Ashcombe

We found the following examples of good practice.

The provider had acted to make sure people could have visitors safely. Temperature and symptom checks were made prior to entry. Hand washing and Lateral Flow Device (LFD) tests were also required for visitors. Family visits had been facilitated through a self-contained pod in the garden. When unable to have visits, the provider supported people with video or telephone calls to keep in touch with their family.

Where social distancing was not possible staff used other mitigation such as full personal protective equipment (PPE). Staff followed the provider’s PPE guidance which reflected government guidance.

The registered manager had rules to ensure there were no more than two staff in a room at once and staff took staggered breaks to maintain social distancing. People were supported to have increased family visits if their wellbeing was affected.

The provider’s admissions policy had been updated and met government ‘s COVID-19 guidance. When new people were admitted, they were tested and isolated upon arrival.

Staff changed their clothes before and after each shift to help prevent infections being transferred to people.

Regular whole home testing was in place in line with government guidance. Staff were tested daily before the start of each shift with a lateral flow device (LFD) test.

The appearance of the home was clean and hygienic. Cleaning checklists were in place including high contact area cleaning guidance. Windows were open for ventilation. Staff laid out the dining room to enable social distancing. There was clear separation of clean and dirty laundry. COSHH products were stored safely.

The provider was supported by the local Clinical Commissioning Group (CCG) with a meeting every Monday. Infection prevention and control (IPC) and PPE training for staff was via eLearning and the home trainer. The registered manager and home trainer undertook observations of staff to check good practice.

RESTORE2 training was provided for nurses (RESTORE2TM is a physical deterioration and escalation tool for care/nursing homes).

Staff were paid by the provider if they were off due to COVID-19.

The provider had a pandemic business continuity plan in place. The registered manager completed audits and daily IPC checks . The provider’s IPC policy had been updated to include COVID-19 guidance and outbreak procedures. The provider had completed risk assessments for staff in more vulnerable groups, such as those from a black, Asian and minority background, appropriate actions had been taken.

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.

Systems were in place to manage complaints. Any received were logged and investigated. The registered manager shared complaints with the staff team so that lessons could be learned. The service had received a number of compliments from people, relatives and other visitors.

Activities were structured and provided daily. Engagement levels were recorded and monitored for effectiveness and enjoyment. There were two dedicated activities workers who planned and organised activities with the involvement of people. The service had good community links in the local area.

End of life care was provided. People were able to record their wishes for this stage of their lives. Nurses worked with local healthcare professionals to make sure people were not in pain and had all they needed at the end of their lives.

Without exception the feedback about the registered manager was very positive. People, relatives, staff and healthcare professionals were happy with their leadership style and thought they managed the service well. There was an open and positive culture at the service, staff told us they worked together as a team and enjoyed coming to work.

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 were kept safe.

People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received additional training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these and the food was pleasantly presented.

People were supported by staff who had received an effective induction and period of support from more experienced members of staff. This enabled them to acquire the skills and confidence to deliver safe effective care. Regular supervisions had been delayed due to a change in management but documented processes were in place to ensure these were competed. Staff were happy to raise any concerns with their colleagues and senior staff and they felt supported as a result.

People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.

The staff and manager promptly engaged with other healthcare agencies and professionals to ensure people’s safety and wellbeing

Staff demonstrated they knew and understood the needs of the people they were supporting and people told us they were happy with the care provided. The manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

People told us they did not always know how to complain however all said they would speak with senior staff if required. Procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings and participation in the completion of annual survey questionnaires.

The provider’s values were displayed within the home but were not immediately known by staff. However staff were able to describe how the manager wanted people to treat people. We could see these standards were evidenced in the way care was delivered.

The manager and staff promoted a culture which focused on providing care in the way that staff would wish to provide to their family members. The manager was newly in position but in the process of providing strong leadership and had fulfilled the requirements of their role as a manager. The manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. They had also included taking positive action to address areas which had previously been identified as requiring action including conducting regular staffing rotas reviews and seeking feedback to improve the quality of service delivery.

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

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.