Ashlands Manor Care Centre

Ashlands Manor Care Centre is a care home that provides personal and nursing care for up to 57 people, some of whom are living with dementia. At the time of the inspection there were 53 people living in the home.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

The service is purpose-built home and set over 3 floors. All rooms are en-suite and each floor had its own separate facilities. The ground floor supports people requiring support with personal care, the first floor supports people living with dementia and the second floor supports people who need nursing care.

People’s experience of the service and what we found

People were kept safe. Staff knew how to raise safeguarding concerns and were aware of the processes to follow in order to keep people safe. Risks of harm were identified and mitigated as much as possible. Overall, medicines were managed well but some areas for improvement were identified during our inspection.

There were enough staff working at the service to meet people's needs and there were adequate staff recruitment practices in place. There were systems in place to minimise the risk of infection.

Staff had received appropriate training and supervision and nurses maintained their clinical skills. Staff were encouraged to take additional qualifications to enhance their roles. People were complimentary about the food and were provided with a balanced diet.

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 were supported by kind, caring staff who respected their privacy and dignity and helped them be as independent as they could. People were helped and encouraged to maintain relationships with family and friends and to engage in meaningful activities.

Governance systems were in place to ensure all aspects of the service were reviewed and checked regularly. There had been several different registered managers since our last inspection, however a new manager had been appointed and people, their relatives and staff provided positive feedback on the new manager.

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 (published 08 February 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about further collaboration with local system partners.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashlands Manor Care Centre 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.

This inspection was carried out on 18 and 19 December 2018. At our last inspection in May 2018, we found the service was meeting the fundamental standards, and we rated it good overall. At this inspection, the service continued to meet the fundamental standards, and the rating remained good overall, and the rating for safe improved from requires improvement to good.

Ashlands Manor 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. The service is a purpose-built home which can accommodate up to 57 people over three floors. All rooms are en-suite and each floor had its own separate facilities. The ground floor supports people requiring support with personal care, the first floor supports people living with dementia and the second floor supports people who need nursing care. There were 55 people living at the home at the time of our inspection.

There was a registered manager in post. 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 had been no change in registered manager since our last inspection.

No-one was receiving end of life care at the time of our inspection. However, we found there were systems and procedures in place to help ensure the service was prepared to provide effective end of life care when needed that followed good practice guidance.

Nurses employed by the home had received training in how to use specialist equipment that might be needed when providing end of life care. At the time of our inspection, staff had not received any general end of life training. However, we found they were aware of good practice and procedures and were aware of where they could seek additional support and advice from, if needed.

The service regularly used agency nurses, and occasional agency care staff. The registered manager had information about their training and qualifications that allowed them to check they had the appropriate skills and experience to meet the needs of people living at the home.

Where possible, the service used the same agency staff to improve consistency. However, at the time of our inspection, the regular agency nurses were on leave, and the nurse on duty on both days of the inspection had not worked at the service before. We spoke with the agency nurses who told us they felt they had received adequate handovers and inductions to the service to allow them to understand their responsibilities and the needs of people living at the home.

We found there were sufficient staff on duty to meet people’s needs. Some staff said they could be ‘pressured’ at certain busy times of the day, which was also our observation on the first-floor household that supported people living with dementia. However, we saw there were no significant delays to people receiving the care and support they needed.

The service used an electronic system to help manage medicines and record the administration of medicines. Staff told us they found the system worked well, and we saw it had a number of safety measures built into it to help ensure medicines were given safely. For example, the system alerted staff if someone required their medicine at a specific time, or if there had not been a sufficient time gap since the last dose of medicines.

The service was of a modern design and was clean. The service had recently received 100% in an infection control audit completed by the local authority area infection control lead.

Required servicing and maintenance of utilities and equipment at the home had been undertaken. However, we found the passenger lift had not had a required safety inspection. The provider sent us evidence that this was completed shortly after out inspection, and the lift was found to be safe to use.

Care plans were person-centred and contained the information staff would need to provide people with care that met their needs in a safe way, and in-line with their preferences. Although few people told us they had been involved in reviews of their care, people were happy with the information they received about their care and the level of their involvement.

Some people had DNACPR’s (do not attempt cardiopulmonary resuscitation) directions in their care files. We found this information was not always accurately reflected on people’s profile sheets or on the electronic medicines system. Whilst staff we spoke with were aware which people had a DNACPR in place, this would increase the risk that staff or other health professionals would not be aware of this information.

People were happy with the activities on offer. They were able to access the community and go on trips out as often as they wished. Since our last inspection, the service had started to hold scheduled activities on different floors of the home to help increase opportunities for engagement. The provider spoke about wanting to have conversations with people about their aims and aspirations when they moved into the home. One person had been supported to attend a surprise visit to the football stadium on the team they were a keen supporter of.

Staff told us they felt they received sufficient support. They said they were confident that they could raise any concerns with the management team and that they would be listened to. Several staff we spoke with demonstrated a clear commitment to the role and providing good quality care.

There were systems in place to help the provider and registered manager monitor the quality and safety of the service. This included audits of medicines, care plans and health and safety. The accident reporting system had recently moved to an electronic system, which provided opportunities for increased monitoring of themes and trends.

We noted the registered manager’s check of service and maintenance records had not been completed in November 2018, and had not picked up the lack of a required safety inspection of the passenger lift.

Ashlands 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.

Ashlands is a purpose built home which can accommodate up to 57 people over three floors. All rooms are en-suite and each floor has its own separate facilities. The ground floor is a residential household, the first floor supports people living with dementia and the second floor supports people who need nursing care. There were 49 people living at the service at the time of our inspection.

There was a manager in place who was registered with the CQC. 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 and their relatives thought they were safe living at Ashlands. The staff said they enjoyed working for the service and felt very well supported by registered manager.

People received their medicines as prescribed. A new electronic medicine administration record (eMAR) system had been introduced which prompted when medication was to be administered. Quantities of stock were checked each week; however we found stock balances on the eMAR system did not always tally with the physical stock held due to an issue with duplicate records in the eMAR system. The training manager was going to work with the dispensing pharmacist and eMAR supplier to identify the cause of the duplicate records.

Senior care staff differed in how they responded to any differences in stock balances found, with one investigating the reason for the discrepancy and one altering the quantity noted in the eMAR system. Additional training was to be provided on the eMAR system so all discrepancies were looked into.

Protocols for when any ‘as required’ medicines were to be administered were not sufficiently detailed. Additional information was added to the system during our inspection. Topical creams were applied by the care staff and recorded on a cream chart. However this chart had not been distributed to the rooms that needed one on the nursing unit in May. Cream charts for previous months had been completed on all floors.

Person centred care plans and risk assessments were in place. These provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. The guidance for staff to distract people who had behaviours that may challenge the service varied in its detail. Staff we spoke with knew people and their needs well. Care files were reviewed each month. People and their families were involved in these reviews.

People were supported with their health and nutritional needs. Ashlands was part of a scheme where a GP visited the home each day. This meant any minor ailments could be raised with the GP with the aim of preventing them becoming more serious and reducing hospital admissions. Two health professionals we spoke with were complimentary about the support provided to maintain people’s health.

Staff thought there were sufficient staff on duty to meet people’s needs; although they thought a hospitality member of staff would be beneficial on the first floor as well as the ground and second floors. People and relatives we spoke with said they felt additional staff should be on duty. During our inspection we found sufficient staff were on duty and call bells were responded to in a timely manner. Daily checks on the call bell response times were made.

Advanced care plans were available if people wanted to discuss their end of life wishes. A GP who visited the home told us they had been involved in discussing end of life care with people, their families and the home. We saw evidence of where the home had supported people to stay at Ashlands at the end of their life as they had wanted.

The service was working within the principles of the Mental Capacity Act (2005). A capacity assessment tool was used and applications made for a Deprivation of Liberty Safeguard (DoLS) if a person lacked capacity.

A safe recruitment process was in place. Staff had completed an induction programme when they joined Ashlands and also received refresher training on an annual basis. A programme of additional training in dementia awareness and distress reaction (managing challenging behaviours), dysphagia (choking) and falls management was being introduced. Training for specific needs, for example catheter care was provided by District or Community nurses when required.

Staff had regular supervisions with a named senior carer or the registered manager. Regular staff meetings were held, which were open discussions.

Residents and relatives meeting were held and a survey had been completed with the responses being positive.

Ashlands had a complaints policy in place. No formal written complaints had been received at the time of our inspection. Issues raised verbally had been recorded and responded to.

An activities programme was in place, including a gardening group and external entertainers. The majority of these activities took place on the ground floor which meant it was more difficult for people living on the other floors to get involved. Links had been made with a local nursery and school who visited the home.

People’s cultural and religious needs were being met by the service.

The service was clean and well maintained throughout. On the first floor, where people living with dementia lived, tactile memory items were in place along the corridors to stimulate memories and to orientate people within the home. Doll therapy was in place if people wanted and a lifelike robotic cat had been purchased which people enjoyed petting and talking to.

A quality assurance system was in place. Incidents and accidents were monitored to identify if there were any patterns or trends. The provider had recruited a new quality manager who would undertake monthly quality audit visits to the home. Provider quality assurance visits had been on a quarterly basis before.