed and staff were still trying to understand people's needs and get to know them. There were issues with medicine management and administration. Information about people's topical creams needed to be clarified and thickening agents for some people's drinks were not signed for on people's medicine administration chats (MAR). We recommended that the provider should follow guidance for all aspects of medicine management. There were also minor infection control issues that were addressed at the time of the last inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question responsive and well-led to at least good and achieve compliance with Regulations 12 and 17.

At this inspection we found improvements had been made. People's care records reflected their full and current needs and people received timely care and support. Staff provided the correct care and support to meet people's individual needs. Audits were robust any issues found were acted upon straight away. Mealtimes were pleasant sociable occasions. The staff team were stable and they knew people and their needs. Medicine management, infection control and data management was robust. Mealtimes were monitored and they were relaxed social events.

The service has a manager in place who has applied to become registered with the Care Quality Commission. Their application has been validated by the registration team and they are awaiting their fit person’s interview. They have been a registered manger prior to applying to become the registered manager of this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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’s health and safety was protected by the staff’s monitoring of their needs and the environment. Staff understood how to identify signs of abuse and harm and issues were reported appropriately. Staff understanding the risks present to people’s wellbeing and gained help and advice from health care professionals to minimise these risks. People who used the service told us they felt safe living there. There were sufficient numbers of competent staff to meet people’s needs.

Accidents and incidents were monitored. Staff understood the action they must take in the event of an emergency to protect people’s health and safety. General maintenance was undertaken.

Staff received supervision and appraisals to maintain and develop their skills. Performance issues were addressed.

The management team and staff had developed caring supportive relationships with people living at the service, their relatives and visitor’s. Staff were knowledgeable about people’s full and current needs and they provided caring support to people by using a team approach.

Staff promoted people’s independence even if there were risks attached to this. People were offered choices of food and drinks and their individual dietary needs were met. People’s communication needs were recorded and staff were aware of this,

Capacity assessments were undertaken, care and support was provided in line with the Mental Capacity Act 2005, which helped to protect people’s rights.

People were treated with respect and staff were kind and patient with their approach to people and their diversity was respected. Advocates were provided for people if this was required, to help them raise their views.

Staff accessed health services to help to maintain people’s health and wellbeing. People received person-centred care and support. Activities were provided in house and links with the community were being enhanced.

There was a complaints policy in place and the provider welcomed feedback from people living at the service, relatives and staff. Issues raised were investigated and this information was used to enhance the service provided to people.

Family and friends were welcome to visit the service and people living at the service were encouraged to maintain family contact.

There was an effective management team at the service who were open and transparent. Work had been undertaken to make sure the quality monitoring of all areas of the service was robust.

At the last inspection of this service we found there were no breaches of regulation. The service gained a rating of ‘requires improvement’ .

Ashgrove Care Home is situated in a residential area of Cleethorpes and is close to local amenities. It is registered to provide personal care for 56 people, some of whom are living with dementia. Communal areas and bedrooms are located on the ground floor. There are secure garden areas for people to use. During the inspection there were 31 people using the service. There is a car park for visitors to use.

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 service has a manager in place who has applied to the Care Quality Commission (CQC) to become registered. Although their application had been received this had not been validated at the time of the inspection. Therefore the manager is not registered with CQC. This meant that the domain well-led could not be rated higher rating than ‘requires improvement’.

During this inspection we found two breaches of regulation; regulation 12 of the Health and Social Care Act (HSCA) safe care and treatment and regulation (HSCA) 17 good governance. There was a variety of shortfalls within people’s care records, which meant staff, did not always understand or deliver the care and support people required in a timely way. Audits were undertaken, however, they had not always found the shortfalls in the service relating to people's care records. Monitoring of the mealtime service at tea time still required improvement along with a further review of pressure area care for people living at the service. On one occasion people's care records were not held securely, this was rectified straight away. You can see what action we told the provider to take at the back of the full version of the report.

We found the service had been placed under pressure because 16 staff had left, some without working their notice over a two week period. This had impacted upon the care and support people received. The management team had worked to address this situation and new staff had been employed, however staff were still getting to know people's needs.

Staff were developing their skills and knowledge about people's needs and risks to their wellbeing. A summary of people’s needs had been produced to highlight specific areas of help and support people needed to receive and risks to their wellbeing.

Staffing levels had been increased by employing three agency staff and undertaking a robust recruitment programme. The local authority was supporting the service with two staff at lunch and tea time to help to meet people's needs.

There were some issues found with medicine administration at the service. We found information about topical cream prescribed by people’s GP’s needed to be clarified to ensure staff had the relevant information about how and where to apply the creams. Thickening agents prescribed to be used in some people’s drinks were not signed for on their medicine administration charts when used by staff. We found staff did not always sanitise their hands if they touched people’s medicines. We recommend that the provider follows current guidance for all aspects of medicine administration.

We found minor issues with infection control that were addressed during the inspection.

Staff knew how to recognise the signs of abuse and knew how to report issues. This helped to protect people from abuse.

Induction training was provided for staff. Supervision’s were occurring to help develop the staff’s knowledge and skills. Appraisals were to be conducted later in the year to allow the manager and staff time to get to know each other.

People's nutritional needs required monitoring along with further monitoring of the mealtime service to ensure people's dietary needs were met.

People’s mental capacity was assessed to ensure they were not being deprived of their liberty unlawfully. Staff gave people choices for their care and support and acted upon what they said.

During our inspection people told us the new staff were caring and kind and confirmed they were all still getting to know each other.

Advocacy information was provided to people and their relatives. People were supported by advocates or family members to help raise their views.

A range of activities were provided and people were invited to take part if they wished.

A complaint policy and procedure was in place, this was made available to people and their relatives. We found issues raised were investigated and feedback was provided to the complainant.

The management team have kept us informed about the issues at the service. The provider suspended new admissions to help stabilise the service. The local authority placed a formal suspension on admissions from 17 July 2017, they continue to monitor the service and provide support as required.

Although the management team and staff have worked to maintain the service for people the issues we found demonstrate that the service still requires improvements to be made.

This inspection was undertaken on 9 and 10 June 2016, and was unannounced.

We had previously inspected the service on 16 and 18 December 2016 when we found the registered provider was in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These were in relation to, person centred care, need for consent and working within the requirements of the Mental Capacity Act (MCA) 2005, safe care and treatment, safeguarding people from abuse, cleanliness and infection control, medicine management, staffing levels, staff skills and training, meeting nutritional and hydration needs, complaints and assessing and monitoring the quality of service provision. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 for non-notification of incidents.

The breach regarding cleanliness and infection control was a continued breach from our inspection which was undertaken on 15 May 2015. Due to these shortfalls the service was rated inadequate in all areas and was placed in ‘special measures’. The registered provider agreed to undertake a voluntary suspension on admissions to give them time to correct the issues we found.

The registered provider sent an action plan in response to our inspection findings telling us what measures they were going to take to address the issues. This inspection was undertaken to check if the improvement action planned had been completed in regards to the shortfalls that we found. We wanted to see if the service was being managed appropriately to maintain and protect people’s health and wellbeing.

We found person centred care was in place. People gave their consent to receive care and treatment, or where this was not possible; the principles of the Mental Capacity Act (MCA) 2005 were followed to protect people’s rights. People received safe care and treatment and were protected from abuse.

Cleanliness had vastly improved and appropriate infection control measures were in place. Medicine management was robust. Staffing levels had been increased and staff had undertaken training to develop their skills. People’s nutritional needs were known and only staff who had received training assisted people to eat and drink.

A robust complaints system was in place and issues raised were dealt with thoroughly. The registered provider had implemented new auditing systems, which helped them monitor the service effectively and helped to ensure any issues were dealt with in a timely and thorough way because action plans were put in place and these were reviewed by the higher management team. This ensured appropriate action was taken to maintain the quality of the service. The registered provider and manager had systems in place to make sure they we were notified of all incidents.

We found the registered provider had improved all areas of the service and the previous breaches of regulation had been addressed. The service now met all relevant requirements. However, we are keeping all areas under review and monitoring them to make sure the improvement made are maintained consistently over time.

The service is required to have 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.’ There was a manager present; at the time of our inspection they had submitted their application to become the registered manager of this service with the Care Quality Commission. This application had not yet been approved at the time of our inspection. The manager was present throughout our inspection. They were skilled, knowledgeable and managed the service effectively.

Staff told us they had had enough staff on duty to meet people's needs although they would prefer more time to be able to sit and talk to people. Comments included, 'We were short staffed but it is better now. Staff do ring in sick and they always try to get cover' and 'The managers and senior carers will come onto the floor to help us on the odd occasion we are short and care is affected.'

People who used the service told us that call bells were usually answered promptly and they were happy with the care they received. Comments included, 'Staff are rushed but they are caring' and 'Sometimes they have time to talk and sometimes they don't.'

The manager told us there was to be a refurbishment programme next year, which would not affect the numbers of bedrooms available but would update a significant number of them by providing toilets and showers en suite. Existing toilets, bathrooms and the shower room were also to be refurbished.

We found improvements had been made since the last inspection in arrangements for cleaning specific equipment used in the home. The sluice room was clean and tidy and cleaning schedules were in place. Equipment was checked by senior staff to ensure it was clean and ready for use.

We found improvements had been made in the management of medicines since the last inspection. People received their medicines as prescribed. There were some minor recording issues and these were discussed with the manager to address.

People's needs were assessed and care plans were produced to guide staff in how to care for them. People told us they were able to see health professionals involved in their care. Comments included, 'I have no complaints. I see the doctor when I need to' and 'I'm looked after very well ' I like to be independent.'

We found that due to stock control issues and on one occasion an error, some people had not received their medicines as prescribed.

We found that some items of equipment had not been cleaned properly so they would be ready for use by the next person.

We found there was a range of equipment provided to help move and handle people safely. Equipment was serviced so it remained safe to use.

We found that staff were recruited appropriately and checks were carried out before staff worked in the home.

We found there were enough members of staff employed to work in the home although some reorganisation of staff during busy periods would help to relieve pressure on staff.

We found the service had a quality monitoring system in place which ensured checks were made and people could comment on the quality of the service.

People told us that staff looked after them well and involved other healthcare professionals when they needed them. They said they answered call bells as promptly as they could but there were times when there was not enough staff on duty. Relatives told us that they were kept informed about health related issues. One relative commented, 'My dad feels like part of the family here but they are short staffed and activities are really good and the food here is marvellous it's like a hotel.'

People told us, 'I like to get up early myself', 'I can get up when I like" and "There is a good choice of food." A visiting healthcare professional told us, 'It's a nice home and there is always someone available.'

Visiting relatives told us 'The staff are brilliant but often seem run off their feet and staff are marvellous but there is just not enough of them.'