Ashdown Lodge

Ashdown Lodge is a 13-bedded care home, providing personal care and accommodation for up to 13 older people and people who have dementia. The home is situated in Rustington. At the time of our inspection there were nine people living at the home.

The home is located over two floors which are accessible via stairs or a lift shaft. The home had a lounge and dining area with a garden at the rear of the home.

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

People’s experience of using this service:

People’s needs were not met by the design and adaptation of the building. For example, the communal toilets were not accessible to people with mobility issues. We found improvements were required, for people living with dementia to ensure people were stimulated and able to orientate themselves regarding the day, date and time.

People told us they felt safe living at the home. One person told us, “The people are friendly the staff are friendly. I’m free to do what I like, go to dinner, sit in the garden.” Staff were trained in adult safeguarding and knew how to raise concerns. Risk to people were known and documented and staff were given guidance to support people safely.

People were supported by trained staff who were knowledgeable and knew how to care for people, in line with their needs and preferences. People were supported to live as independently as possible and have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and the policies and systems supported this practice.

People were encouraged and supported to eat and drink well. The meals were varied, and people were able to have choice in what they ate and drank. People had access to other health care professionals and people’s health needs were monitored by staff.

Relatives and visitors were welcomed to visit people and they told us that staff treated them with kindness. We observed friendly interactions throughout the day and people appeared happy and relaxed.

Care plans described people’s preferences and needs, and people’s end of life care was discussed and planned with their wishes respected.

People were encouraged to express their views and had completed surveys. They said they felt listened to and any concerns or issues they raised were addressed.

The provider had quality assurance systems in place to monitor the standard of care and drive improvement. Systems supported people to stay safe and reduce the risks to them, ensuring they were cared for in a person-centred way.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (Report published on 3 May 2018).

Why we inspected: This was a scheduled inspection

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

We carried out a comprehensive inspection of Ashdown Lodge on 8 and 9 February 2018. The inspection was unannounced.

Ashdown Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ashdown Lodge is registered to provide personal care and accommodation for up to 13 older people and people who have dementia. At the time of the inspection there were 13 people living at Ashdown Lodge.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in August 2017.

We had received information prior to the inspection that people had been subject to abuse and placed at risk of avoidable harm. People told us they felt safe and we did not find any evidence that people had been subject to abuse.

However, we identified medicines were not always safely managed. Systems processes and practices to safeguard people from abuse and the assessment of risks, monitoring and management of people’s safety require improvement.

Quality assurance and information governance systems at the service were not yet fully operational. There was no on-going development plan in place to help the service continuously learn and improve. This meant quality, safety issues or potential risks were not always recognised or identified and action was not always taken when needed.

Care homes and other health and social care services are required by law to notify the Care Quality Commission, (CQC), of important events that happen in the service. This enables us to check the action the service took and if necessary request additional information about the event itself. However, not all of the relevant notifications had been submitted.

There was lack of adaptations inside and outside the home to support people with dementia to be comfortable and remain as independent as possible.

People had consented to their care and staff respected this. However, not all staff could explain their understanding of the Mental Capacity Act 2005 (MCA) and link the principles of this legislation with their everyday practice.

Staff knew people well and understood how people liked to be supported. However, people’s care plans did not contain enough information about them to enable staff to provide care in a person centred way. This meant there was a risk that people might not be supported in a personalised and meaningful way.

The service promoted a supportive, open and inclusive culture and staff told us that they felt supported. However, we found there was a lack of formal policies and procedures to protect and promote staff well-being and equality and inclusion rights in the workplace.

The above areas of practice have all been identified as requiring improvement.

Staff received an induction and had on-going training, supervisions and appraisals. However, some staff told us they felt they needed more training in order to be able to effectively meet some people’s specific individual needs. This meant people were at risk of not achieving the most effective outcomes from their support. We have made a recommendation about staff training on the subject of dementia and behaviours that may challenge.

The service had enough staff to meet people’s needs safely and followed safe recruitment practices. Staff had received infection control and food hygiene training and followed best practice guidance in these areas. Regular health and safety checks of the physical environment, including people’s rooms, took place. We observed the service to be clean and in a good state of repair.

The registered manager was aware of their responsibilities and had followed the correct process for assessing and submitting applications for Deprivation of Liberty Safeguards (DoLS) for people who required them. We checked to see whether any conditions on authorisations to deprive a person of their liberty were being met and found that they were.

People’s physical, psychological and social needs were assessed so the service had relevant information about people to make sure they got the support they wanted and needed. People experienced no discrimination regarding a specific assessed need or if they made a particular decision relating to their protected characteristics under the Equality Act 2010.

People had support to meet their medical and health care needs and had were assisted to eat and drink enough, and maintain a balanced diet. People told us they thought staff were caring. One person said, “Everything is done with the utmost care and respect”.

People could express their views about how they wanted to be supported, their choices were respected and they were involved in decisions about their care. People were encouraged to be as independent as possible when having support. Staff communicated with people in ways they understood. Information about the service was available in accessible ways for people with a disability or sensory loss.

Staff were compassionate and took time to sit and talk with people and respected people’s privacy and dignity. People’s confidentiality was respected. Information about them was collected stored and shared in line with the principles of the Data Protection Act.

There was a complaints policy in place which was followed if any complaints were received. People felt confident to do raise a complaint if they had to. People had support to follow their interests and take part in meaningful activities inside and outside the service.

People were involved and had support with planning, managing and making decisions about their end of life care. Staff offered reassurance to people and sought advice from relevant health and social care services to assess and manage people’s end of life symptoms effectively.

Staff had a good understanding of their responsibility and accountabilities to deliver high quality care. People and staff were involved in the development of the service. The registered manager demonstrated their awareness of the Duty of Candour CQC regulation.

The service shared information with other agencies to implement actions and improvements to support care provision for people and promote partnership working.

During this inspection we found number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.