Ashmead Care Centre

Ashmead Care Centre is a care home that provides nursing and personal care for up to 108 older people. At the time of our inspection there were 108 people using the service including those living with dementia. The care home accommodates people in six units, two on the ground floor, two on the first floor and two on the second floor.

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

The home was not always responsive to people’s activities needs. The home was updating the activity needs of people, had employed an activities co-ordinator and external training for staff was in place, although the current individual and group activities were not quite meeting people’s needs. The registered manager and staff regularly assessed and reviewed people’s care needs and updated their care plans accordingly. This included any communication needs. People were provided with person-centred care by staff who knew them and their preferences well. People were given choices, and encouraged to follow their routines, interests and maintain contact with friends and relatives to minimise social isolation. People and their relatives were given easy to understand information about the service to decide if they wanted to move in. Complaints were appropriately recorded, investigated and responded to.

People and their relatives said that the Ashmead Care Centre was a safe place to live and staff told us it was a safe place to work. People had any risks to them regularly assessed and reviewed. This meant they were able to take acceptable risks, enjoy their lives and live safely. Any accidents, incidents and safeguarding concerns were reported, investigated and recorded. There were enough appropriately recruited staff to meet people’s needs. Trained staff safely administered medicines. The home used Personal Protection Equipment (PPE) effectively and safely and the infection prevention and control policy were up to date.

The home had a management and leadership team that was transparent with a culture of openness, positivity and honesty. The provider’s vision and values were clearly set out, understood by staff and followed by them. Areas of responsibility and accountability were identified, and a good service maintained and reviewed. Audits were thorough and records kept up to date. Where possible community links and working partnerships were established and kept up to minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals told us that the service was well managed and met people’s needs in a professional, open and friendly way.

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 (published 19 September 2019). The overall rating for the service remains good. This is based on the findings at this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 did not inspect the key questions of effective and caring.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Recommendations

We have made recommendations regarding the activities provided for people and how some areas of the home and mealtimes can be better used to enhance the experience of people using the service.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Responsive section of this full report.

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

We found the following examples of good practice.

The measures in place were robust and effective in preventing and minimising the risk to people, staff and those that visited the care home from catching or spreading COVID-19.

We saw staff and managers wearing personal protective equipment (PPE) appropriately during our inspection. Staff were given up to date infection prevention and control (IPC) and COVID-19 training, which was routinely refreshed. There were adequate supplies of PPE that met current demand and foreseen outbreaks.

Staff followed IPC and PPE policies and procedures, that were regularly updated to reflect ongoing changes to COVID-19 related guidance. They included specific Covid-19 related risk assessments for people, and contingency plans for managing adverse events, including COVID-19 outbreaks and staff shortages.

Although access to the care home was restricted, due to an outbreak designated people could visit their relative or friend in line with Government COVID-19 care home guidelines. All visitors to the care home had to follow the providers IPC guidance and procedures.

The care home provided alternative communication arrangements to help people maintain relationships with relatives and friends that were important to them. Staff actively supported people to keep in touch with those who could not visit the care home in-person, via telephone and video calls.

The home was not currently taking new admissions due to a Covid-19 outbreak. Once the current outbreak has passed the care home will be taking new admissions and people will be returning after a hospital stay. They will be required to have a negative COVID-19 test and self-isolate for the prescribed period to minimise the risk of the virus spreading.

The care home followed a ‘whole home’ COVID-19 testing program. This made sure everyone living, working or visiting the care home was regularly tested for COVID-19. People using the service were tested twice per week and all staff were vaccinated. The provider was aware of how to apply for COVID-19 home testing kits and had adequate supplies.

The care home was clean, hygienic and detailed records were kept of cleaning schedules. They included a rolling program of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. The registered manager said cleaning and all staff were fully aware of their crucial role and responsibilities.

Infection risks to everyone living and working in the care home were thoroughly assessed and where people were deemed to be disproportionately at risk from COVID-19, appropriate action had been taken to minimise the impact. All staff including those most at risk from underlying health care conditions or other relevant factors, had specific two part risk assessments in place.

The provider did not use agency staff and ensured bank staff worked exclusively in the one care home and on specific designated floors to reduce the risk of spreading infection.

The provider's IPC policy was up to date.

Ashmead is a purpose built home accommodating people on three floors; each floor is divided into two units with accommodation and related facilities. The two ground floor units, known as Primrose and Bluebell, specialise in supporting older people with nursing care needs; the two first floor units, known as Lavender and Buttercup and the third floor unit called Rose support older people living with dementia. The second floor unit called Daffodil is a specialist step-down unit that provides intermediate short-stay support to people. A step-down unit is traditionally used to provide people with the short-term care and support they need to enable them to return home.

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

At the last inspection we found people were not always kept safe at the home because some staff did not always follow risk management plans properly. At this inspection we found the provider had improved people’s risk management plans through regular assessments and reviews and staff were aware of these and were putting them into practice.

We also found at the last inspection staff did not always have all the right knowledge and skills to effectively carry out their roles and responsibilities. At this inspection we found the provider had improved the specialist training offered to staff so they could effectively meet people’s needs.

Also at the last inspection the service did not always support people to take part in social activities relevant to their social interests. At this inspection we found the provider had recruited a new activities team who were developing activities based on people’s preferences. However, we found the staff required further support to be able to provide meaningful activities for older people, those bedfast and people with disabilities.

We have recommended to the provider that activities staff receive training in this area and we will check progress at our next inspection.

People we spoke with were happy with the care they received and with the staff who assisted them. People were protected from avoidable harm, discrimination and abuse. Appropriate staff recruitment checks were made. Procedures were in place to reduce the risk of the spread of infection. Medicines were administered, stored and disposed of safely. Risks in the environment were very well managed, which helped to ensure the premises were safe.

Staff were suitably trained and supported. 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 to maintain a healthy balanced diet and to stay healthy, with access to health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respect and ensured people's privacy was always maintained. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

The provider was exploring ways of ensuring they were meeting the Accessible Information Standard for communication. The provider had effective systems in place to deal with concerns and complaints and to assess and monitor the quality of the service people received.

The service had a registered manager who we found to be open and transparent. They were working in partnership with other health and social care professionals and agencies to plan and deliver an effective service that met the needs of the people they supported.

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 18 September 2018) and there were two 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

This was a planned inspection based on the previous rating.

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.

The care home can accommodate up to 110 people across six self-contained units located over three floors, each with their own separate adapted facilities. The two ground floor units, known as Primrose and Bluebell, specialise in supporting older people with nursing care needs; the three units known as Lavender, Buttercup and Rose support older people living with dementia; and Daffodil is a specialist step-down unit that provides intermediate short-stay support to younger and older adults with a range of personal and health care needs, including physical disabilities, mental ill health and behaviours that might be considered challenging. A step-down unit is traditionally used to provide people with the short-term care and support they need to enable them to return home. At the time of our inspection 109 people resided at the home.

The service has not had a registered manager in post for the past 2 months. In the interim the deputy manager has been in operational day-to-day charge of the service. At the time of our inspection a regional peripatetic manager was appointed as the service's new manager. They have submitted their registered manager application to us. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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.

In August 2017 the home was re-registered by the CQC after the service was taken over as a going concern by a new provider known as MMCG (Maria Mallaband Care Group). At the last comprehensive inspection of this home in June 2017 when they were owned and managed by Lifestyle Care Management, we rated them 'Requires Improvement' overall. This was because staff record keeping, governance systems and risks associated with people’s nutritional needs were not managed well.

At this comprehensive inspection, we found after 12 months in charge the new provider had begun to improve the standard of care and support people living in the home received, but they acknowledge further improvements are required. We have therefore rated Ashmead Care Centre ‘Good’ for the one key question, ‘Is the service caring?’ and ‘Requires Improvement’ overall and for the other four key questions ‘Is the service safe, effective, responsive and well-led?’

This was because some staff failed to always correctly follow risk management plans that were in place to keep people safe. Three significant incidents involving people living in the home had occurred in the last 12 months which resulted in people sustaining injuries that could have been avoided if staff had followed their risk management plans.

In addition, staff did not have all the right knowledge and skills to effectively carry out their roles and responsibilities. Although the new provider had a well-established training programme in place, it did not cover the needs of everyone who lived at the home. For example, staff had not received any training in learning disability or autistic spectrum disorder, mental ill-health or sensory impairment.

Both these shortfalls represent breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Furthermore, people did not always have sufficient opportunities to participate in meaningful activities that reflected their social interests. We discussed this issue with the new managers who acknowledged the range of fulfilling activities people could choose to engage in was limited. We also recommended the provider seek advice and guidance from a reputable source, about developing a programme of social activities that met the needs and social interests of people living with dementia.

We saw the premises were not suitably decorated or adapted to meet the needs of people living with dementia. People living in the home with communication needs could not always access information they needed to make informed decisions and choices about the care and support they received because it was not available in easy to understand pictorial, large print, audio or different language formats.

Finally, although good governance systems to assess and monitor the quality and safety of the care and support people received were in place, we found these were not always operated effectively. During our inspection we identified many issues that the providers governance systems had failed to pick up, such as staff medicines recording errors, poor basic food hygiene practices and outstanding maintenance jobs.

The negative comments described above notwithstanding, most people living in the home, relatives and community health and social care professionals felt the standard of care provided at Ashmead Care Centre had begun to steadily improve since the new providers and managers had been in charge.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse and neglect. Appropriate recruitment checks took place before staff were permitted to commence working at the home. The environment was kept hygienically clean and safe. People received their medicines as prescribed.

People were supported to eat and drink enough to meet their dietary needs and preferences. Managers were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People had an up to date personalised care plan, which set out how their care and support needs should be met by staff. The new manager and his deputy were well-regarded by people living in the home, their relatives, community professionals and staff. The provider had suitable arrangements in place to appropriately deal with people’s concerns and complaints.