Ashdowne Care Centre

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement.

At this assessment the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Improvements were needed in how the outcome of complaints were recorded and reviewed to help identify patterns and themes.

Improvements were needed to update the complaints system to ensure concerns could be easily audited and complaints information was personalised to the home. In the current format it was difficult to track patterns of complaints. People’s relatives gave mixed feedback as to whether their complaints had been resolved appropriately but most were satisfied their concerns were taken seriously. For example, one relative said, “We did make a complaint…They treated it seriously…They dealt with it very, very well.” However, some relatives had contacted CQC as they were unhappy with how complaints were managed.

The provider’s leadership team were committed to learning from concerns to make the improvements needed. They were recruiting for a manager to help embed change, respond to complaints, and be accessible to people living, visiting and working at the home.

The nominated individual took complaints seriously, responded appropriately with details of actions taken to improve practice and monitored changes. The provider understood their responsibilities under Duty of Candour and relatives confirmed they were kept informed of any incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Care and support was planned and organised with people and their families together with healthcare partners to ensure continuity of care. However, people’s families told us when their relative was discharged from hospital to the service, they had not been provided with information about the home. They said this would have been helpful and informative. The nominated individual told us they would address this by putting together an information pack.

There were safe systems to ensure people were receiving the care they needed. For example, the electronic system alerted staff when a care task had not been completed. We spot checked this system and saw people had been supported with identified care tasks, with the home screen showing when care tasks had been completed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

When safeguarding matters were identified, the provider worked with people and healthcare partners to address risk. The provider shared concerns with relevant organisations appropriately. There were provider level systems which ensured data shared and requested by the local authority was captured.

Staff understood their safeguarding responsibilities and were aware of internal and external reporting processes.

We saw people living with dementia using communal areas were generally tolerant of each other and at ease with each other. Staff knew people well and therefore could take steps to intervene before situations escalated. Visitors were generally positive about the safety of their relative. For example, one relative said,” It all appears to be very good there…From what we see she is safe.” Another relative said, “She is safe.” But some visitors worried about other people going into their parents’ rooms uninvited and were considering requesting their doors to be locked.

The provider had appropriate systems and processes in place. But there was recognition that improvements to the Deprivation of Liberty Safeguards (DoLS) process would ensure applications were made in a more timely manner.

The provider and staff worked well with people to understand and manage risks and keep relatives updated on changes. However, records did not always show when planned care had taken place.

Care plans were well written. For example, around catheter and diabetes care, and oxygen use. However, completion of mental capacity assessments was not consistently completed despite the care plan indicating the person did not have capacity in some areas of their life.

Records relating to pressure care for people at risk of skin damage, did not routinely show people were being moved at the intervals stated in the care plan. This potentially meant risks were not being managed appropriately, although a relative was complimentary on the frequency their relative’s skin pressure areas were checked. This type of feedback indicated re-positioning was happening but not always recorded. Staff were clear how they supported people at risk of pressure damage. We saw improvements were needed in the level of detail around diabetes management to ensure risks to people’s health were managed safely and in a timely way.

There had also been an incident where a person had become distressed and attempted to climb over their bed rail, but the risk assessment for bed rails had not been updated. Staff told us these concerns would be addressed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Equipment such as lifts, hoists and checks linked to gas safety had been maintained in line with requirements. Each month, safety checks were completed on equipment used to support people, such as specialist beds, bed rails, call bell systems, wheelchairs and walking aids. Fire safety was well managed. For example, on the day of our inspection we saw staff respond appropriately to an unplanned fire alarm.

Personal evacuation plans were in place and included people on a short stay, which showed staff ensured records were up to date. Staff received fire training in person and on-line.

The provider did not always make sure there were enough qualified, skilled and experienced staff. However, they did make sure staff received effective support,supervision and development. The staff team worked together well to provide safe care that met people’s individual needs.

During our visit there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. The nominated individual said staffing levels were determined on occupancy levels and individual care needs.

Staff gave mixed feedback on whether they felt there was always sufficient staff on duty to meet people’s needs, particularly on the Ashdowne side of the home and during the summer. Staff told us this had been raised with the nominated individual by nursing staff as there were an increased number of people needing 2 staff members to assist them to move, which impacted on staff availability. Staff also commented the provision of activities could be impacted if staff with this role had to step in to assist with care tasks when the service was short staffed.

Staff said they worked well as a team with a range of skills and experience. We saw on both days of our visit how the calm atmosphere benefited people living with dementia. For example, staff were attentive, took their time with people and did not rush them. Relatives generally felt staffing levels were appropriate, particularly during the day. They were complimentary about the staff group and the quality of care provided. For people who chose to stay in their room, welfare checks were in place, although some families said they like these to happen more often to reassure them their relative was not isolated.

Recruitment practice checked applicants suitability to work in a care setting, which included references, police checks, identity checks, as well as the registration status for nurses.

The provider assessed and provided training to prevent the risk of infection. However, they did not always detect and control the risk of it spreading as some staff did not follow good infection control procedures.

Training was provided to the whole staff group to ensure they understood the fundamentals of infection control. Housekeeping staff, including laundry staff, were positive about additional external training when new products were introduced to the home. In the laundry, there were good infection control measures to help prevent cross infection.

However, on the first day of the inspection, we saw staff wearing gloves inappropriately in communal areas which was not good practice. We fed this back to the nominated individual who said it would be addressed; staff practice had improved by the second day of our inspection.

There was a stale odour in parts of Ashdowne, and also an unpleasant odour around the entrance to Pinnex Moor. However, equipment was kept clean as were people’s bedrooms and communal areas.

Most relatives were satisfied with the standard of cleanliness, but some said the communal toilets on Pinnex Moor needed to be cleaned more often during the day. We saw why they had raised this issue when we spot checked the cleanliness of toilets during the inspection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People received their medicines safely as prescribed for them. When medicines were prescribed to be taken ‘when required’ there was personalised information in place to guide staff when these might be needed.

Improvements were needed to the recording and application of non-medicated creams when they were applied by care staff. New systems for recording the use of these preparations were introduced during our inspection.

Staff had regular training updates, and had competency checks to make sure they gave medicines safely before being authorised to administer medicines. However, these were not always reviewed annually in line with best practice guidance, and this was not covered in the home’s medicines policy.

Regular medicines audits took place which identified some improvements that were needed, and actions were recorded. However, the audits did not pick up some of the areas for improvement found during the inspection.

There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security. Suitable temperature monitoring was carried out to make sure medicines would be safe and effective.

Records were in place to show individual risks had been considered for some higher-risk medicines such as flammable topical preparations. However, these were not always in place for anticoagulant blood thinning medicines. This was addressed following the assessment. Two people’s medicines care plans needed updating to reflect changes that had taken place, and these were updated during our visit.

If medicines were given covertly (without the person’s knowledge ) then suitable mental capacity assessments and best interest decisions were recorded, and these medicines were checked to make sure they were given safely.