Ashdene Care Home

The service provides accommodation and personal care for up to 41 older adults and people living with dementia. There were 37 people living in the service on the day of our inspection.

People’s experience of using this service:

Systems were in place to ensure the safety of people being supported. Risks to people were assessed and managed. Medicines were well managed, procedures, systems and checks were in place to support safe administration. Accidents and incidents were recorded, and measures were taken to improve and learn.

People’s needs were thoroughly assessed, and desired outcomes were met. The food was of good quality, the cook had good systems in place to ensure that people ate and drank what they wanted and liked. Fresh fruit and snacks were available. Staff received training they needed to do their job well and were supported by managers in their roles. People’s consent to care was sought and the principals of the Mental Capacity Act were being met.

Staff and managers were kind and caring. The values of the organisation placed an emphasis on the home being a ‘home’ for people. Staff described a working environment that represented family values. Staff interactions with people living in the home was attentive and kind. People were given the opportunity to express their views regularly and were involved in their own care. Privacy and dignity were maintained to a high standard.

People were receiving care that was responsive to their needs. Care planning captured peoples wishes and care was delivered by staff who understood the needs of the people they were supporting. Care records were person centred and contained good detail about people, their likes and dislikes and what is important to them. People know how to complain and raise concerns and were listened to.

The registered provider had a genuine desire and passion to provide good quality care to people living in the home. Leadership was strong, visible and accessible. Processes were in place to ensure that the delivery of care was monitored and checked regularly. Governance systems identified areas for improvement and plans were developed and actioned.

The manager and the team have built good working partnerships with other health and social care professionals and have built strong links in the community.

The service met the characteristics of Good in all areas that we inspected. More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement and was published on 10 October 2017.

Why we inspected:

This was a scheduled inspection based on previous rating.

Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely however they were not consistently managed safely.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had not been consistently completed. This issue had been identified at our previous inspection and the provider had failed to fully address the issue.There was a breach of Regulation 11. You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular supervision and appraisals People were provided access to a range of leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. However the provider had failed to identify the issues we identified at our inspection regarding medicines. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

Is the service safe?

All of the relatives we spoke with told us they trusted service staff and had not had any reason to raise concerns about the care provided. One person said, '(My relative) is safe here.' Another told us, 'I am very observant and will tell them straight if I have any problems or complaints.'

Staff understood how to recognise and report any concerns they might have about people's safety. We saw staff received training in the protection of vulnerable adults and had the skills and knowledge required to ensure people's health and safety in areas such as moving and handling.

We looked at systems to ensure people's health and safety including accident and incident reporting and the management of fire risk and evacuation. We saw these issues were monitored and reviewed on a regular basis.

We saw the care people received was safe because staff understood people's right to choose how their care was provided. Where this was not the case, as a result of a diagnosed condition such as Alzheimer's disease, there were systems in place to ensure valid consent was sought and provided.

The manager understood their legal duty and knew how to refer people who might be at risk of receiving inappropriate care, for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS).

Is the service effective?

Relatives told us they were happy with the service provided. One told us the care home was, 'The best (their relative) had been in.'

People's needs were assessed prior to moving to the care home and were reviewed regularly. We saw people's care was more likely to be effective because it was planned based on their individual needs.

Staff told us the way people's care was planned helped them to understand people's needs and provide effective care.

We saw from records, conversations and observations during our visit that staff provided care effectively and in the ways described in people's plans of care.

Is the service caring?

People told us they found service staff to be kind and caring. One relative said the, 'Staff were all friendly and helpful.' Another said whenever they visited they found

their relative and other people who received care to be, 'Relaxed and happy.'

We observed staff interacting with people in a warm and caring way. We heard laughter and singing during our visit and noted staff working to provide care to people with patience and in ways that protected their dignity.

We saw from a comments book and a recent survey of people's opinions that most of those who contributed praised the attitudes of staff. Recent comments included, 'Thanks for the wonderful care.' And, 'It's a pleasure to come and see my (relative).'

Care records we looked at included information about people's lives and families. They conveyed a sense of what was important to the person. We saw these wishes reflected in the way activities were organised and the way care was provided.

Is the service responsive?

People told us staff were approachable and responded positively to requests for information or help. One relative told us, 'Staff and the manager are always available.' Another said that when they had issues they needed to discuss, 'Staff give you an answer.'

The activities co-ordinator told us they were provided with the materials and support to offer a programme of activities that included everybody who received a service and reflected people's interests and wishes. They said if they asked for extra resources the manager and owner responded positively. Staff we spoke with told us colleagues were positive in helping others. During our inspection we noted care workers helping with recreational activities people were enjoying.

We noted from care records we looked at that concerns raised about people's health and welfare were addressed quickly and effectively. Medical support to ensure regular and responsive health care included a weekly GP surgery provided at the care home by one local GP practice.

Is the service well-led?

Staff we spoke with said they enjoyed their work and felt well supported by the manager of the service.

Staff told us about initiatives to encourage people's families and friends to visit and join in activities at the care home. Activities have included family teas and the hosting of wedding anniversary celebrations for people who used the service, their partners and families. One member of staff told us the manager was very good at engaging and encouraging family involvement. We saw that each year family's views about the quality of the service were sought through the circulation of a questionnaire.

We found that the service consistently monitored and reviewed its own practice in order to ensure the care home was a safe place for people to live and a good place to work.

We found that people who lived at Ashdene were well cared for in an environment that protected their rights and promoted their independence.

The people we spoke with said they were happy with the care and support they received and felt it was delivered in a safe way.

They told us that staff offered them choice and respected their dignity while encouraging them to be as independent as possible. One person we spoke with told us,'The staff always knock and ask before coming into my room.You never know your luck, I might have a young lady in here!'

We saw that people were offered a choice of food and drinks in sufficient quantities to meet their needs.

The home was well maintained and equipped to meet the needs of the people who lived there.

People said they felt confident in taking any suggestions or concerns to the manager or any of the staff team. They were satisfied with support they received and the service provided.

The service was well led and managed and the staff team reacted quickly to meet people's needs.