Ashbrook Nursing Home

Ashbrook Nursing Home is a care registered to provide nursing and personal care to older people, some of whom have dementia care needs. It is registered to accommodate and support up to 70 people. At the time of the inspection, 70 people were living at the home.

The home has three floors with adapted facilities and en-suite rooms.

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

There were systems to protect people from the risk of abuse. Potential risks to people were assessed and monitored. However, some risk assessments required further development with more suitable guidance for staff, so they could provide safe care. Staff were recruited safely and appropriately. There were enough staff to meet people's care needs. Systems were in place to record and monitor accidents and incidents in the home. Medicines were managed safely and administered to people as prescribed. People were protected from the risks associated with the spread of infection.

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. People's needs were assessed before they started to use the service. People were supported by staff who had received professional training and ongoing development. Staff worked with other health and social care professionals to ensure people were in good health.

People were encouraged to maintain a healthy balanced diet and were provided food and drink that met their preferences and needs. We have made a recommendation about improving the meal service experiences for people to make them more comfortable and enjoyable. Staff knew people who used the service well and they provided care and support to them in a kind and compassionate way. People were treated with respect and their views were listened to and their requests acted upon.

People received person-centred care. Care plans provided guidance on how to support people, in accordance with their choices and communication needs. People were offered a range of activities that were engaging and meaningful. People and their relatives were positive about the management team and could approach them with any concerns. Complaints were responded to appropriately.

People were positive about the care and support they received from staff and the management team. There was a positive culture in the home and equality, diversity and inclusion was promoted.

The provider had systems in place to assess, monitor and improve the quality and safety of the services provided. The home worked in partnership with services within the community to help maintain people's social involvement.

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 the service was Good (report published 7 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashbrook Nursing Home provides nursing and personal care to 48 people aged 65 and over at the time of the inspection. The service can support up to 70 people. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it.

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

The provider made improvements to the service following our last inspection. Medicines records were available and there were no gaps in them. The provider was aware of and had a plan to make some improvements in medicines. Risk assessments were in place to ensure risks to people were managed.

Staff received support, training and supervision to deliver effective care. As part of the recruitment processes, staff were checked to ensure they were safe to work with people. There were enough staff at the service.

Staff were kind, compassionate and caring. They treated people with respect and dignity by giving them choice and promoting their independence. People enjoyed activities within and outside the service.

All parts of the care home were very clean with no sign of offensive odours.

Care plans were personalised and were based on people’s assessed needs. The service accepted people only if it was confident their needs could be met. Equality and diversity were part of the service which meant that any discriminatory practices were not tolerated.

There was a safeguarding system in place. Staff knew what adult safeguarding meant and the proper action to take if they became aware of an abuse.

The meals were nutritious and staff were available to support people who needed help with their food.

Staff worked with other professionals to support people to have access to social and healthcare service. People and relatives' views about the quality of the service were sought and helped improve the service. The provider welcomed complaints which meant people and relatives were able to raise their concerns.

The registered manager was open to ideas from people, relatives, staff and others and was committed to making improvements.

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

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 requires improvement (published 24 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashbrook Nursing Home is a care home. People in care homes receive accommodation and nursing or 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.

Ashbrook Nursing Home is a purpose built 70 bed care home for older people, including people living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. When we visited, 36 people were using the

service. This was because since December 2017, when building work had been completed, Ashbrook Nursing Home changed registration from a 37 bed home to a 70 bed home. The provider had limited admissions to the service during the transition period.

At the last inspection in September 2015, the service was rated Good overall with a rating of Requires Improvement in well led. We made a recommendation that improvements were made to provide consistent and robust management of the service so that people received a safe, quality service. This was complied with.

The service had a registered manager. 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.

We found that the arrangements for administering medicines were not always safe. Robust systems were not in place to manage prescribed medicines consistently and safely. Medicine records were not always accurate and we could not be confident that people received all of their prescribed medicines safely.

We found that not all care plans were personalised for people who used the service and did not contain all of the necessary information to enable staff to support them safely.

Staffing levels were not sufficient to meet people's needs. Appropriate systems were not in place to review staffing levels in line with people's needs.

Staff received training but the registered manager did not have suitable systems in place to ensure this was kept up to date and in line with best practice. Staff did not always receive training, appraisals and supervision to support them in their role.

The provider's governance and quality assurance systems were not robust. They had failed to identify the concerns identified at this inspection. However, the management team had submitted an action plan after the inspection to show how they will address the concerns raised.

People and relatives told us that people felt safe using the service.. The provider's recruitment process ensured that staff were suitable to work with people who needed support. Staff received safeguarding training and knew how to report safeguarding concerns.

Risk assessments were completed and management plans were in place to enable people to receive safe care and support. Staff had a good understanding of infection control procedures and used personal protective clothing such as aprons and gloves to prevent the spread of infection.

Systems were in place to maintain the safety of the premises and equipment. Lessons were learnt when accidents and incidents occurred to minimise the risk of recurrence. However, improvements were needed to ensure all health and safety measures, such as regular fire drills were in place and robustly implemented.

People’s needs were assessed before they began using the service and they had access to healthcare professionals as required to meet their needs.

Staff had a clear understanding of the application of the Mental Capacity Act 2005 and appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. People were offered nutritious food and drink to maintain good health.

People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People had the opportunity to participate in activities. People and their relatives knew how to make a complaint. We have recommended that the registered manager keeps a record of all the complaints received and what had been done in response to these, to ensure people were satisfied with the way it was dealt with and identify any lessons to be learnt.

People had the opportunity to participate in a programme of activities. However, there were mixed views about the activities available to people so we have made a recommendation to keep this under review.

The service had systems in place to seek the views of people and their relatives regarding the quality of the service. Quality monitoring systems needed to be consistent to identify areas for improvement.

People and their relatives told us the manager and management team were supportive and approachable.

We found four breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People and their relatives told us they were well looked after and that their health and welfare needs were met. One person said "perfect, they are there for you and it's lovely." Another person told us "yes everything is fine here, the staff are very good and look after us well as you can see." A relative said "lovely staff attitude. They look after my mum well in here."

The care records we reviewed contained a range of assessments and care plans outlining how to support people using the service.The staff worked with other professionals, for example the tissue viability nurse and speech and language therapist to ensure that people's health needs were met.

A relative said " I wouldn't have kept her here if the care wasn't good enough." Another told us " they asked us what she likes and about her needs. She is happy here and joins all the activities."

People who use the service were supported to access health and social care professionals when required with their consent. However,we found that there was a discrepancy between information contained in care plans relating to nursing care and the actual care they received. We have therefore made a compliance action. People's medicines were safely administered by nurses who were trained to carry out this task.

Staff told us they received appropriate training and support from the management team to carry out their roles. The service had systems in place to monitor the quality of the service provided, taking action to make appropriate improvements so that people received the care that they needed.