Ashlea Lodge

Ashlea Lodge is a care home that provides nursing and personal care to a maximum of 37 older people, some of whom are living with dementia. At the time of inspection there were 35 people who were using the service.

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

People and their relatives were very positive about the care provided. People told us they felt safe and staff had the skills to support them. Relatives provided positive examples of how staff had helped improve people’s lives since moving to the home.

Staff were safely recruited and received an induction followed by training from the provider. Training was monitored and staff were supported with regular meetings and supervisions. There was enough competent staff to meet service user needs.

People and relatives were involved in every stage of care planning. Systems and records were in place to ensure people received person-centred, safe care.

The registered manager had an effective quality assurance system in place. Regular audits and checks werecompleted. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home.

All staff ensured people living in the service were happy with the environment and found ways to promote their independence; their passions and interests maintained wherever possible.

The service was following safe infection prevention and control procedures to keep people safe

Medicines were managed safely. Risks to people were assessed and action taken to reduce the chances of them occurring. The registered manager acted on feedback immediately. People were safeguarded from abuse.

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

The last rating for this service was good (6 April 2018).

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.

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.

We found the following examples of good practice:

• Appropriate measures were in place to reduce the risk of infection. Social distancing rules were being complied with. Some minor changes had been made to the layout of furniture to encourage and support social distancing.

• The environment was very clean. Additional cleaning was taking place, including of frequently touched surfaces.

• National guidance was followed on the use of personal protective equipment (PPE). There was clear signage on the correct use of PPE and handwashing techniques, and staff had received appropriate training in infection prevention and control.

• Staff supported people’s social and emotional wellbeing. Local visiting restrictions were in place so people were supported to keep in touch with their family members via video or telephone calls.

• Staffing levels had been maintained and supplemented with agency staff. Agency staff were appropriately trained and only worked at this service.

Further details can be found in the key question below.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe, effective, responsive and well-led to at least good. We requested the provider supply the Commission with regular updates to enable close monitoring of progress. We found progress had been made and the provider was now meeting the regulations. Medicines were usually managed safely, although further improvements were needed to ‘when required’ medicines. People confirmed they received their medicines when they were due. Assessments to keep people safe were accurate and up to date. Care records now contained accurate information to account for the care provided at the home.

People, relatives and staff felt activities were not always available to keep people engaged throughout the day. We have made a recommendation about this.

Ashlea Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashlea Lodge accommodates up to 40 people across two separate units, each of which have separate adapted facilities. At the time of our inspection there were 33 people living at the home some of whom were living with dementia.

The home 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.

People, relatives and staff said the provider and registered manager had made significant improvements to the home.

People and relatives gave us mostly positive feedback. They said the home provided good care and staff were kind and caring. People told us they were always treated with respect and staff promoted their independence. A person said, “They are always respectful towards me and I genuinely believe they care about the residents.” A relative commented, “There are none better because they really look after and care for [family member].” However, some people and relatives felt staffing levels could be improved.

The home was clean, well decorated and well maintained. People, relatives and staff told us the home was much cleaner now.

Staff did not have any concerns about people’s safety and knew how to raise concerns if required. The provider followed local safeguarding procedures when dealing with safeguarding concerns. These had been fully investigated and resolved.

The provider followed effective recruitment processes to ensure new staff were recruited safely.

Staff carried out health and safety checks to maintain a safe environment for people to live in. The provider also had up to date procedures to deal with unforeseen emergency situations.

People and relatives commented positively about the meals provided at the home. Staff supported people to have enough to eat and drink.

Management provided good support to staff and staff completed training to their role. Records confirmed training, supervisions and appraisals were up to date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people had access to external health care when required.

The provider investigated complaints in line with its complaint procedure.

Ashlea Lodge provides residential care for up to 40 older people, some of whom are living with dementia. At the time of this inspection there were 35 people living at the home. A new provider took over management of the home in April 2016.

The home did not have a registered manager. A new manager had been started their employment at the home three weeks prior to our inspection. They had applied to the CQC to become the 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.

During this inspection we found the provider had breached the regulations relating to safe care and treatment and good governance. We found the arrangements for managing medicines were not always safe. Medicines records were not always completed correctly, such as for the administration of medicines, application of topical creams, stock control and for the safe storage of medicines. We found medicines care plans were not always accurate or up to date. One person had received their medicines incorrectly on two occasions in the last month. Risks had not been adequately assessed as the assessments we viewed were inaccurate. Where measures had been identified to keep people safe, evidence was not always available to confirm these had been actioned. For example, some care plans had not been written or contained inaccurate and out of date information. We also found there were gaps in records and some essential records had not been kept, such as fluid charts. We observed an occasion where care workers did not follow a person’s care plan to reduce their anxieties.

The new provider took over management of the home in April 2016. They contacted the CQC to advise that due to the poor standards they had inherited an improvement plan was to be brought forward. When we inspected the provider had made significant progress against the actions identified in the plan. For example, actions to ensure all relevant people had the appropriate MCA assessments and best interest decisions, all staff had completed essential training, recruiting additional care staff and domestic staff and the appointment of a new manager. Other actions were still on-going at the time of our inspection. The provider submitted a revised action plan following our inspection which reflected the concerns we found during the inspection. The provider agreed to also submit a weekly progress update to ensure close monitoring of the outstanding actions and to meet the requirements of the regulations.

People, relatives and care workers told us there had been improvements made to the home since the current provider took over. They said the home was cleaner and the quality of meals had improved.

In May, August and November 2016 we received anonymous concerns relating to medicines management, moving and handling, high turnover of staff, cleanliness, people not being encouraged to eat their meals, people’s individual care, care plans lacking meaningful information and the management of the home under the previous provider.

People and relatives told us the home provided good care. They also told us care workers were kind and caring and knew people’s needs well.

Care workers understood the importance of treating people with dignity and respect and encouraging people to be independent. They gave us examples of how they aimed to promote this when caring for people.

We saw care workers used safe moving and handling techniques when supporting people to mobilise. Where concerns had been identified, disciplinary procedures had been initiated to investigate the concerns. The provider took action to help prevent people from falling.

Staffing levels had been increased following the recruitment of new care workers and ancillary staff. Care workers told us the staffing levels were much better now and they had time to interact and socialise with people.

The home was clean with no unpleasant odours. Dedicated domestic staff had been recruited and these were visible undertaking cleaning duties when we visited. There were ample supplies of cleaning materials available for domestic staff to use. Relatives and care workers told us cleanliness had improved since the new provider took over.

Care workers did not have any concerns about people’s safety. They felt people were safer now than before. Care workers knew how to raise concerns through the provider’s whistle blowing procedure and said they felt their concerns would be taken seriously. A safeguarding log had been implemented as this had not previously been in place.

The provider had effective recruitment checks. This included requesting and receiving two references and Disclosure and Barring Service (DBS) checks to ensure new care workers were suitable to work with people using the service.

Health and safety checks were carried out regularly and were up to date when we visited. These included checks of fire safety, specialist equipment, the electrical installation, gas safety, water safety and portable appliance testing. The provider had specific procedures to deal with emergency situations.

People and relatives gave only positive feedback about the meals provided at the home and commented about the improvements the provider made. Generally people received the support and encouragement they required to have enough to eat. We observed a small number of occasions when care workers missed cues that people required support. We also observed people were not routinely offered a choice of drinks to accompany their meals. If people did not want to have any of the meal choices on the menu alternatives were offered.

Care workers told us they received good support and the training they needed. Regular supervisions were now taking place so that care workers had opportunities to discuss their role and development needs. Training records showed training was up to date.

The provider was following the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). The provider had taken action to ensure all relevant people had the appropriate DoLS authorisation in place. MCA assessments and best interest decisions had been documented where decisions had been made in people’s best interests. Care workers understood how to support people with making choices and decisions.

People had access to external health professionals, such as GPs, specialist nurses, district nurses and dietitians.

A new activities co-ordinator had recently started employment. They had plans to develop activities in the home including developing links with the local community. Records showed people were involved in a range of activities such as quizzes, sing a longs, watching films, arts and crafts and manicures. We observed activities were on-going during our visit to the home.

The provider had a complaints procedure which was available to people using the service. Previous complaints had been investigated and resolved.