You are here

Ashwood Lodge Care Home Good

Reports


Inspection carried out on 16 September 2019

During a routine inspection

About the service

Ashwood Lodge is a residential care home that provides accommodation and personal care for up to 23 people with mental health problems. On the day of our visit there were 19 people using the service.

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

Medicines were administered safely. Medicine records were not always correct; however, this was addressed immediately. People were protected from abuse by staff who understood how to identify and report any concerns. The risks to people’s health, safety and welfare had been assessed, recorded and plans put in place to reduce these. Staffing levels enabled people’s needs to be met safely, and ensured people received consistent and reliable support. The management team sought to learn from any accidents or incidents involving people. Some concerns with infection control were addressed immediately.

Staff were recruited safely and received appropriate training and support to enable them to carry out their role effectively. 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 happy with the food provided

Staff were caring and treated people with kindness and respect.

People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them. People were confident to raise any concerns. People enjoyed the activities provided.

There was a clear management structure and staff were supported by the registered manager. Quality assurance systems were completed. The registered manager would benefit from some administrative support.

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 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 24 January 2017

During a routine inspection

This inspection took place on 24 and 25 January and 2 February 2017. The first day of the inspection was unannounced. This meant that the registered provider and staff did not know we would be visiting. The other two days of inspection were announced.

The service was previously inspected in November 2015 and was not meeting one of the regulations we inspected. This related to people not being supported to maintain relationships or involvement in their community due to a lack of activities provision. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had been addressed, though some improvement in activity provision was still required.

Ashwood Lodge is a 27 bedded care home providing residential care. The service does not provide nursing care. The home is a converted building, with all of the communal areas and bedrooms situated on the ground floor. At the time of the inspection 23 people were using the service, 14 of whom were living with dementia.

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 2008 and associated Regulations about how the service is run.

Risks to people were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the service’s premises and equipment were carried out to ensure they were safe to use. Plans were in place to support people in emergency situations. The registered manager monitored accidents and incidents to see if lessons could be learned to help keep people safe.

People’s medicines were managed safely. Safeguarding procedures were in place to protect people from possible abuse. The registered manager monitored staffing levels to ensure enough staff were deployed to keep people safe. The registered provider’s recruitment process reduced the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported through regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the support they received from staff at the service, describing it as kind and caring. People were treated with dignity and respect. Staff encouraged people to be as independent as possible, while always ensuring they were available to provide support and keep people safe. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where these were needed.

We have made a recommendation about the planning and delivery of activities.

People’s care was based on their assessed needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs. The service had a complaints policy, which was publicly advertised and accessible in the reception area. People and their relatives told us they knew how to complain and would be confident to do some.

Staff spoke positively about the culture and values of the service and said they felt supported by the registered manager and registered provider.

The registered manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people using the service and their families in an annual questionnaire. We received required notifications from the service.

Inspection carried out on 10 and 12 November 2015

During a routine inspection

This inspection took place on 10 November 2015 and was unannounced. This meant that the provider did not know we would be visiting. A second day of inspection took place on 12 November 2015, and was announced. The service was previously inspected on 12 and 16 March 2015, and was not meeting six of the regulations we inspected.

Ashwood Lodge is a 27 bedded care home providing residential care. The service does not provide nursing care. The home is a converted building, with all of the communal areas and bedrooms situated on the ground floor. At the time of the inspection 20 people were using the service, 14 of whom were living with dementia.

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 2008 and associated Regulations about how the service is run.

There was a safeguarding policy in place that contained detailed guidance on possible types of abuse. Staff received training in safeguarding and felt confident in reporting issues should they arise.

Risks to people were assessed and minimised. Deficiencies in the premises had been remedied since our previous inspection though the building was in need of redecoration.

People were supported by staff who had been appropriately recruited and inducted.

The service had up-to-date policies and procedures in place to safely manage medicines and people had their own documents showing how their medicines should be used.

Staff received suitable training to ensure that they could appropriately support people. Some training was overdue but there was a plan in place to address this. Staff said they received sufficient training to do their jobs.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Standards to ensure that people received care that they consented to or was in their best interests.

People received suitable support with food and nutrition and were able to maintain a balanced diet. Mealtimes were enjoyable for people using the service.

The service worked with external professionals to support and maintain people’s health. The professionals we spoke with had no concerns about the service.

Staff treated people with dignity, respect and kindness and were knowledgeable about people’s needs, likes, interests and preferences. People had access to advocacy services.

Care records were detailed, personalised and focused on individual care needs. People’s preferences and needs were reflected in the support they received. External professionals thought that staff knew the people they were supporting well.

People did not have access to a wide range of activities, which meant that they sometimes felt socially isolated. This prevented them from maintaining relationships and links with their community.

The service had a clear complaints policy that was applied when issues arose.

The registered manager used audits to monitor and improve standards. The provider undertook site visits to review service quality.

Staff felt supported and included in the service by the registered manager. However, staff did not feel supported by the provider. The registered manager said they felt supported by the provider.

Inspection carried out on 12 & 16 March 2015

During a routine inspection

We inspected Ashwood Lodge Care Home on 12 & 16 March 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

At the last inspection in June 2014 we found the home did not meet the regulations related to cleanliness and infection control, safety and suitability of premises and assessing and monitoring the quality of service provision. The provider sent us an action plan that detailed how they intended to take action to ensure compliance with these three regulations.

Ashwood Lodge is an older building that has been converted for use as a care home and is located in a residential area of Billingham. It provides residential care and accommodation for up to 27 older people, some of whom may have a dementia. The service does not provide nursing care. Accommodation and communal areas for people who use the service are all provided on the ground floor. Office space for the use of staff and management was provided on the first floor.

The registered provider is Nationwide Healthcare Limited. The service has a registered manager, who has been registered with us since 14 March 2014. 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.

Staff had received training in safeguarding and were able to demonstrate an awareness of abuse and how concerns should be reported. However, we found that local safeguarding reporting procedures had not been followed recently, when concerns about possible neglect had been raised with the service’s registered manager and provider. We also found that the service’s safeguarding policy did not provide appropriate information.

Maintenance work identified as needed during our visit in June 2014 had not been completed when we revisited on 12 March 2015. Additional maintenance work was also identified as needed during our visit. Robust processes to ensure good standards of infection control and hygiene were still not in place, particularly around the use of bin liners and in the laundry and sluice areas.

Medicines were being administered, stored and managed safely, although some improvements to medicine records could be made.

People who used the service and relatives felt that staff were sometimes too busy and not available when needed. People were also concerned that staff had to cover other roles, such as care staff working in the kitchen and the registered manager covering care shifts. Staffing records and discussions with staff showed that minimum staffing levels were maintained, but we also saw that staff were not always present in communal areas and at times appeared to need more direction.

The required information relating to staff employed at the home had not always been obtained when staff were recruited. Staff received training and support, although some improvements could be made to the training provided and the frequency of formal support, such as one to one supervision sessions.

Staff had been trained on the Mental Capacity Act (MCA), but could not explain the fundamental principles of the MCA when asked and care records did not demonstrate that the MCA was being implemented correctly. The manager was familiar with the Deprivation of Liberty Safeguards and one person at the home was subject to them at the time of our visit.

People’s nutritional needs were being assessed and monitored, with a choice of regular meals provided. Staff confirmed that food was always available if people were hungry between meals and regular drinks were offered. People had access to health and social care professionals, and those we spoke with were complimentary about the care provided at the home. However, we found examples where the service had not always been proactive in taking action to address difficulties and delays when working with other professionals, to ensure that people received timely care and treatment.

Staff were observed to be caring and respected people’s privacy and dignity. People who used the service said that staff were caring and kind. However, improvements could be made to the level of interaction between staff and people who used the service while care was being provided. The health and social care professionals we spoke with told us that people were supported to take risks and that in their experience staff had been “really good” when providing end of life care.

People’s needs were assessed and their care planned, but the care records we saw were disorganised, confusing and did not always contain up to date daily care records that were accessible to care staff, because these were stored on the computer and not printed out very often.

People who used the service and relatives told us that there wasn’t enough going on at the home, with people saying they were “bored” and “frustrated.” We found that people didn’t have access to opportunities for social stimulation or activities that met their individual needs and wishes. A complaints process was in place, but three people told us this had not worked effectively for them and there was no record of how informal complaints or concerns were dealt with.

The registered manager and provider did not effectively identify areas that needed improvement or take appropriate action to put them right. Issues we had identified during our last visit in June 2014 still needed to be put right when we revisited on 12 March 2015. The local authority commissioners told us that they also had concerns that the improvements they had asked for had not been made.

Notifications about incidents and events that the service is required to make to us had not always been made when required. When we asked the registered manager about this they knew about some notification requirements, but were not clear about others.

We found 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 the report.

Inspection carried out on 11 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to look at seven outcome areas and use our findings to consider five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Some part of the home needed maintenance work to ensure that they were safe and pleasant places for people to live. Some parts of the home were not clean and hygienic. For example, some carpets were badly marked, bathroom flooring was cracked and slippery when wet, some pieces of equipment and parts of the home were dirty and in need of cleaning. Compliance actions have been set and the provider must tell us how they plan to improve.

Medication systems were in place to help people get the medication they had been prescribed. Suitable arrangements were in place for the safe storage and administration of medication, with the manager able to demonstrate improvements that had recently been made. For example, increased stock checks and better recording.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One authorisation was in place at the time of our visit. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Assessment and care planning systems were in place, to identify people�s needs and help staff provide the care people needed.

Quality assurance systems and checks were in place, but these had not always been effective at identifying and addressing problems at the service without external interventions. For example, the food hygiene issues recently raised by the Environmental Health Officer or the maintenance and cleanliness issues raised by our inspection.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were caring and supported people in kind and pleasant ways. People who used the service were complimentary about the attitude of the manager and staff, and care that they provided. One relative commented, �It may be a bit tired (the premises), but in what matters it�s amazing, in care, the way staff treat people�. Another relative told us, �They (the staff) are very good actually.�

Is the service responsive?

People�s needs had been assessed and care plans put in place describing their care needs. These records included information about people�s individual needs and preferences. There was evidence that people�s records had been reviewed and that other professionals were involved in people�s care appropriately. Where we have raised concerns the manager has listened and kept us informed of the actions they are taking.

Is the service well-led?

There was a registered manager in place, but they were often working as the senior carer on shift, rather than as a supernumerary manager. This had impacted on the time they had available to oversee the management and leadership of the service. Staff we spoke with indicated that the nominated individual (official company representative) did not visit the home very often and the records of the directors �monthly� monitoring visits indicated that they had only completed three official monitoring visits in the last year. Concerns have recently been raised about the home's performance in some areas by the local authority, environmental health and ourselves. This indicated that the provider was not proactive in identifying and resolving issued independently.

Inspection carried out on 28 October 2013

During a routine inspection

One person told us, "The staff are good and I am well looked after." Another person told us, �I am very happy here, the staff can�t do enough for me.�

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke to staff and found that they were very knowledgeable about people�s likes and dislikes and how they wished to be supported. We were able to see how people�s skills and independence were promoted.

Where people were highlighted as being at risk, for example, with pressure sores care plans had been developed. We found that care records contained up to date care plans and risk assessments.

We found that the care records contained evidence to confirm that people had been involved with health professionals. People's health, safety and welfare were protected when more than one provider was involved in their care and treatment.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because records were accurate and up to date.

Inspection carried out on 28 January 2013

During a routine inspection

Feedback from people who used the service, and their relatives, showed that they had been involved in discussions about their care and were happy with the service they received. Comments that were made to us included �they are all lovely�, �they are brilliant here, they really are good, sometimes they go beyond the call of duty� and �it�s a good care home I think�.

The care records we looked at, and our observations during this visit, showed that people�s needs were assessed and their care was planned and delivered appropriately. Staff were able to describe the care and support people needed and explain how they maintained people�s privacy and dignity.

Although the home is located in an old building, we found that it provided a safe and comfortable place for people to live. There had recently been some redecoration and new carpets installed. Staff told us that essential maintenance was carried out and people were not put at risk.

Feedback from people who used the service, and their relatives, indicated that staff were usually available when people needed them. Staff rotas, discussions with staff and our observations, showed that sufficient staff were on duty to meet the needs of the people living at the home.

People who use the service and their relatives told us that the manager was approachable and that they could speak to her if they wanted. There was a complaints procedure in place and records showed that complaints had been responded to appropriately.

Reports under our old system of regulation (including those from before CQC was created)