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Ashgreen House Residential and Nursing Home Good

Reports


Inspection carried out on 7 March 2018

During a routine inspection

This inspection took place on 7 and 15 March 2018 and was unannounced. At our last inspection on 1 and 7 December 2015 the service was rated Good. At this inspection we found the service remained Good and continued to meet the regulations and fundamental standards.

Ashgreen House Residential and Nursing Home 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. The home provides care for up to 52 older people requiring residential or nursing care. The service is provided over four floors and within five units. At the time of this inspection the home was providing care and support to 46 people.

There was no registered manager in post. The registered manager had resigned from their post prior to this 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 home manager had been appointed and had started work at the time of this inspection. The deputy manager was in charge of the day-to-day management of the home and was being supported by a registered manager from the provider’s other home and a regional manager.

There were sufficient numbers of staff available to support people’s; however staff felt additional staff were required on some units to promote safety. The provider had safe recruitment practices in place and had vetted staff before they were employed to work in social care. People were protected from the risk of abuse because staff were aware of their responsibility to safeguard them.

Risk to people had been assessed, identified and had appropriate management plans to prevent or reduce the risk occurring. The provider had procedures in place to protect people in the event of an emergency and had carried out regular health and safety checks including the maintenance of equipment to ensure they were safe for use. People were given their medicines as prescribed by healthcare professionals and there were safe systems in place for acquiring, storing, administering and disposing of medicines. Staff had received medicines training and their competencies had been assessed to ensure they had the knowledge and skills to manage medicines safely. People were protected from the risk of infection because staff had followed the provider’s infection control protocols. Accidents and incidents were recorded, managed and monitored regularly to prevent future occurrences.

Before people started using the service, their needs were assessed to ensure they would be met. Staff received an induction when they started work at the home and were supported in their roles through training in areas the provider considered mandatory. Staff were also supported with regular supervision and an annual appraisal of their performance. People were supported to eat and drink sufficient amounts for their well-being and people’s preferences were taken into consideration and respected. People had access to healthcare services to ensure they received safe care and treatment. Where required staff had made prompt referrals to health and social care professionals to ensure appropriate support was in place for people.

Staff understood the requirement of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted in accordance to this legislation. People were supported in an environment that was suitable and met their needs.

People were treated with kindness and compassion and had built relationships with staff. People and their relatives were involved in making decisions concerning the care and support they received. People’s privacy and dig

Inspection carried out on 1 and 7 December 2015

During a routine inspection

Ashgreen House provides accommodation and support for up to 52 elderly people who have nursing, residential, or rehabilitation care needs. The home is situated in the Royal Borough of Greenwich, south London. At the time of this inspection the home was providing care and support to 40 people.

At our last inspection on 25 and 26 November 2014 we found that some equipment within the home was not functioning properly which posed a potential risk to people’s safety and welfare. Systems for the management of medicines were not safe and did not protect people using the service. Accurate records had not always been maintained relating to peoples care needs, staff training and recruitment.

At this inspection, 1 and 7 December 2015, we found that action had been taken by the provider to make sure equipment within the home was functioning, serviced and maintained, systems for the management of medicines were safe, and records were maintained relating to peoples care needs, staff training and recruitment.

The home did not have 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. The previous registered manager left the home in August 2015. The current home manager started work at the home on 12 October 2015. They had applied to the CQC to become the registered manager for the home.

People using the service said they felt safe and that staff treated them well. Medicines were managed safely and records showed that people were receiving their medicines as prescribed by health care professionals. Appropriate recruitment checks took place before staff started work. There were enough staff on duty at the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure in place and staff said they would use it if they needed to.

Staff had completed an induction when they started work and they were up to date with the provider’s mandatory training. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and acted according to this legislation. There were appropriate arrangements in place to ensure that people were receiving food and fluids in line with their care plans. People had access to a GP and other health care professionals when they needed it.

People’s privacy was respected, and staff spoke to them in a respectful and dignified manner. People and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There were a range of activities available for people to enjoy, and they received appropriate end of life care.

Staff said they enjoyed working at the home and good support from the manager. There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider conducted unannounced night time checks at the home to make sure people where receiving appropriate care and support. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Inspection carried out on 25 and 26 November 2014

During a routine inspection

This inspection took place on 25 and 26 November 2014 and was unannounced. At the last inspection on 11 July 2013 we found the provider met all the regulations we inspected.

Ashgreen House accommodates up to 52 people who have elderly nursing, residential, or intermediate care needs (people needing short term nursing or residential care to meet their needs). The accommodation is on three floors and there are four units: two for residential care, one for nursing care and one for intermediate care.

There was a registered manager in place. 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.

We found some concerns about the maintenance of equipment, particularly as one unit had very few working call bells. The manager took steps to address this during the inspection. We also had concerns that medicines were not stored securely or safely at all times. This put people at risk of unsafe care.

CQC is required to monitor the operation of the Deprivation of Liberty Safeguards. At the time of our inspection no one was subject to the Deprivation of Liberty Safeguards. (These are to protect people’s rights when their liberty may be restricted for their safety.) Some staff had not received training on the Mental Capacity Act 2005 or were not aware of the Code of Practice. This meant they may not be aware of their responsibilities under the act. Staff training in other important areas such as first aid and infection control was not always refreshed, meaning there was a risk staff did not have the current skills to deliver safe effective care.

Some records related to people’s care and support needs were not always up to date. This put people at risk of inappropriate care. Some records related to the management of the service were not easily located. While audits were carried out to monitor the quality of the service they had not always identified the concerns we found.

People felt safe using the service. Staff were knowledgeable in recognising signs of abuse and the associated reporting procedures. Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified and to identify people’s support needs.

Staff engaged with people in a caring manner and respected people’s privacy, dignity and independence. They understood and responded to people’s diverse individual needs and were familiar with people’s histories and preferences. We heard mixed views about staffing levels with some people feeling there were not always enough staff available and some who felt the service was staffed sufficiently. We found steps were being taken to address problems with the absence of the regular activities organiser.

People told us they thought the service was well run and organised. There was a complaints procedure in place and the manager had a weekly surgery that people could attend if they had any issues about the service.

At this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 11 July 2013

During an inspection looking at part of the service

At our last inspection on 22 and 23 January 2013 we found the provider needed to take compliance action to meet essential standards for: care and welfare of people who use services; safety of premises; assessing and monitoring the quality of service provision; and records.

At our inspection on 11 July 2013 we found the provider had taken action to meet these essential standards.

We did not speak to people using the service as part of this inspection because of the nature of the compliance actions we were following up.

Inspection carried out on 22, 23 January 2013

During a routine inspection

People using the service and their relatives we spoke with said they were receiving a good service. They were very complimentary about the staff working at the home. One person said; �I can�t praise the staff enough. They do a wonderful job�. Another person said; �There�s usually one or two who stand out. It�s the little things they do. They treat you like a proper human being�. People felt comforted and safe in the home, and told us their families were involved decisions in their care.

A residents survey was completed in 2012 which showed, for example, that most respondents were happy with the care they received and that they and their family and friends had been involved in their care plan. They said their care and medical needs were attended to.

We found people using the service were treated with dignity and respect. They were protected from the risk of abuse and were cared for by staff who were suitably qualified and skilled to meet their needs. However, care was not always planned, delivered, or recorded in a way that ensured people�s needs were met. Nor was care always reviewed fully after an incident such as a fall. We also found a fire safety mechanism in the home was not working.

Inspection carried out on 29 June 2011

During a routine inspection

People who used the service and their relatives told us during our visit on 29 June 2011 that Ashgreen House was very good. They were involved in discussions about people�s treatment, care and support, and staff were praised for being dedicated and caring. �The care is very superior here and the staff have been very reassuring.�

People and their relatives appreciated the quality of the premises and facilities on offer. One relative commented that �it�s like a real home�. Overall, they were satisfied with the food and drink Ashgreen House provided, although one relative was concerned that people could be encouraged more to drink enough fluids.

People using the service were able to comment on the running of Ashgreen House and to raise any concerns through an elected residents� representative, who took part in the home�s senior team meetings. There were also regular residents and relatives meetings held at the home.