Ashton Court Residential Home

Ashton Court provides personal care to older people with a range of support needs, including dementia. It accommodates up to 24 people, and 14 were using the service at the time of the inspection.

People’s experience of using this service:

We identified infection control systems could be improved in the home. All the staff we spoke with confirmed they had received infection control training, however, we observed staff were not consistently using personal protective equipment (PPE) correctly. The registered manager told us that visitors were screened on arrival to manage the risks associated with the current COVID-19 pandemic, however, we had to prompt staff on our arrival for this to be undertaken.

We have made a recommendation in relation to the management of infection control.

The registered manager undertook a range of audits, although we identified these were not always effective. For example, the care plan audits had not identified some of the areas requiring improvement.

We have made a recommendation that the robustness of governance systems is improved, so that they contribute effectively to service improvement.

People gave us positive feedback about the home. One person’s relative described the home as “ten out of ten.” People receiving care appeared to be happy, and staff knew their needs well.

People were supported by staff who were deployed in sufficient numbers to meet their needs. Staff were aware of how to safeguard people from abuse and had received training about how to recognise and respond to concerns.

Medicines were managed in a safe way, with detailed record keeping and safe storage.

Rating at last inspection:

The last rating for this service was requires improvement (published November 2019).

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected:

This was a planned focussed inspection based on the rating at the last inspection. As this was a focussed inspection, we reviewed the key questions of safe and well led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Ashton Court is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

We completed a tour of the home and found the service required some attention in certain areas. The flooring in the toilet downstairs, sluice room and dining area were particularly worn.

Staff we spoke with raised concerns as they felt they were not always able to manage the needs of people with the number of staff allocated per shift. Medicines were not always managed safely. We looked at staff files and found the recruitment process had not always been followed.

People were safeguarded from the risk of abuse. Risks associated with people’s care were identified and managed in a safe way. Lessons were learned when things went wrong.

The provider had an audit system in place and areas such as infection control, health and safety, care plans and medicine management were checked. A corrective action plan followed if issues needed to be addressed. However, some of the issues raised during our inspection had not been previously noted as part of this system. During our inspection we noted that two incidents, one serious incident and a safeguarding issue had not been reported to CQC.

People’s needs were assessed, and care delivered in line with their preferences. Staff received training and supervision to carry out their role. People had access to healthcare professionals.

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 received a balanced diet and their nutritional needs were met. However, the dining experience could be improved on.

We observed staff interacting with people and found they were kind, caring and patient. Staff respected people’s privacy and ensured their dignity was upheld.

Care plans were person centred and care delivered was in line with people’s choices and preferences. An activity co-ordinator provided social stimulation. The provider had a complaints procedure and when people raised concerns they were appropriately dealt with. End of life care was discussed with people and recorded in their care planning documentation.

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 26 May 2017).

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.

Ashton Court is a care home for older people who require personal care. It can accommodate up to 24 people. The bedrooms are situated on three floors which can be accessed by a passenger lift or stairs. There is a small car park to the rear and an enclosed garden at the front of the building.

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.

Staff we spoke with were knowledgeable about how to safeguard people from abuse. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it.

We looked at four recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored and administered correctly.

Care plans we looked at identified risks associated with people’s care. We saw plans were in place to instruct staff on how to minimise the risk.

We spoke with staff who said they received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene.

Through our observations and from talking with staff and the registered manager we found the service to be meeting the requirements of the Mental Capacity Act 2005. Staff confirmed they had received training in this subject.

People were offered a choice of food at each meal and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements. The mealtime experience was calm and relaxed.

We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required.

We observed staff supporting people and found they were respectful and caring in nature. Care plans we saw included information about people’s likes and dislikes.

We looked at care records belonging to three people and found they were informative and reflected the care and support being given.

The service employed an activity co-ordinator who was available in this role 20 hours a week. This person organised events and social stimulation for people, based on their individual preferences.

The provider had a complaints procedure and people felt able to raise concerns if they needed to. The registered manager kept a log of concerns received and addressed them effectively.

People told us the registered manager was supportive and they felt able to approach the manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service provision. Action plans were devised to follow up any issues.

People were involved in the service and their views were sought. We saw evidence that people were involved in residents and relatives meetings and were able to comment about the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Improvements had been made since the last inspection of the service. This meant the service was mainly safe, clean and hygienic.

Is the service well-led?

The manager had taken appropriate steps to ensure compliance in the prevention and control of infection. Audits and cleaning schedules had been developed and corrective action had been undertaken where required.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people using the service, three relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. One person we spoke with said, 'Staff are always available to make sure we get the care we need, I would speak to the manager if I was worried about anything.'

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. Some areas required attention to improve the prevention and control of infection.

Recruitment practice is safe and thorough. The manager had recently taken action to ensure staff that was deemed unsuitable to work with vulnerable adults had been referred to the relevant bodies. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Relatives confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with said, 'The staff are very good they bring me my meals to my room and ask if they can help me with anything.' Relative's we spoke with told us they thought the care was good and staff made sure they (the relative) were kept informed about the care given to their relative.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We saw that staff responded quickly to meet the needs of people. For example one person said they did not feel very well. The person was assisted back to their room and the doctor was called to visit the person within a few minutes.

People knew how to make a complaint if they were unhappy. One person we spoke with said, 'If I have a problem the manager deals with it quickly.' Relatives also confirmed that they had raised concerns and the provider had listened and had taken appropriate action.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. For example dieticians and speech and language therapist had been involved when assessing people's nutritional needs.

The service held meetings with relatives' and residents' to gain their views on the service. Comments from relatives confirmed they felt involved in making decisions to improve the service.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff had a good knowledge of the needs of people who used the service.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People experienced care, treatment and support that met their needs and protected their rights. Relatives said, 'I visit regularly and my mum always seems to be happy, and the staff do the best they can.'

People were cared for by sufficient staff. However, improvements were required to ensure staff were supported and trained to deliver care and treatment safely and to an appropriate standard.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

We spoke with two relatives of people who used the service. They told us they were happy with the care provided. They said they were kept informed about any changes to their relatives care and treatment. Relatives knew how to raise concerns and they had confidence in the new provider and manager.

People we spoke with told us that staff were kind and always treated them with respect. One person said 'I like living here I have good friends and we spend time together.' Another person told us they enjoyed activities like sing-a-longs with staff.

There were policies and procedures in place to keep people safe and protected. Staff had received training in the protection of vulnerable adults.

There were sufficient staff to meet the needs of people who used the service. The provider had taken steps to ensure management arrangements were in place; however the registered manager was unavailable during this inspection.