We carried out a review of the data available to us about Ashwood Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashwood Care Centre, you can give feedback on this service.
Ashwood Care Centre is a nursing home for up to 70 older people. The provider cares for people living with the experience of dementia, people with nursing needs and people being cared for at the end of their lives. At the time of the inspection 63 people were living at the service.
People’s experience of using this service and what we found
People using the service and their relatives, were happy with the care they received. They felt well supported, care was personalised and reflected their needs and preferences. People had been involved in planning their care and were able to make decisions about this.
People received their medicines in a safe way. The staff worked closely with other health care professionals to monitor and meet people's needs and make sure they received the health care they needed. When people were being cared for at the end of their lives, external palliative care teams offered support and guidance for staff so they could help make sure people were comfortable and pain free. People were supported to have enough to eat and drink. The staff responded appropriately where there were changes to people's needs, in their condition, weight or wellbeing.
The staff were well supported and trained. There was a positive culture and the staff enjoyed working at the service. They knew people well and were kind, caring and responsive to people's needs. There were appropriate procedures for recruiting staff to make sure they were suitable.
There were effective systems for managing the service. These included regular checks on all aspects of the service, as well as good communication between managers and staff. Incidents, accidents, complaints and safeguarding concerns were dealt with appropriately and lessons were learnt from these to improve the service. People using the service, visitors and staff knew and respected the registered manager. They felt able to discuss any concerns and felt these would be investigated and addressed.
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
Our last inspection of the service was a targeted inspection looking at infection prevention and control only (Published 6 November 2020). We did not award any ratings at this inspection.
The service was rated Good at our inspection of 6 June 2018 (Published 29 June 2018).
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.
We found the following examples of good practice.
The provider had suitable procedures for infection control and prevention, including regular audits, effective cleaning regimes and personal protective equipment (PPE) for staff. The staff had training around COVID-19, infection control and how to use PPE. The management team carried out checks and supervised staff to help make sure they followed procedures.
The environment was set out to minimise the risk of the spread of infection. Each unit was self contained and staff worked exclusively in specific units. People using the service were supported to social distance where possible. There were dedicated cleaning staff for each unit and appropriate systems for dealing with laundry and clinical waste.
People with infections were cared for in their rooms for a period of isolation and there were procedures to ensure good infection control when entering and leaving these rooms. The staff had created comprehensive care plans and risk assessments for each person which outlined how they should be cared for and how risks to their safety and the safety of others could be minimised.
The provider had appropriate visiting arrangements which took account of people's safety and well-being. Families were able to visit people who were very unwell and those who were dying. The arrangements around this were designed to minimise risks whilst allowing people this important contact at at time when they and their families needed this.
The provider carried out regular testing for staff and people using the service. They had responded appropriately following test results and when people displayed symptoms which could be related to COVID-19. The staff carried out daily observations on people's well-being, such as oxygen levels, temperature checks and blood pressure. They increased monitoring and adapted people's care when these checks indicated a change in their health. The registered manager had regular discussions with external healthcare professionals during which they highlighted any concerns they had about people's safety, health or well-being.
Further information is in the detailed findings below.
The last inspection of the service took place on 13 March 2018 and was a comprehensive inspection where we looked at all five key questions.
Following 13 March 2018 inspection, we rated the service Requires Improvement in the key questions of 'Is the service Safe, Responsive and Well-led?' The service was given an overall rating of Requires Improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive and Well-led to at least ‘Good’. We also issued a warning notice in respect of breaches relating to medicines management telling the provider they must make the required improvements by 30 April 2018.
We undertook this focused inspection of 6 and 15 June 2018 to check that improvements to meet legal requirements planned by the provider after our 13 March 2018 inspection had been made. The team inspected the service against three of the five questions we ask about services: ''Is the service well led?'', ''Is the service responsive?'' and ''Is the service safe?
No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.
We found improvements had been made in all three key questions we inspected. The rating for these key questions has been changed to Good and the service has been rated Good overall.
Ashwood Care Centre is a 'care home'. People in care homes receive accommodation with nursing and 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 registered to accommodate up to 70 older people. Accommodation is provided on three floors. People living on the first and second floor were living with the experience of dementia. At the time of our inspection 44 people were living at the service.
Bondcare (London) Limited manage nine care homes within London and are part of Bondcare, a national provider of care homes in the United Kingdom.
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 and associated Regulations about how the service is run.
The provider had made improvements with regards to medicines management and we found medicines were being managed safely at the home.
The provider had made improvements to the governance of the service. They had a range of audits and checks which effectively monitored the quality of the service and mitigated risks.
The two breaches of Regulation we identified at the previous inspection had been met.
People lived in a safely maintained and clean environment. The provider undertook checks to make sure the environment and the equipment being used was safe and clean.
There were enough staff to meet people's needs and keep them safe.
There were procedures designed to protect people from the risk of abuse. The staff were aware of these and there was information on display so that people using the service, visitors and staff knew what to do if they were concerned someone was being abused. The provider had taken appropriate action following allegations of abuse to help protect people from further harm.
The risks to people's safety and wellbeing had been assessed and planned for.
The provider had systems in place to learn from accidents, incidents and complaints.
People's care had been planned for and their needs were being met in a way which reflected their preferences.
People knew how to make a complaint and were confident these would be dealt with.
Where people were being cared for at the end of their lives, there were appropriate plans in place and the provider worked with other professionals to make sure people received the right care.
People using the service and other stakeholders were invited to share their views about the service. The provider responded to these and acted on information to help make changes.
The provider had developed an action plan where they had identified improvements were needed, as well as from stakeholder feedback, Care Quality Commission inspection reports and reports from other organisations, such as the local authority quality monitoring team. They had demonstrated a commitment to making improvements.
There was a clear management structure. People found the registered manager approachable and knew who to speak with if they had concerns or wished to discuss the service.
The last inspection of the service took place on 11 October 2017 when we rated the service Requires Improvement in all key questions and overall. We issued warning notices in respect of breaches of Regulations in relation to person-centred care and good governance, and made requirements in respect of dignity and respect, safe care and treatment, nutrition and hydration and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least ‘good’.
At this inspection we found that improvements had been made in all areas however not enough to improve the rating to Good. We found that whilst improvements had been made in relation to the safe care and treatment of people and good governance, further improvements were required in order to meet these Regulations. We found the provider had met breaches of Regulation regarding person-centred care, dignity and respect, nutrition and hydration and staffing. We have rated the service Requires Improvement overall and in the key questions of Safe, Responsive and Well-led. We have rated the key questions of Effective and Caring as Good.
Ashwood Care Centre is a 'care home'. People in care homes receive accommodation with nursing and 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 registered to accommodate up to 70 older people. At the time of the inspection there were 46 people living at the service. Accommodation is provided on three floors. People living on the first and second floor were living with the experience of dementia.
Bondcare (London) Limited manage nine care homes within London and are part of Bondcare, a national provider of care homes in the United Kingdom.
There was a manager in post. They had applied to be registered with the Care Quality Commission and this application was being processed at the time of our 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 and associated Regulations about how the service is run.
People did not always receive their medicines in a safe way and as prescribed.
The provider's systems and processes had not always identified risks such as the way in which medicines were being managed, risks of unsafe support being provided by a visitor and risks associated with infection prevention and control. This meant that they were not able to respond and take action to mitigate these risks.
We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance.
We are taking action against the provider for failing to meet Regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Following our feedback regarding areas of concern, the provider took action to mitigate the risks we had identified.
People's needs were being met, although there was a risk that these would not always be met in a way which reflected their preferences. Information about individual care needs was not always clearly recorded. The staff had recorded when people refused care, but they had not always investigated if there were other ways they could offer care to ensure people had the support they needed in a way they preferred.
The provider had improved the service. They had listened to feedback from the local authority, people using the service, staff and other stakeholders to help identify improvements they wanted. They had also addressed the majority of concerns identified at the last CQC inspection and we could see that there were systems and processes to continue making improvements.
People were happy living at the service. They felt well supported by kind and caring staff. They told us their needs were being met and they were able to make decisions about how they were being cared for. People were treated with dignity and respect and were able to maintain their independence if they wanted this. There were a range of organised social events and activities, and people also received individual support to meet their social and leisure needs.
The staff were happy working at the service. They felt supported by their manager and had the training and information they needed to care for people. There were enough staff to keep people safe and meet their needs. There were effective systems for sharing information amongst the staff team to make sure people received effective care.
People lived in a safe environment. The provider undertook checks on the safety of the environment and equipment. People had the equipment they needed. The home was clean. There had been improvements to design of the environment but further improvements were needed. For example, some bathrooms could not be used and best practice guidance for promoting dementia friendly environments had not always been followed.
People had enough to eat and drink. The staff monitored this and took action when people were identified as at risk. The staff worked with other professionals to ensure people's healthcare needs were being met. The provider had assessed people's needs and preferences and had recorded these in care plans. The staff kept records of the care that they had provided. They had responded to changes in people's needs and had taken action when people fell, became ill or their condition deteriorated. Some people were receiving care and support at the end of their lives. The staff had the skills and support to make sure these people were comfortable, pain free and their preferences were respected.
The provider had acted in accordance the principles of the Mental Capacity Act 2005 and restrictions on people's freedom had been lawfully agreed in their best interests.
There was a clear and visible management team, with the manager supported by the provider's representatives. People felt they could speak with the manager and that complaints were appropriately responded to. There were systems for identifying and improving the quality of the service and these included asking people living there and others for their views.
This was the first inspection of the service since it was registered with the provider Bondcare (London) Limited on 4 October 2017. Previous to this the service was registered with and managed by another organisation.
Ashwood Care Centre is a care home providing nursing and personal care to up to 70 older people. At the time of our inspection 50 people were living at the service, some were living with the experience of dementia and some had general nursing needs. Nurses were employed to work on two of the three floors.
Bondcare (London) Limited manage nine care homes within London and are part of Bondcare, a national provider of care homes in the United Kingdom.
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 and associated Regulations about how the service is run.
There was not always the equipment needed to care for people safely and meet their needs.
People received their medicines as prescribed but the way in which medicines were managed meant that there was a risk they would not always receive medicines in a safe way.
The staff who cared for people did not always get the support they needed. People were not always cared for by suitably qualified and experienced staff.
The provider was not always meeting people's hydration needs.
The staff were not always kind and did not consider people's feelings.
The staff tended to focus on the tasks they were performing rather than the person they were caring for.
People were not always cared for in a way which met their needs and reflected their preferences.
The provider's systems for identifying and monitoring risk were not always effective.
We found breaches of six Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Some aspects of the environment were not suitable to meet the needs of people living with the experience of dementia. We made a recommendation in respect of this.
There were enough staff to keep people safe, but people's needs were not always being met and the staff felt this was because there were not enough of them.
People were happy living at the service. They felt their needs were being met and they told us that the staff were kind and caring.
The staff were generally happy working at the service and felt supported by the new manager and provider. The staff had opportunities to meet with their manager and were provided with training to help them understand their roles and responsibilities.
The risks to people's wellbeing had been assessed and planned for. The provider had procedures designed to safeguard people from abuse. The provider's procedures for recruiting staff were suitable.
The provider was acting within the principles of the Mental Capacity Act 2005.
People knew how to make a complaint and felt confident they would be listened to.
People were encouraged to be independent where they could be.
The provider had a good understanding about the areas of the service which needed improving and had an action plan so that they could make these improvements. They worked closely with the local authority who was monitoring the improvements they made.