Archived: Ashgrove Nursing Home

We found the following examples of good practice.

The provider maintained good levels of personal protective equipment (PPE) and staff were wearing PPE correctly.

There was a clear process in place to monitor staff vaccination status and the registered manager explained the process when recruiting new staff.

Regular spot checks were carried out to ensure staff were donning and doffing (putting on and taking off) PPE correctly as well as hand washing assessments.

The registered manager explained how staff would use pictorial cards, white boards and hand movements to reassure people at the service.

The service was clean and effective systems were in place to oversee this.

We found the following examples of good practice.

¿ People were supported to maintain contact with their family and friends. All visiting was pre-booked and in designated areas within the garden; this helped to stagger visits and prevented more than one visitor. People also kept in touch with their relatives and friends by the use of SKYPE calls, window visits and postcards.

¿ The manager had purchased a hand washing kit to utilise as a practical training session with staff; this enabled staff to see visually how easily the virus could be transmitted by not washing their hands effectively.

¿ Discussions were held with staff to reduce any anxieties they felt; in particular with staff in high risk groups and the provider had signposted and supported them to access health and wellbeing services if needed.

¿The provider had developed a COVID 19 APP for managers. The manager recorded key information daily such as temperature readings, staffing levels and PPE supplies. This enabled the provider to have a good oversight of the current situation at the service.

¿ Practical competency observations of staff were in place and completed by the Infection Prevention and Control (IPC) champions, this included handwashing and donning & doffing. A WhatsApp group had been set up for staff to share current IPC guidance.

Further information is in the detailed findings below.

Ashgrove Nursing Home is a residential care home that is registered to provide nursing and personal care and accommodation for a maximum of 57 older people and younger adults. 39 people were using the service at the time of the inspection. The home is separated into two individual units, Ashgrove and Coppice. Some people living in the Coppice unit experience dementia.

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

People felt that more staff were needed to meet their needs effectively. The deployment of staff was not always effective. People were supported by staff to remain safe. Risk assessments were in place to minimise any potential risk to people’s wellbeing. Staff were required to have checks in place before commencing their employment. People received their medicines as expected and people were supported with their skin care needs.

Audits were in place and these provided a clear overview of any patterns or trends. We received notifications as required to enable us to see what action the provider took to keep people safe, except for one occasion where this was sent in later and all other actions had been completed to keep the person safe. Checks were carried out on people’s satisfaction with their care using questionnaires. People knew the registered manager and felt they were visible around the home and were approachable.

Rating at last inspection

The last rating for this service was Good (published 04 July 2018)

Why we inspected

We received concerns in relation to the management of skin care. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this specific concern. The provider had taken action to mitigate any risks to people regarding their skin care and this has been effective.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashgrove Nursing Home 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.

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

The provider is registered to provide accommodation and nursing care for up to 57 people, including older people. People live in two separate units, Ashgrove and Coppice. The provider provides care for people with dementia, some of whom are supported in Coppice. At the time of our inspection there were 45 people living at the home.

The inspection was undertaken on 18 and 23 May 2018. .

There was a registered manager in post and they were present during this inspection. 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.

At the previous inspection on the 27 January 2017 the provider had an overall rating of ‘requires improvement.’ At this inspection the provider had achieved an overall rating of ‘good’ as they had made significant improvements.

People told us they felt safe when staff supported them with their needs and staff applied their training when using equipment to ensure people were safe and comfortable. Staff practices were consistent in monitoring people’s care needs so risks to people from avoidable harm were reduced. The registered manager kept staffing arrangements under review to ensure people’s needs were supported in a safe and timely manner. Recruitment checks had been completed before new staff were appointed to make sure they were suitable to work with people who lived at the home.

People were happy with the support they received from staff when taking their medicines as prescribed. Staff practices around the administration and management of people’s medicines reduced the risks of people not receiving their medicines as prescribed to meet their health needs.

Staff received and induction and on-going training to meet the specific needs of people who lived at the home. People were supported to stay well and had access to health care services and enjoyed their mealtime experiences with the registered manager ensuring staff’s main focus at mealtimes was the care needs of people.

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

People appreciated the support they received to make their individual rooms as homely as possible. The physical environment and facilities in the home reflected people's requirements with redecoration on-going to enhance people’s wellbeing. Systems were in place to ensure effective infection prevention and control.

People felt staff were caring towards them and staff had developed respectful relationships with people. People’s privacy and dignity were respected by staff who enjoyed their work and wanted to provide people with the best possible outcomes. People were given encouragement to make their own decisions about their day to day care when they needed it. People's rights to dignity and privacy was understood and acted upon by staff.

People were provided with fun and interesting things to do although the registered manager had identified plans for further improvements to support people with dementia. Staff provided end of life care in a sensitive and centred on each person.

People who lived at the home and their relatives were supported by the management and staff team to raise any complaints they had. The registered provider had a complaints procedure which included investigating and taking action when complaints were received.

The management team had established a positive open culture where staff were clear about their responsibilities and continued to have learning opportunities.

The registered manager had made every effort to bring about the improvements required and had done this by effectively developing and regularly assessing and monitoring the quality of care. This ethos had continually driven improvements to the care experiences of people, which reflected the registered manager and registered provider were committed to provide high quality care.

Further information is in the detailed findings below.

Ashgrove Nursing Home is registered to provide accommodation and nursing support for up to 57 older adults with a variety of health conditions including dementia. On the day of our inspection there were 47 people living in the home. There were 30 people living in the nursing unit with eight beds allocated as a short stay for people leaving hospital managed through the Clinical Commissioning Group (CCG) and 17 people living in the residential dementia unit. A manager had recently been appointed and was in the process of applying to register to manage the service. 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 felt safe within the service. Staff knew how to keep people safe and had received the appropriate safeguarding training to do so. There was insufficient staff to keep people safe within the dementia unit. People were administered their medicines as it was prescribed.

Staff had the skills and knowledge to support people appropriately. People were supported by staff in a way that ensured their human rights were protected within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The provider needed to make improvements to how people knew what choices of meals were available to them, but people were able to get enough to eat and drink. Where people needed to see health care professionals this was available to them.

People had a mixed view as to whether staff were consistently kind and caring towards them. People’s independence and privacy was respected, however we found that people’s dignity was not always being respected. An advocacy service was not available to support people who needed to make choices and decisions as to how they were supported.

The provider had an assessment and care planning process in place which involved people in identifying their support needs. We found that people’s support needs were being reviewed. While we found that people were able to take part in activities, this was not consistent or appropriately linked to their interests and hobbies.

The provider had a complaints process in place to enable people to raise complaints. We found that spot checks and audits were taking place by the manager and provider however these were not consistently effective in identifying areas of concern.

People were able to share their views on the service they received by completing a quality assurance questionnaire. We saw that where actions were identified these were being discussed with people.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "It's a friendly, homely place and the care is excellent". Another person told us, "The food is great, the people are nice and I get everything I need".

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that staff were supported to carry out their role and trained to meet people's needs. Staff told us they were given opportunities to develop their skills beyond their core training.

We found that systems were in place to deal with complaints. This meant that people had their concerns listened to and acted upon.

On the day of the inspection the home was having its main lift replaced and planned refurbishments were underway as part of improving the home's facilities.

People told us that staff were supportive. Relatives told us that people's dignity, privacy and independence was respected. We saw staff knocking bedroom doors before entering and people spending time alone in their rooms. One person said, 'I am able to do things how I want for myself'.

One person said, 'We have a laugh with the staff'. People told us that staff knew how to care for them and they loved living at the home. Relatives told us the care delivered was at times on a one to one basis with people.

Records showed that systems were in place to keep people safe. Relatives had no concerns for people's safety.

The provider had a system in place to check that only suitable staff worked in the home.

Records showed that appropriate quality audits were being done as part of ensuring the quality of the service. We saw that people living there were able to share their views on the service regularly.