Archived: Ashbourne Court Care Home

We spoke with eight people, three people's relatives, six care workers, the activities coordinator, the deputy manager, the chef, the maintenance person and the Registered Manager. We observed staff interactions with people. Records relating to the management of the home were reviewed. These included five people's support records, incident records and audits.

We considered all the evidence we had gathered under the outcomes we inspected, which related to people's dignity, care and welfare, nutrition, safeguarding arrangements, staffing and assessing and monitoring the quality of service provision and records. We used the information to answer five key questions; is the service safe, effective, caring, responsive and well-led.

This is a summary of what we found. The summary describes what people's relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Relatives of people who use the service were complimentary of how the provider maintained people's safety. One person said 'Staff are always here to keep an eye on me.' The provider had taken action to ensure that staff knew how to respond to potential abuse. Staff we spoke with had a good understanding of their responsibilities to keep people safe in accordance with the provider's safeguarding procedures. We found safety incidents had been reported and investigated appropriately.

There were enough staff to meet people's needs safely. The provider had taken action to implement a staffing tool to determine the safe level of staffing required. We found the home was over staffed while they were inducting new staff and piloting the new staffing tool. People did not wait too long when requesting assistance and the Registered Manager monitored the call bell response times to ensure people were responded to promptly.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to this type of service. The service was safe because requirements in relation to the DoLS had been met. The registered manager had received training in relation to DoLS and had completed DoLS applications in the home appropriately. One person in the home was subject to a DoLS. Staff were aware of the conditions of this safeguard and how to ensure this person was kept safe whilst respecting their rights.

Is the service effective?

The service demonstrated effective practices through the assessment of people's needs and the delivery of care and treatment. Nurses and care staff understood their various responsibilities in meeting people's health and care needs. This meant when people received care, for example, wound care and falls prevention, this was done consistently and in accordance with national treatment and care recommendations.

People and relatives told us that they were happy with the care they received. One person said 'They are good here, I really have no complaints'. Relative's comments included 'They always keep me informed of anything and get the GP in when needed'.

The provider had robust monitoring systems in place to monitor the effectiveness of people's care and treatment and specialists were involved to evaluate treatments and provide guidance to staff.

The provider had taken action to ensure people had enough to eat and drink. Some people had been identified to be at risk of malnutrition, and staff took appropriate action to manage this. We observed lunch time on the first and second floors and found people who required support to eat and drink were supported appropriately.

Is the service caring?

The service was caring. People and relatives consistently told us that staff treated them with respect and kindness and our observations confirmed this. Comments included 'they are always chatty and polite', 'even though my relative might not respond they always talk to her' and 'they always make time to chat with me'.

The provider had taken action to ensure staff understood how to support people with dementia and our observations confirmed that they were able to do so with care and respect.

During our observations on the Charlton Unit for people with dementia we found that staff engaged positively with people. Staff had a good understanding of how to support people with dementia to remain engaged and involved in making day to day decisions. We saw staff giving people time to respond to questions, supporting people to make choices for example by showing them the food options.

Is the service responsive?

The service was responsive. People's care had been planned around their needs and preferences. Activities were available to everyone in the home and staff supported and encouraged people to take part.

Systems were in place to support the manager to monitor the quality of care and the risk to people. We saw that care practice for example in relation to falls had been reviewed in response to an increase in falls. This has resulted in a decrease in falls.

We saw people's and relative's feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as improvements to the home's decoration and menu's to meet people's wishes and suggestions.

Is the service well-led?

Staff, people and relatives told us that they felt the service was well led.

The staff were very satisfied with the leadership and the management of the service. Staff told us that they were able to call the registered manager if they had any concerns.

Improvement was integral to the service and we saw that coordinated action had been taken to address the concerns we had identified at our previous inspection on 27 March 2014. The Registered Manager had also monitored whether the action plan had been implemented and improvements had been made.

The provider had systems in place to regularly assess and monitor the quality of service that people received, in relation to health and safety and clinical care. We found that learning took place form investigations and was implemented to improve the service.

One person described being 'told off' by staff as they liked to stand at their door. They felt this was unfair and said there appeared to be a 'regulation' that you did not stand at your door.

People we spoke with were generally positive about the service. One person told us they were 'certainly well cared for.' Another praised the night staff describing them as 'out of this world,' they described the day staff as 'inexperienced but caring.'

During lunch time we observed that there was inconsistent support for people to eat their meals. It was not evident that everyone who needed encouragement or prompting received this in a consistent way so that they were assisted to eat what they could. For example, people were assisted to eat by someone who stood over them, rather than sitting and engaging with them. Others did not receive support to eat independently, were assisted by more than one person, or were left to try and eat for a period of time before help was offered so that food started to get cold.

Staff showed a variable understanding about the concept of safeguarding vulnerable people. One member of staff could not describe what safeguarding meant or what vulnerable adults meant although they said they had completed the safeguarding e learning program.

People told us that it took variable amounts of time for call bells to be answered and some people said that staff answered the call bell, turned it off as 'answered' and then said they would return when they had finished what they were doing. One person said 'They are sometimes very short of staff and then they don't come quickly.' Another told us 'the night staff answer the bell quickly but during the day you just have to wait due to a lack of staff.'

People were treated with respect and kindness by staff. If necessary, they were supported with their meals and there were a range of activities on offer within the home and in the wider community.

People's needs were assessed and care was delivered to support people's safety and welfare. Staff had a good understanding of people's needs, and any changes were discussed at staff handovers. People's care was reviewed and updated regularly.

During our inspection, we spoke with the relatives of two people who used the service. They were both complimentary regarding the service provided to their relative with comments such as 'Their care is immediate and appropriate,' 'I am so grateful and thankful that (their relative) is here.'

We found that staff were well supported with opportunities for training and development. Staff reported that they felt valued working at the service and they were familiar with the safeguarding procedures to keep people safe.

The service had several effective systems in place to monitor and improve the service being provided.