Ashurst Mews Care Home

Ashurst Mews Care Home is a residential care home providing nursing and personal care to up to 60 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 53 people using the service.

Ashurst Mews accommodates people across three separate areas, each of which has separate adapted facilities. On the ground floor, support is provided to people with residential needs. On the second floor there are two separate areas, one providing support to people with dementia and the other support to people with nursing needs.

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

Systems to monitor the quality and safety of the service were in place to ensure people received safe and person-centred care. These required time to be embedded in the service to ensure they were sustained and improvements continued.

The systems and processes for identifying risks to people had improved. Further improvements were required to ensure effective management of risks to people’s skin integrity, people’s health needs and environmental risks.

Staffing levels and deployment had improved but further improvement was required to ensure people were consistently supported by sufficient numbers of staff who knew them well. People were supported by staff who were safely recruited and were supported within their roles.

People received their medicines as prescribed from trained staff.

People's needs were assessed, and care plans guided staff how to meet those needs. A system was in place to monitor people's health needs.

Staff felt supported within their roles and felt confident to discuss any concerns they may have with the management team.

Feedback was sought from people, relatives and staff to identify where improvements were needed. Staff, people and relatives were also offered regular meetings to share information and discuss any concerns they had.

People were protected against infections such as COVID-19. Staff followed government guidance on testing and wearing appropriate personal protective equipment (PPE). The home appeared clean. Cleaning schedules were in place to evidence when cleaning was completed.

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.

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 09 March 2022) and there were 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. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to safeguarding concerns and concerns about the leadership and management of the service. As a result, we undertook a focused inspection to review the key questions of safe 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.

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 remains requires improvement. 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 Ashurst Mews Care Home 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.

Ashurst Mews Care Home is a residential care home providing personal and nursing care for up to 60 people aged 65 and over. At the time of the inspection there were 59 people living at the service.

Ashurst Mews Care Home is a purpose-built building providing en-suite rooms for three units across two floors. The ground floor is a residential unit, the second floor has two units one which specialises in supporting people living with dementia and the second provides nursing care. Each unit has a communal lounge and dining area. There are communal gardens and a cinema room which at the time of the inspection was being utilised as a COVID-19 testing and visiting area.

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

Risks to people were not always assessed and mitigated.

Systems and processes had not always ensured effective managerial oversight of the infection prevention, safety and quality of the service or identified and prioritised risks to people’s safety.

There was a system in place to record accidents and incidents, but lessons had not always been learned.

There was not always enough staff to ensure people’s needs were met. Staff did not always have the time to provide care in a timely way or fully support people’s needs and preferences.

Some staff were overdue training updates and did not always feel supported by the registered manager.

Activities and entertainment were limited. People were supported to maintain contact with families.

Staff used personal protective equipment (PPE) appropriately and understood the importance of good hand hygiene. The home was clean and free from malodour. Visitors were screened and tested before entering the building to prevent the risk of infection from COVID-19. Staff were vaccinated as per the regulatory requirement.

People were encouraged to be as independent as possible. Staff were respectful of people’s privacy and respected their personal space. People's Records were stored securely.

Complaints were managed in line with the providers policy and procedure

Resident and relative meetings took place and the registered manager made themselves available for meetings with people and their families when requested.

The registered manager had been open and transparent when things had gone wrong and submitted notifications as per the regulatory requirement.

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.

Systems and processes protected people from the risk of abuse. Staff understood the sign of abuse and how to report it.

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 outstanding (published 9 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staff numbers, staff training, and the managerial oversight of the safety and quality of the service. A decision was made for us to inspect and examine those risks.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing numbers and the safety and managerial oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashurst Mews Care Home is registered to provide accommodation and nursing care for up to 60 older people. The service is purpose built to meet the needs of people using the service. At the time of the inspection there were 56 people using the service.

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

People were at the very heart of the service. Staff promoted people's right to make choices in every aspect of their lives and actively supported them to maintain their independence.

The staff at Ashurst Mews were committed to making sure people lived fulfilling lives and were highly motivated with a 'can do' approach which meant they were able to achieve positive outcomes for people. Without exception, people spoke positively about the management and of their care experiences.

It was clear the culture within the service valued the uniqueness of all individuals who lived there. The provider used person centred and innovative ways to provide people with the support they needed, based on best practice.

The staff and the management team were passionate about providing people with support that was based on their individual needs, goals and aspirations. As a result, their care was tailored to meet their exact needs.

The service took a key role in the local community and was actively involved in building further links. The arrangements for social activities were inventive and met people’s individual needs.

There was a high level of satisfaction with the service and people were well supported to express their views, so improvements could be made. There was strong leadership that put people first and set high expectations for staff.

We found an open ethos with a clear vision and values which were put into practice by staff, who were proud to work for the service and felt valued for their work. A very positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people.

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to reduce any risks. There were sufficient numbers of staff who had been safely recruited to meet people’s needs.

Peoples medicines were safely managed, and systems were in place to control and prevent the spread of infection.

People’s care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service and ongoing training that enabled them to have the skills and knowledge to provide effective care.

People were supported to eat and drink enough and staff placed a strong emphasis on the dining experience to ensure it was enjoyed by all. Staff supported people to live healthier lives and access healthcare services.

The service had a vibrant and welcoming atmosphere where visitors were welcomed and encouraged. The premises was homely and purpose built to meet the needs of people using the service.

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.

Staff provided care and support in a very caring and meaningful way. They knew the people who used the service very well and had built up kind and compassionate relationships with them. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

The last rating for this service was : (published 23 March 2017) At this inspection we found the service had improved to Outstanding.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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.

The service is registered to provide accommodation for up to 60 older people who require nursing care. At the time of our inspection there were 55 people staying there.

The service had 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.

There were not always sufficient enough staff to meet people’s needs in a safe and timely way. However, once this had been drawn to the registered manager’s attention they had been proactive and made changes to the deployment of staff and agreed to keep this under review.

People received care from staff that knew them well and were kind, compassionate and respectful. Their needs were assessed prior to coming to the home; care plans were person-centred and regularly reviewed.

There were appropriate recruitment processes in place which ensured that people were protected from being cared for by unsuitable staff and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

Staff were supported through regular supervisions and undertook training which helped them to understand the needs of the people they were supporting. People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. People’s health care and nutritional needs were carefully considered and acted upon. Appropriate health care professionals were appropriately involved in people’s care.

People were cared for by staff that were respectful of their dignity and that demonstrated an understanding of each person’s needs. This was evident in the way staff spoke with people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

There were a range of audits in place and action was taken to address any shortfalls found. The registered manager was visible and open to feedback, actively looking at ways to improve the service.