Archived: Ardath

We found the following examples of good practice.

The home had recently recovered from a COVID-19 outbreak. They were following government guidance in relation to visitors. Each person had identified a relative/friend for in-house visits. In addition, a new summerhouse had been installed in the garden with a floor to ceiling screen and intercom. Risk assessments had been carried out to determine any individual safety measures that were needed. All visitors to the home were required to wear personal protective equipment (PPE), had their temperature taken on arrival and were asked to carry out a Lateral Flow Device (LFD) COVID- 19 test before they could enter the home. The results were recorded.

There was very detailed guidance in relation to infection prevention and control. Cleaning schedules were maintained, and records demonstrated that all touch points were cleaned at least three times a day. All staff wore PPE and had received training on infection control, the putting on and taking off of PPE, hand washing and COVID-19 awareness training. Spot checks were carried out to ensure staff remained competent in all these areas. Hand sanitisers were readily available throughout the home along with stocks of PPE. There were detailed arrangements to ensure all laundry was handled safely and the risk of cross contamination minimised.

Individual risk assessments had been written for people and staff to determine any specific risks for each in relation to any underlying health conditions or specific considerations. One staff member was reliant on lip reading to support their communication. Whilst this had no impact on their day to day communication with people, specific guidance was put in place to assist the staff member to communicate safely with their colleagues.

When the home had their outbreak, there were systems to ensure that people who tested positive for COVID-19 were isolated in their own rooms all of which had ensuite facilities. People who were not isolating and chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow additional space between people. Some soft furnishings had been removed and disposable tablecloths were introduced.

Regular testing for people and staff was taking place in accordance with government guidelines. Individual plans were written to give staff advice on how best to explain and support each person with testing. The provider ensured staff felt safe and appreciated. Gifts were provided for all staff and staff that normally used public transport were given taxis to work instead. All staff had received regular one to one support. The regional manager told us that counselling and bereavement services were available to any staff member or person that wanted this support.

Throughout the pandemic people were supported to maintain contact with family and friends by telephone or through social media. Letters or emails were sent to relatives to keep them up to date. Activities continued to be provided twice daily and during their outbreak staff continued to offer one to one time for activities with people in their rooms. As not everyone had a visitor on Mother’s Day, a special lunch was provided to mark the occasion.

There were detailed policies and procedures in place that had been analysed, reviewed and updated throughout the past year based on new government guidance.

Ardath is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. Accommodation was provided in one adapted building. The service can support up to 32 people. People living at the home had a range of needs. Some people required assistance with daily living due to physical frailty and health needs, such as diabetes. Some people were living with the early stages of dementia.

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

People received support from staff who knew them well as individuals. They understood their needs and were kind and caring. People’s care and support needs were assessed and reviewed regularly. This meant people received care that was person-centred and reflected their needs and choices.

People were supported to maintain their own interests and friendships. Some people went out independently. People were able to take part in a variety of individual and group activities that were meaningful, and they enjoyed. These included quizzes and music and movement. External entertainers also visited the home.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

Staff understood the risks associated with the people they supported. Risk assessments provided further guidance for staff about individual and environmental risks. People were supported to receive their medicines when they needed them.

Staff received training that helped them to deliver the care and support people needed. This included specialist training to meet people’s complex needs. They attended regular supervision meetings and told us they were very well supported by the registered manager. A staff member told us, “Yes I feel supported by the management and we are all good at supporting each other.”

People’s health and well-being needs were met. Where appropriate, staff supported people to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People's nutritional needs were assessed. They were supported to eat a wide range of healthy, freshly cooked meals, drinks and snacks each day.

People had the equipment they needed to meet their individual needs. The provider had embraced new developments in technology and an electronic care planning system was being introduced.

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.

The provider and registered manager had good oversight of the service. They knew staff and people well and provided a supportive environment to live and work. There were a series of audits which helped the provider and registered manager to identify where improvements were needed to continue to develop the service. There was a detailed complaint procedure, and this was displayed so anyone wanting to raise a concern could do so.

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 9 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last visited Ardath on 26 June 2013 when we judged they were compliant with all the areas we inspected.

The provider is a not-for-profit housing association providing sheltered housing, independent living and care homes. Ardath is one of four care homes owned by the provider. The management team consisted of a registered manager, a deputy manager and senior care staff. The manager at the service had registered with CQC. 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.

Ardath was well run by an experienced registered manager, who promoted a positive culture in the home to listen and act on people’s feedback. Staff practice respected people’s choices and valued people as individuals so staff knew when to change their approach based on their knowledge of the person. There were systems to monitor the quality of the service, including responding to suggestions for improvements.

The range of activities had increased. Improvements were planned to make the garden more secure and some areas of the home had been refurbished and updated. There were positive relationships between staff and people living at the home, and their visitors. People told us they felt safe. There were systems in place to protect people from harm and abuse. Medicines were well managed.

There were sufficient numbers of appropriately qualified and experienced staff available to meet people's individual needs. Recruitment practices ensured people were supported by suitable staff.

Some people living at the home said they had concerns about staffing. The registered manager was committed to continuity when using agency staff by working with the agency to have the same staff visit the home. They provided information the day after the inspection to show how they were providing further ways for staff to feedback on staffing levels and the current arrangements for back up staff. Work was taking place to recruit staff during the inspection and since the inspection; the registered manager has confirmed new staff had been recruited.

People were kept informed about changes within the home and plans to improve the service through meetings and newsletters. The registered manager was known to people living at the home and they were confident concerns or complaints would be listened to and acted upon.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and demonstrated through their practice an understanding of how this impacted on the way they worked. However, some records needed to be improved to further protect people’s rights. People were offered a choice of meals. They were supported with their health and had access to health and social care professionals, when necessary.

People we spoke with told us they enjoyed living at the home and that they felt well cared for by the staff. One person told us, "The staff here are beautiful. They couldn't be better." Another said, "I can't find fault with them. The food is good and there is always an alternative."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Staff were aware of their responsibilities in relation to safeguarding.

We saw by direct observation and checking staff rotas that there were a sufficient number of experienced, skilled and qualified care staff to provide appropriate levels of support to people who lived at the home. This included two dedicated domestic staff, a chef and a kitchen assistant as well as a handyman.

We examined medicine administration systems and records and found them to be safe and appropriate. We also examined systems and records kept by the home and saw that there were good levels of quality assurance monitoring to maintain standards. Where the need for improvement had been identified, changes had been planned or implemented.

We observed the interaction between people in the home and this was seen to be positive and constructive at all times. People told us that they and the people they represented were treated with dignity and respect, and received the care they required.

We looked at arrangements in place to maintain a suitable and safe environment. These were found to be effective with the home's environment being well maintained and promoting people's well being.

We reviewed the recruitment practice and found the home did not follow robust recruitment processes.

We looked at the systems and processes the home had in place to respond to complaints. These processes ensured complaints could be raised and resolved to people's satisfaction.

In this report the names of a two registered managers appear Miss Jane Narborough was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time