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Inspection carried out on 22 May 2018

During a routine inspection

This inspection was unannounced and completed on the 22 and 23 May 2018. At our last inspection in August 2016 we found the service required improvement in the key questions safe and effective. At this inspection the required improvement had been made so the service is rated good.

Ashcombe 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. Ashcombe accommodates 31 people in one adapted building. At the time of our inspection 26 people were living at the service.

Ashcombe is a two storey building with a lift to access the upper floor. The home has communal areas such as a lounge and small conservatory. There is a small secure garden and a sheltered seating area at the front of the property with garden furniture.

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.

Medicines were managed safely. Registered nurses were responsible for medicines management and were assessed and trained by the provider. People had individual medicines administration records that had been completed in full with no unexplained gaps.

Staff had been recruited safely. There were sufficient staff available to people and staff rotas demonstrated consistency. Staff were aware of their responsibility to keep people safe from harm and told us how they would report any concern. Staff were confident that the registered manager would take appropriate action.

The environment was clean and well maintained. All equipment was serviced regularly and safety systems were checked and tested. Fire systems were tested weekly and staff practiced fire drills monthly.

Risks had been identified and assessed. There were safe systems in place which were reviewed on a regular basis. If people required equipment to keep them safe such as hoists or bed rails this had been sourced and were available.

Staff were trained in a variety of topics relevant to their role and all new staff had an induction. Supervision was provided on a regular basis, all staff we spoke with told us they felt well supported in their role. There were daily meetings for the heads of department and monthly team meetings with minutes produced.

People had regular food and drinks. There was support provided for people to eat if needed. The dining experience was relaxed and unhurried. The tables were laid with tablecloths, napkins and flowers to support a positive dining experience. The chef served all meals when possible so they could monitor satisfaction levels.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Where people had their liberty restricted, the service had completed the related assessments and requested the authorisation from the local authority.

The environment had been refurbished and improved in many areas. The registered manager had also submitted requests to improve more areas and was waiting for approval from the provider. Some people’s rooms had been updated with decoration and new furniture.

We observed many positive social interactions which demonstrated that staff were kind and caring. People’s privacy and dignity was promoted and respected by all staff. Visitors were welcomed and there was opportunity for them to stay and enjoy a meal with their relatives.

People had individual care plans that were person centred and reviewed regularly. Care plans detailed people’s needs and how the support was to be provided.

Inspection carried out on 9 August 2016

During a routine inspection

This inspection was unannounced and took place on the 8 and 9 August 2016. At the last inspection on 19 and 28 May 2015 we found that the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). The provider had not ensured that sufficient numbers of suitably trained and skilled staff were delivered. They had also not ensured that people’s care records were accurately and contemporaneously completed.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that improvements had been made with regard to each of the breaches identified and the provider was now meeting the legal requirements of the Regulations.

Ashcombe is a home which provides nursing and residential care for up to 33 older people who have a range of needs, including those living with dementia, epilepsy and diabetes. At the time of our inspection 27 people were living in the home.

Ashcombe is a two storey building set in grounds on the outskirts of Basingstoke town centre. The home comprises of both single and double sized bedrooms, some with washing facilities such as wash basins. There is a small secure garden to the rear of the home and sheltered seating area to the front of the home allowing people to enjoy sitting in the garden patio area in all weather conditions.

There was no registered manager at this location. 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 HSCA and associated Regulations about how the service is run. A new manager had been appointed by the provider two weeks before the inspection and they were in the process of becoming registered at the time of the inspection.

The provider ensured there were sufficient numbers of staff deployed to meet people’s individual needs. Processes had been put in place to regularly review the required level of staff deployed to meet people’s need. However these processes required additional time to ensure they remained embedded in working practices.

The home provided both long term and short term care for people and to those living with dementia however the environment did not always support people to move around the home safely enabling them to remain independent. Corridors were often used to store moving and handling equipment, handrails were not in place to aide people who were able to walk and appropriate signage was not always available to help people to orientate themselves around the home.

We have made a recommendation that the provider seeks further guidance on the environmental factors which can be adapted to meet the needs of those living with dementia.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place and regularly reviewed to keep people safe.

Thorough recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. Induction training for new staff was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence to support people safely.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented, known by staff and practiced to ensure people

Inspection carried out on 19 and 28 May 2015

During a routine inspection

The inspection took place on 19 and 28 May 2015 and was unannounced.

Ashcombe is a care home in Basingstoke that provides nursing and residential care for up to 33 older people who have a range of needs, including those living with dementia. It also provides nursing and residential care for people on short term stays for respite and post-operative care. At the time of the inspection there were 32 people using the service.

There was no registered manager at this location. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim manager had been brought to the service by the provider six weeks before the inspection to provide direction and leadership however they were not in the process of becoming registered at the time of the inspection. The provider was supporting the interim manager in their position with the aim of assessing their suitability to become registered with CQC.

People using the service told us that they felt safe. Safeguarding training was delivered annually and care staff were able to identify and recognise signs of abuse. Procedures were in place identifying how people could raise concerns and staff were aware of these.

People told whilst they felt safe they were having to wait long times to receive assistance. Call bell audits showed that there were not always enough suitably deployed care staff to meet people’s needs in a timely fashion.

Care staff were knowledgeable about the requirements of the Mental Capacity Act 2005 (MCA). Mental capacity assessments were undertaken for people who lacked capacity to make specific decisions. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

When risks were identified people were supported to remain safe. Care staff were able to recognise when people were at risk and change their care accordingly to meet any additional needs.

Thorough staff recruitment procedures were in place so that people were protected from the employment of unsuitable staff. Induction training was mandatory to ensure care staff were prepared for their roles

Nurses responsible for supporting people with their medicines had received additional training to ensure people’s medicines were being administered, stored and disposed of correctly.

People were supported to eat and drink enough to maintain a balanced diet. People at risk of malnutrition and dehydration were assessed to ensure their needs were met. However records for people who required food and fluid chart monitoring were not always completed fully. As a result it could not always be identified whether people were eating and drinking sufficiently to maintain their health. People told us that the food was of a high standard and in more than sufficient quantities.

When changes were identified in people’s healthcare the manager engaged with other healthcare agencies and professionals to maintain people’s safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Care staff sought consent before carrying out care, treatment and support. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.

People told us that their care was provided to a good standard. Care staff demonstrated that they had taken the time to know the people they supported. People were encouraged and supported by care staff to make choices about their care on a daily basis.

People told us and we could see that all staff treated people with respect and their dignity was respected at all times.

Care plans were personalised to each individual and contained detailed information to assist care staff to provide care in a manner that respected that person’s individual needs and wishes. Relatives were involved at the care planning stage and during regular reviews

People knew how to complain and were happy to provide feedback if this was required. Procedures were in place for the provider to manage and respond to complaints in an effective way. People, relatives and care staff were encouraged to provide feedback on the quality of the service provided regular meetings with the care staff, manager and provider.

The provider operated a quality audit process however the results were not always actioned appropriately to drive improvements in the service. People’s records did not always contain all of the required information for care staff to deliver consistent care to meet people’s needs effectively and safely.

Not all care staff told us they felt supported by the new manager. However, care staff told us they felt supported by their colleagues and the deputy manager.

We found 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.

Inspection carried out on 25 September 2013

During an inspection to make sure that the improvements required had been made

On our inspection of 21 May 2013 we found non-compliance with record keeping. We asked the provider to send us an action plan of the improvements they would make to achieve compliance. On this inspection we found that the required improvements had been made.

There were processes in place to ensure that records were current, accurate and stored securely.

Inspection carried out on 21 May 2013

During a routine inspection

We spoke with seven people who lived in Ashcombe, two relatives, four staff and the interim manager. People told us that in general they were happy living in the home. One person told us “I can’t imagine better”, another said ”I don’t want for anything, I do as I please, its lovely”. One person said they thought that staff were rather busy. They told us “I can’t fault the care but they sometimes miss the little things”.

People were offered a varied and nutritious diet. Where appropriate people were provided with support to eat and drink. There was a process in place to identify people who were at risk of malnutrition and dehydration and this was monitored regularly.

The home was clean and tidy with no unpleasant odours. There were processes in place to minimise the risk and spread of infection. People told us that they had no complaints about the cleanliness of the home or their rooms.

All staff underwent necessary checks before starting work; they then completed a two week induction before being signed off as competent to work.

We found that people’s care and support plans did not always reflect the care and support that they required and were receiving. The plans were not all accurate and so not fit for purpose.

Inspection carried out on 4 July 2012

During a routine inspection

We were told by residents and their relatives that Ashcombe House was "lovely" and that the staff were "caring and kind". They told us that the food was excellent with plenty of choice. The residents and relatives we spoke with told us that they felt safe and that their family member was well cared for.

People were involved in the activities within the home and we saw them being treated with dignity and respect.

Reports under our old system of regulation (including those from before CQC was created)