We carried out a review of the data available to us about Ashminster House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashminster House, you can give feedback on this service.
Ashminster House is a care home registered to support people with nursing and care needs relating to their health conditions, such as dementia, and frailty of old age. At the time of our inspection there were 55 people using the service.
Ashminster House accommodates 57 people across three separate wings, each of which has separate adapted facilities. Two units provided nursing care with registered nurses leading the staff team on each of those units. One of these units was called 'memory lane', to care for people who were living with dementia in the more advanced stages. The third unit provided care for those people who required residential care.
People’s experience of using this service and what we found
People using the service told us they felt safe and listened to at Ashminster House. People were encouraged to raise concerns and told us action was taken when this happened. Safeguarding incidents and accidents/concerns were investigated thoroughly, and the registered manager worked closely with local authority safeguarding teams.
Care records were comprehensive and detailed risks people faced. Risks had been assessed and guidance was in place for staff to follow to minimise the risk of these occurring and to keep people safe. Risks were regularly reviewed and updated as required. People who were receiving support from external healthcare professionals had updates to their care plans and there was clear guidance in place for staff to support people appropriately.
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.
People were supported by trained staff who had been recruited safely. There was a clear structure in place for staff to report to and the registered manager had an ‘open door policy’ in place enabling staff to go straight to them if they were concerned.
People were supported to take their medicines as prescribed. Records reviewed were complete and up to date and medicines were stored and disposed of correctly.
Staff supported people to stay as safe as possible and minimise the risk of infections. Staff had access to Personal Protective Equipment and had completed infection control training.
The registered manager completed a range of checks and audits of the service to ensure any issues were identified quickly and actions were taken to put things right. Accidents and incidents were investigated fully, and any lessons learnt from these were shared with the wider staff teams to minimise the risk of reoccurrence.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 8 September 2018)
Why we inspected
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.
The inspection was prompted in part due to concerns received about staff practice. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe section of this full report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Ashminster House is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashminster House provides accommodation and support for up to 60 older people. There were 55 people living at the service at the time of our inspection, however one person was in hospital so 54 people were present during the inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had suffered a stroke, some people were receiving end of life care. Some people required support with their mobility around the home and others were able to walk independently.
The service was split into three units. Two units provided nursing care with registered nurses leading the staff team on each of those units. One of these units was called ’memory lane’, to care for people who were living with dementia in the more advanced stages. The third unit provided registered care for those people who required 24 hours care, however, did not need nursing care. This unit was led by a team leader who was not a registered nurse, but skilled and experienced in providing social care. Lounges and dining areas were available in each unit.
A registered manager was employed at the service by the provider. 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.
At our last inspection on 22 June 2017, the service was rated as ‘Requires improvement.’ We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to the health and safety of people receiving care had not been mitigated to prevent harm; checks and audits had not always been effective and action had not been taken to address shortfalls; the provider had not acted on people’s and stakeholder’s views to improve the service.
At this inspection improvements had been made and the provider was now compliant with Regulations 12 and 17. People were safer as risk assessments were comprehensive and up to date. Staff had the guidance they needed to support people to maintain and improve their independence while at the same time preventing harm. A range of audits were now undertaken to check the quality and safety of the service provided and action had been taken where necessary when areas for improvement had been identified.
We also made two recommendations to the provider, that they assessed the dependency levels of people in their care in order to calculate the numbers of staff needed; that care plans provide a more consistent approach within different sections of the care plan.
The provider had introduced a tool to assess the dependency levels of people and this was reviewed each week. This provided the information the registered manager needed to ensure staffing levels were in line with people’s needs. We found staffing levels were suitable to meet people’s needs.
People’s care plans now covered all the areas of care and support they had been assessed as requiring. A more holistic approach was taken when planning people’s care.
Two further areas were noted as requiring improvement at the inspection on 22 June 2017, a better understanding was needed amongst staff of people’s rights within the principles of the Mental Capacity Act 2005; staff one to one supervision meetings were focused on the negative areas of their work and did not address personal development.
Staff now showed a better understanding of the Mental Capacity Act 2005 and documents showed the basic principles were being adhered to. The registered manager made appropriate applications to the supervising authority to deprive people of their liberty when people were assessed as lacking capacity to consent to their care and treatment.
Staff supervision now showed a more proactive and inclusive approach to their personal development. Positive encouragement was given as well as constructive criticism to support development.
Staff were aware of their responsibilities in keeping people safe and reporting any suspicions of abuse. Staff knew what the reporting procedures were and were confident their concerns would be listened to by the registered manager.
Accidents and incidents were appropriately recorded by staff; action was taken and followed up by the registered manager. Infection control procedures were in place and followed by staff to protect people from cross infection.
The procedures for the administration of people’s prescribed medicines were managed and recorded appropriately so people received their medicines in a safe way. Regular audits of medicines were undertaken to ensure safe procedures continued to be followed and action was taken when errors were made.
The registered manager and deputy manager carried out a comprehensive initial assessment with people before they moved in to the service. People were fully involved in the assessment, together with their relatives where appropriate.
Care plans were developed and regularly updated and reviewed to consider people’s changing needs. People’s specific needs were taken account of and addressed in care planning to ensure equality of access to services.
People had access to a range of activities to choose from. Some people preferred their own company and wished to spend time in their room reading or watching TV and this was respected by staff. People were asked their views of the service and action was taken to make improvements where necessary.
Registered nurses were employed to ensure people’s nursing care needs were met by skilled and professional staff. People were supported to access external healthcare professionals when they needed additional advice or treatment.
There was clear evidence of the caring approach of staff. People and their relatives were happy about the staff who supported them, describing them as caring, saying they were confident in the care they received. Staff knew people well and were able to respond to their needs on an individual basis.
The provider used safe recruitment practices so only suitable staff were employed to work with people who required care and support.
Staff were supported well by the registered manager and the deputy manager. Staff told us they were approachable and listened to their views and suggestions. Nurses received the training they needed to maintain their professional development and all staff had access to the training they required to provide people’s care and support. Regular staff meetings were held to aid communication within the team and to provide updates and feedback.
People and their relatives knew how to make a complaint should they need to. Where complaints had been made, these had been investigated appropriately and the outcome shared as described in the provider’s complaints procedure.
People and their relatives thought the service was well run. People knew the registered manager and the deputy manager and were happy with the service provided.
All the appropriate maintenance of the premises and servicing of equipment was carried out at suitable intervals.
Further information is in the detailed findings below.
Ashminster House provides accommodation, personal care and nursing care for up to sixty older people, some of whom are people living with dementia. The premises are split into three different units. The ground floor (Windmill Lodge) is for up to 24 older people with nursing needs. On the first floor ‘Rose Court’ is a 12 bed unit for people with dementia and ‘Memory Lane’ is for up to 21 older people with dementia and nursing needs.
At the time of the inspection there was no registered manager. A new manager had been recruited and was due to start in July. The deputy manager was acting manager and present at the time of the inspection. 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 arrangements for managing risk were inconsistent. Risk assessments were in place but they did not contain enough detail to give staff guidance to mitigate risks. The information contained in the risk assessments and the records in people’s room were inconsistent. There was a risk that people would not be moved safely. There was an emergency evacuation procedure and practices had been conducted but there were no personal emergency evacuation plans in place with details about how to support each person in the event of an emergency.
Care plans contained insufficient detail, conflicting information, were out of date or were not completed. There was a risk that people would not receive safe care responsive to their needs.
Audits in the home had been completed but only the recent audits had been effective at picking up shortfalls and the acting manager was working through the resulting action plans. People, their relatives and other stakeholders were asked for their views about the service. Feedback had been responded to and some action had been taken but there was no clear development plan for the service to drive improvements overall.
Staff were not sufficiently deployed in all parts of the service, particularly during the morning and lunch time. Staff were polite and took their time with people when giving care but there were long periods of time when people were left unattended with just a quick check to make sure they were safe.
There were gaps in some essential training as some staff had not received training in epilepsy and diabetes. Staff supervision and meetings were task focused and looked at areas for improvement only, rather than enabling staff to discuss their development and balancing this with what they did well.
People were asked for their consent before staff gave care or treatment. The acting manager and staff were aware of their responsibilities under MCA. Assessments and best interest meetings had been held when people needed support to make decisions about their care.
People were supported to have choice and control of their lives within the limitations of the service and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
People said they felt safe and staff knew how to recognise and report potential abuse. There were clear processes in place to safeguard people and for staff to blow the whistle. People were confident that the acting manager and staff would act if there were any concerns. People and their relatives knew how to complain and said they would feel comfortable raising any concerns to the acting manager and staff. There were safe recruitment processes in place.
People were supported to be as healthy as possible and to eat and drink well. There were choices and specialist diets were catered for. The service worked alongside other health professionals and people were supported to maintain as much independence as they were able to. There were clear procedures to help people take medicines safely.
People and their relatives spoke highly of the caring nature of the staff and the warm friendly culture. People said they were treated with kindness and respect.
The staff had taken part in a new project “10/66” to support people with dementia and had received training in this. Activities had been initiated as part of the “10/66” project that helped staff find out about people’s hobbies, past interests, careers and what was important to them.
Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service. This is so we could check that appropriate action had been taken. The registered person and acting manager were aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.
We found two 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 this report.
We made two recommendations with regard to making sure there are sufficient staff and providing consistent person centred care.
The inspection visit was carried out on 19 and 20 May 2015 and was unannounced. The previous inspection was carried out in March 2014, and there were no concerns.
Ashminster House provides accommodation, personal care and nursing care for up to sixty older people, some of whom are people living with dementia. The premises provides care on two floors in three units. There is a passenger lift between floors. The ground floor (Windmill Lodge) is for up to 24 older people with nursing needs; and the first floor has two units for people living with dementia. ‘Memory Lane’ is for up to 21 older people with nursing needs and living with dementia; and ‘Rose Court’ is a 12 bed unit for people with residential needs and living with dementia.
The service is run by a registered manager, who was present on the day of the inspection visit. 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 Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Applications had been made to the DoLS department for all of the people living with dementia for depriving people of their liberty for their own safety. This was because the doors to the units and the passenger lift were safeguarded by key pad locks.
Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.
The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. There were comprehensive risk assessments in place for each area of the premises. These showed how to minimise the assessed risks. The registered manager or deputy reviewed these with the regional director as part of monthly monitoring programmes. There were individual risk assessments for each person living at the service. These included risks such as the risk of falls, or the risk of choking; the use of bed rails and the risk of developing pressure sores. All of the risk assessments were written in relation to each person’s needs. Actions were identified and put in place to lessen the risks. Emergency procedures were suitably detailed and included a personal emergency evacuation plan for each person.
Staff were visible in all areas of the service during the inspection visit. There were sufficient numbers of staff to meet people’s individual needs without rushing them. People spoke highly of the staff and said they “Always have time for us”. The service had robust recruitment procedures in place to check that staff were suitable for their job roles.
Staff were given a detailed induction, and were supported through their probationary period. This included essential training such as fire safety, safeguarding adults, and food hygiene. Staff training records showed that staff kept up to date with training requirements, and were given additional training relevant to their job roles. This included dementia care, and customer care. Most care staff had completed formal qualifications in health and social care or were in the process of studying for these. Records of supervision and appraisals confirmed that staff were working to appropriate standards and were supported by the registered manager and the deputy manager. Staff were encouraged to attend meetings, and to take their part in the development of the service.
Nurses were able to keep up to date with their skills and competencies and complete training or refresher courses in subjects such as catheterisation or venepuncture (taking blood samples). Nursing and senior staff administered medicines and followed safe practices for this.
The premises were visibly well maintained and well presented. There were no offensive odours, and people told us “They always keep it very clean”. There was an on-going business plan to keep the service in a good state of repair, and to make changes to further enhance the environment. This included regular redecorating and refurbishment of bedrooms and communal areas.
People’s own views were listened to and taken into account, and their care plans showed that their independence was promoted and their dignity was respected. People were given choice in how they lived their lives, and made their own decisions about when they wished to get up and go to bed, their meal choices, their clothes, and social activities. They were given clear information about the service, and discussions were carried out with the person and/or their representative for any changes in their care planning. People who lacked mental capacity or had fluctuating capacity were supported with decision-making. This followed agreed protocols to involve their next of kin or representative, and health and social care professionals, to make decisions on their behalf and in their best interests. Staff were fully informed about the importance of applying the Mental Capacity Act 2005, and to enable people to make decisions within their capacity.
The nurses and care staff maintained good links with the local GP practices, and contacted people’s doctors as needed. Referrals were made to other health professionals such as dieticians and dentists when necessary.
People were able to choose their food at each meal time, and snacks were always available. Each unit had it’s own kitchenette area where staff could make drinks and snacks for people. People spoke highly of the food, using words such as “Excellent” and “First-class”. The food was home-cooked, including home-made biscuits and cakes each day. Dining areas were attractively presented with tables laid with tablecloths, napkins and fresh flowers, and several people said how much they appreciated this.
People said that staff had a very caring approach. This was evident from the welcome received in the reception area, through to care staff, nurses, and other staff on each unit. Relatives and visitors were made welcome and were encouraged to recognise it as people’s home. The different units maintained a homely feel with pictures, games and ornaments in evidence. Units for people living with dementia had many items available to support people throughout the day with familiar objects to trigger memories and enjoyment.
An activities co-ordinator oversaw the management of activities programmes and entertainment, but the staff had a holistic approach, and all of the staff saw it as their responsibility to spend time with people, talk with people, and carry out small acts of kindness (such as getting drinks or showing people where to go). Each person was provided with a key worker who spent a minimum of three occasions per week talking with people they supported, to see that they were happy and settled in the service, and to identify any areas where they could be further supported. There was a wide range of individual and group activities every day, and we observed people laughing together, playing cards, playing dominoes and skittles and enjoying music and singing.
People’s care plans were person-centred, were discussed with people and their relatives (as preferred), and contained comprehensive information. Separate care plans were written for each aspect of care, and monthly reviews were carried out. People’s family members were invited to take part in reviews if they wished for this. People were informed about the service’s complaints procedure and this was clearly displayed. There were systems in place to monitor and follow through minor concerns as well as complaints. These showed that people’s views were taken into account, were listened to, and changes were made in response where needed.
The service was led by a registered manager who worked closely with the deputy manager and the staff team. Staff were fully informed about the ethos of the service and its vision and values. They recognised their own roles as important in the whole staff team, and there was good team work throughout the inspection. Staff showed respect and value for one another as well as for people living at the service and their family members. Staff spoke highly of the registered manager and deputy manager, and said they were always available and very supportive. They led by example, and spent time wherever possible working alongside the rest of the staff team. Staff said they made them “Feel valued”. People and their relatives said they could “Not speak highly enough” of the registered manager and deputy. Relatives often nominated staff for care awards given by the company. This was due to how they “Spent time with people, had a cheerful attitude and gave consistently good care”.
The registered manager carried out monthly audits to monitor the progress of the service. Quality assurance surveys were carried out for people living in the home and relatives, and the results were displayed in the reception area. The results for 2014 had been very positive, with an overall score for all aspects of the service as 927 points out of a possible 1000.
At our inspection on 24 October 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. The provider wrote to us and told us that they would address these matters by 8 December 2013. At this inspection we saw that written guidance was available to staff about people’s care, staff completed records at the time they provided care and there were systems in place for the registered provider to be able to monitor that these records were accurately maintained by staff.
At our inspection on 9 January 2013, 25 March 2013, 29 May 2013 and 12 August 2013 we identified concerns around people's health needs, in that they were not always being monitored or met. At this inspection we saw that staff responded to people’s health needs effectively. However, we saw one example of a person not always having their blood pressure monitored as directed in their care plan and a nurse in charge of the unit for people who were physically frail was not aware of one person being at high risk of developing pressure areas on this unit.
At our inspection on 25 March 2013 and 29 May 2013 and 12 August 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. At this inspection we saw that staff still did not always complete records to accurately reflect the delivery of care, written guidance was still not always available to staff about people’s needs and there were no records to show how the registered provider checked that records about care delivery were completed accurately by staff.
The provider had systems in place to obtain feedback from people who live at the service, staff and relatives to be able to monitor the quality of the service it provided.
At our inspection on 9 January 2013, the 25 March 2013 and the 29 May 2013 we identified concerns around people's health needs not always being monitored or met. At this inspection we saw that people's health needs were being met because staff monitored people’s health and ensured people received medical attention when they needed it. However, one senior staff member was unaware that they needed to check one person’s blood pressure that day. We saw an example of one person’s high pulse rate not being effectively monitored to promote their health. We saw that guidance from healthcare professionals was being followed to promote people’s health and wellbeing.
At our inspection on the 25 March 2013 and the 29 May 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. At this inspection we saw that there was written guidance available to staff about people’s needs. However, this guidance did not always provide clear instructions for staff to follow. We saw there were systems in place for staff to record the delivery of care. However, the system in place to monitor records identified that staff were not always accurately recording the delivery of care.
At our inspection on 9 January 2013 we identified concerns around care not always being delivered in a respectful manner, staff knowledge around potential adult protection concerns and the action to take, staff not always being supported in their roles and the systems in place to monitor service delivery effectively. At this inspection we saw that these areas had been addressed.
At our inspection on 9 January 2013 and 25 March 2013 we identified concerns around people's health needs not always being monitored or met. At this inspection we saw that people's blood pressure was not always being monitored effectively and instructions from health professionals were not always being implemented.
At our inspection on 25 March 2013 we identified concerns around records not always providing relevant information to staff. At this inspection we saw that guidance from health care professionals was now included in people's care plans, however not all records provided guidance to staff around people's needs and staff did not always maintain records accurately.
During this inspection we saw that some areas where we had identified a concern had improved. People had the opportunity to engage in social activities. A person now had their oral health needs met, their skin integrity monitored and their arm positioned in line with the guidance in place.
However, we saw that people did not always have their health needs met or followed up. Staff did not implement the guidance in place to address a person's specific health needs. Two people had unexplained weight loss that had not been investigated further and relevant health professionals had not been informed. One person's blood pressure had not been effectively monitored in accordance with their guidance in order to promote their health.
Guidance from health care professionals was not always implemented to help in the management of behaviours which were described as challenging. Incidents continued to be noted whereby their behaviour resulted in injuries to other people who lived at the service.
We saw that people's care records did not always provide guidance for staff to be able to meet the needs of people effectively. The recording systems in place did not always support the effective management of service delivery.
We saw that people's privacy was promoted. However, people were not always treated with consideration and respect. Some staff we spoke with referred to people that needed support to eat their food as 'feeds'.
People were not always involved in decisions around their care and treatment. The delivery of care did not always reflect people's care plans and there was limited guidance for staff on meeting the needs of people who had dementia.
We found that not all staff were able to demonstrate they knew how to recognise potential abuse and the action to take in response to it.
We saw that the building was designed to enable people and equipment to move around freely and it was an environment that was pleasant for people to live in.
Staff told us there were enough staff on duty to meet the needs of people. People told us there were not enough staff on duty. One person told us, 'I could die waiting for them to answer my call.' Staff did not always receive adequate supervision to be able to deliver care safely and consistently.
We saw there were systems in place to regularly assess and monitor the quality of service delivery, however, these were not always effective in identifying areas of concern for service development.