Ashdowne Care Centre

Updated 22 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They joined us at the service and spoke with people and relatives to ask their views about the service.

Service and service type

Ashdowne Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ashdowne Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection.

We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

At the inspection we asked the registered manager to display our poster asking staff and relatives to share their views.

We met people who lived at the home and spoke with 18 of them on the Ashdowne unit about their experience of the care provided. On the Pinnexmoor unit people were unable to share their views with us, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with four relatives visiting the home.

We spoke with 14 members of staff including the provider’s operations manager, new manager, a unit lead, a registered nurse, care workers, activity staff, the chef, the maintenance person, the administrator and housekeeping staff. We also spoke with three college students undertaking a health and social care course who were on a week’s placement at the home.

We reviewed a range of records. This included seven people's care records on the provider’s computerised system and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including fire safety, maintenance records, staff rotas, minutes of staff meetings and audits were also viewed.

Between the inspection visits we spoke with the provider on the telephone; they were the nominated individual responsible for supervis

Updated 22 November 2022

About the service

Ashdowne Care Centre is a care home, registered to provide accommodation with nursing or personal care, for up to 60 people. There were 57 people using the service on the first day of our inspection.

The service is in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne unit and Pinnexmoor unit. The Ashdowne unit is primarily used for older people with physical disability and the Pinnexmoor unit is for older people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose.

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

People told us on the Ashdowne unit they did not feel there were always enough staff on duty to meet their needs. Comments included, “We do have to wait at times for help”, “They are too busy to spend the time” and “They were short of staff sometimes". We found that the staff levels across the home were not consistent.

On the Pinnexmoor unit, we observed people’s needs being met promptly and appropriately by a full staff team. However, on the Ashdowne unit we observed they were short of staff which meant people’s care needs were not always met promptly.

We have made a recommendation to the provider to monitor the deployment of staff across the home to minimise the impact on people.

Improvements were needed to ensure staff recruited at the service had all of the required checks. A revised recruitment checklist was put in place after the inspection and all recruitment files were checked to ensure they contained the required information.

The provider had processes in place to monitor the risks to people. However, we identified not all people able to use a call bell had access to one, pressure mattress checks had not identified that one had been turned off and it was not clear if one person had an adequate fluid intake. We were assured that action was taken regarding these concerns.

Environmental risks were on the whole, managed well. This included fire checks and drills and regular testing of fire and electrical equipment, and maintenance issues being dealt with effectively. Radiators which were identified as a possible risk on the first day of our visit were covered the following day to ensure people were not at risk of burns.

People generally received their medicines safely. However, it was not clear if people who had been prescribed supplements as they were at risk of weight loss, had received them. The manager took action and improved the recording of people’s supplements and monitoring.

On arrival at the home we found some areas which were not clean and bed bumpers which were ripped and therefore not able to be cleaned, which posed a risk to people. Action was taken by the manager and these areas were clean and bed bumpers were replaced on the day of the inspection.

People were supported by staff who had received safeguarding training and were aware of the different types of abuse. People said they felt safe living at the service. Comments included, “Yes I feel safe with staff...They (staff) are very careful”; “The staff are very good and helpful…I am well looked after.” And “Yes, quite safe. It’s just sort of natural the way they look after me...”

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.

Accidents and incidents were, on the whole, managed appropriately. Each accident or incident was reviewed by the manager to ensure staff had taken appropriate action. After a discussion they said they would be looking at potential trends to be identify and minimise the risk of future incidents.

Since the last inspection a new manager had been appointed. They were supported by the provider, operations manager and unit leads. They were committed to working with staff to provide people with a good quality person-centred service. They worked alongside staff to pass on their ethos and ways of working. Staff were complimentary about the new manager and were hopeful the changes they were making would be embedded.

The provider had a program of audits they required managers to undertake. These had been completed and actions were being undertaken when areas of concern were identified. At the inspection we highlighted areas of concern which had not been identified by the program of audits. When we raised these concerns the management team reviewed the quality of their audits process. They gave us reassurances this would ensure the risk of future concerns would not be missed. We recognise these changes have been made and we will expect to see an improvement at our next inspection. We have made a recommendation that they continue to monitor their auditing process to ensure it is effectively highlighting areas which might need to be addressed.

People’s and relatives’ views were sought through surveys and meeting with the manager.

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 good (published 21 August 2021)

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashdowne Care Centre on our website at www.cqc.org.uk.

Follow up

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