Ashley Court

Ashley Court is a care home registered to provide personal and nursing care to 60 older people. There were 59 people receiving care and support at the time of the inspection many of whom were living with dementia.

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

People were safe living at Ashley Court. The home had made improvements since our last inspection which had been embedded into daily practice. This included improvements to recruitment practices, medicines management and the management oversight within the home.

Staff knew how to keep people safe and who to report to if they had concerns. There was confidence in the registered manager that they would take any concerns seriously and act upon them. There was enough staff on duty, and they had been recruited safely and had the necessary skills and training to support people.

People’s risks had been assessed and this included risks around the home, these were regularly updated. Medicines were managed safely and staff responsible for giving medicines had their competency assessed. The home worked well with health and social care professionals when needed. Infection prevention and control procedures were robust, and the latest government guidance was followed regarding COVID-19. Lessons were learnt and shared amongst the team, with a chance to reflect on practice.

People had care plans and assessments in place and the registered manager created a plan to ensure all documentation relating to the person was personalised. People knew how to make a complaint and records showed they had been dealt with in line with the providers policy. 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 had access to a range of activities and additions to this were ongoing.

Improvements had been made to the governance systems. There was a range of audits which checked, monitored and improved practices within the home. Staff were proud to work at Ashley Court and had confidence in their colleagues, they told us people living at the home were their priority. People, their relatives and staff told us they had confidence in the management of the home. Ashley Court worked to gain the views of the people living there and their relatives in order to make improvements.

The registered manager and staff understood their role within Ashley Court. The registered manager told us they were open and transparent, and records supported this. Where necessary referrals had been made to external agencies including CQC.

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 requires improvement (published 12 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

At our last inspection breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve their staff and recruitment processes and good governance. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the caring key questions. We therefore did not inspect it. The rating from the previous comprehensive inspection for the effective and caring key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashley Court on our website at www.cqc.org.uk.

Follow up

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.

People’s experience of using this service:

• There was no registered manager in post at the time of this inspection. The previous registered manager had left their post at the end of December 2018. Interim management arrangements had been put in place and a new manager had been recruited and was due to start on 23 April 2019.

• The recruitment of new staff was not always safe and robust.

• Improvements were required in relation to the training and competency assessments of staff in the management of medicines.

• Governance systems and oversight of the service were not sufficiently robust and had not identified the issues we found in relation to staff recruitment and medicines administration.

• People, staff and visitors had mixed views about whether there were sufficient numbers of staff on duty to support people appropriately.

• Some people may not have always had their privacy and dignity respected because their preferences for the gender of staff providing care could not always be met.

• People, visitors and staff spoke positively about the management of the home and the support they received.

• Ashley Court was furnished and decorated in a way that gave a homely feel to it. The home was clean and well maintained throughout.

• People were supported by staff who understood how to identify, and report abuse and how to whistle blow.

• Staff were experienced and well supported by the management of the home.

• People, and visitors were confident they could raise any concerns, and these would be addressed appropriately.

Rating at last inspection: At our last inspection in September 2017, the service was rated Good overall.

Why we inspected: We received information of concern and possible risk about the service, so the inspection was brought forward from the original planned date.

Enforcement: We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations relating to the, recruitment of staff and governance of the service. Please see the “Action we have told the provider to take” section at the end of this report.

We have made recommendations regarding the safe administration of medicines and a review of staffing levels.

Follow up: We have asked the registered provider to send us an action plan telling us what steps they will take to make the improvements that are needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided. We will return to re-inspect the service in line with our inspection timescales for requires improvement services.

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

Ashley Court is a purpose built home and is registered to accommodate a maximum of 60 people who require either nursing or personal care. There were 53 people living there at the time of our inspection.

Accommodation is provided in individual bedrooms on the ground, first and second floors. Each room has ensuite facilities. Communal areas include a lounge and a kitchen dining room on each floor, a sensory room and an activities room. There is a secure, well maintained garden at the back of the building with garden furniture and shelters.

The service was led by a registered manager. 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.

All of the people we spoke with, and visitors, told us they felt safe and well cared for. We received only positive comments about Ashley Court throughout our inspection. Staff were also positive about the service they provided. They told us they felt well supported by the registered manager.

People told us that their care and support needs were met and that staff were kind, caring and respectful. People also said they felt safe and had confidence in the staff. People’s needs were assessed and plans were in place to ensure that their needs were met. People’s choices and decisions were respected and staff enabled people to retain their independence wherever possible.

Staff knew people well and understood their needs. Care plans were detailed and regularly reviewed. This meant that there was always information for staff to refer to when providing care for people.

The provider had satisfactory systems in place to recruit and train staff in a way that ensured relevant checks and references were carried out and staff were competent to undertake the tasks required of them. The number of staff employed at Ashley Court and the skills they had, were sufficient to meet the needs of the people they supported and keep them safe.

People were protected from harm and abuse wherever possible. There were systems in place to reduce and manage identified risks and to ensure medicines were managed and administered safely. Staff understood how to protect people from possible abuse and how to whistle blow. People knew how to raise concerns and complaints and these were investigated and responded to.

Observations and feedback from staff, relatives and professionals showed us that the home had an open and positive culture. There was a clear management structure in place. People and staff said was the registered manager was approachable and supportive.

There were systems in place to monitor the safety and quality of the service. This included the use of audits and surveying the people who used the service and their representatives.