Archived: Ashbourne Nursing Home

The service had a registered manager. A registered manager is a person who has registered with the 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.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. Staff were trained in the prevention and control of infection to help protect the health and welfare of people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home. Plans of care were individual, person centred and reviewed regularly to help meet their health and social care needs.

We saw that people could attend activities of their choice and families and friends were able to visit when they wanted.

Staff were trained in end of life care to offer support to people and their family members at the end of their lives.

Audits, surveys and meetings helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive. There were systems to audit the quality of service provision.

We received action plans from the provider that stated they would be compliant with the requirement actions by 31 March 2016. We undertook this inspection of 18 and 19 October 2016 to re-rate the service and to check they were compliant with the requirement actions.

Ashbourne Nursing Home provides accommodation for up to 41 people who have personal care needs, including those with dementia. There were 38 people living in the service on the day of our inspection.

The service did not have a registered manager in place at the time of our 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. A new manager had been appointed, however they had only been in post seven weeks. They were in the process of registering with us.

During this inspection we found improvements had been made and the provider had met all the requirement actions from the previous inspection.

At our inspection of 27 October 2015 we found the service had not considered any risks the environment may pose to people who used the service, staff members and visitors. We also found that where risks associated with people’s care and treatment had been assessed control measures to reduce the risks had not been identified or put in place. During this inspection we examined four care files and found improvements had been made. We saw that risk assessments had been completed for health related issues and for the environment.

Concerns raised by us at our inspection of 27 October 2015 in relation to the recording of accidents and incidents had been addressed. During this inspection we found new documentation was in place which evidenced what actions had been taken and learning from these.

We looked at all the records in relation to fire safety. We saw a risk assessment was in place, regular checks of fire systems were in place and fire drills were undertaken on a regular basis. At our inspection of 27 October 2015 we found personal emergency evacuation plans (PEEPs) were not in place for people who used the service. During this inspection we found each person within the service had a PEEP which should ensure they were evacuated effectively in an emergency situation.

All the staff members we spoke with told us they felt staffing levels were adequate to meet the needs of people who used the service. Records we looked at confirmed the staffing levels the manager told us were required daily.

We reviewed the systems and processes in place to ensure the safe management of medicines. We have made a recommendation that the service considers current best practice guidance in relation to the administration of creams.

Wheelchairs, hoists and moving and handling equipment had been serviced to ensure it was safe to use. Records showed that staff members had received training in moving and handling procedures.

Although the manager had not commenced supervisions and appraisals with staff members (as they had only been in post for seven weeks) they were able to show us a supervision and appraisal pack they had developed and were due to put in place.

People who used the service had access to healthcare professionals. We saw that people had been referred to dieticians, speech and language therapists and had access to their GP.

At our inspection of 27 October 2015 we found the environment did not suitably meet the needs of those people living with dementia due to a lack of pictorial signage. During this inspection we found improvements had been made. We saw that pictorial signs were in place to identify toilets, bathrooms, dining room and the lounge.

Bedrooms we looked at provided ample space for people to be able to personalise them. In some rooms we noted people had brought their own items of furniture, ornaments and pictures.

At our inspection of 27 October 2015 we made a recommendation that the service considered its own policies and procedures in relation to the privacy and dignity of people who used the service. This was due to people’s bedroom doors being left open without documented evidence of this being agreed. During this inspection we found one person was being nursed in bed with their door open. However, this had been fully documented in their care plan as being their wishes.

Concerns were raised by us at our Inspection of 27 October 2015 in relation to pre-admission assessment and care plans. Pre-admissions assessments did not contain enough detail and care plans did not reflect personal preferences. During this inspection we found improvements had been made. Pre-admission assessments were more detailed and care plans had been re-written to reflect preferences and guidance for staff.

We checked our records before the inspection and saw that accidents or incidents that CQC needed to be informed about had been notified to us by the manager.

There were policies and procedures for staff to follow good practice.

We saw there was a service user guide in place. This was given to each person who used the service and should ensure that people new to the service were equipped with a good understanding of the service and what it offered.

At our inspection of 27 October 2015 we found effective and robust systems were not in place; namely quality assurance audits. During this inspection we found some improvements had been made. We found audits had been developed and were being competed until the previous manager left. The new manager showed us a new planner they had developed to ensure audits were completed monthly going forward, commencing in October 2016.

From our observations we saw staff were patient and supportive when assisting people. Staff appeared to have a good understanding of people's individual needs and routines.

We also spoke with the manager and two members of staff. Staff told us that they were fully supported in their role and that they had a good rapport with families.

Care records provided detailed information about the individual needs and wishes of people. Where able, people had signed their records to evidence their involvement in planning their care and support. Staff spoken with understood their responsibilities where a person lacked capacity to make decisions for themselves so that the person was kept safe.

Staff worked closely with other agencies so that people's social, emotional and physical needs were effectively met. One staff member said they had a 'good relationship' with those agencies involved in people's care and support.

Relevant checks had been carried out to show that new staff had been safely recruited. Improvements were required in some staff records so that information clearly showed what actions had been taken when appointing and inducting new staff.

Sufficient nursing and support staff were available to meet the specific needs of people. Two people we spoke with said, 'I've no grumbles, the staff are wonderful' and 'I feel the care is very good'.

Systems were in place for the reporting and responding to any complaints or concerns raised about the service. Relatives spoken with felt they were able to approach the manager if they had any issues or concerns they wished to discuss.

Up to date records were maintained in relation to the management and conduct of the service.

People also commented about the staff and the care they received. They told us, 'They [the staff] give 100%', 'The staff are very helpful, nothing is too much trouble' and 'They [the staff] know what they are doing'.

Two of the visitors we spoke with said they had no issues with the care provided for their relative and felt staff were supportive and responded promptly to any requests. All of the visitors spoken with said they were made 'very welcome'. One visitor said 'The carers are wonderful'.

Staff were seen to support people in a gentle, supportive and respectful manner. People were offered encouragement and care tasks were explained. Staff were attentive and appeared to have a good understanding of people's individual care needs.

Activities were provided each day offering people variety to their daily routine. We were told that communion was held regularly at the home, the hairdresser visited weekly and the delivery of newspapers and magazines were arranged upon request.