Ashton Lodge Residential Home

Ashton Lodge is a residential care home providing accommodation and personal care to up to 27 people. At the time of our inspection there were 20 people using the service.

The service provides support to younger and older people, some of whom are living with dementia, have mental health needs, or physical disabilities.

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

Although the provider had made improvements since our last inspection, work was still outstanding to ensure the safety of the people using the service. The provider had not always assessed risks in the environment or taken effective action to prevent and control the spread of health infections.

The provider’s governance and performance management systems remained unreliable in places and had failed to identify some safety issues at the premises. Lessons had not always been learnt.

Staff were kind and caring and got on well with the people using the service. There were enough suitable staff on duty to meet people’s needs. People were supported to receive their medicines safely.

The service had a welcoming atmosphere. Staff knew people well and the service’s activity co-ordinator involved people in group and individual activities. People’s cultural and language needs were met.

The way people were assessed prior to coming to the service had improved. This helped to ensure the service was suitable for all the people using it. Care plans had been updated and were more personalised.

The menu had improved, and the chef prepared a wide variety of dishes to meet people’s personal and cultural preferences. The dining room had been rearranged to make it more homely and give people the opportunity to socialise if they wished to.

There was improvement to some areas of the premises, to staff training, and to some of the provider’s audits. People and staff had a say in the running of the service and were consulted when changes were made.

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.

During and after our inspection, and in response to our findings, the provider acted to improve the safety of the premises and put new risk assessments in place where necessary.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 August 2023). At this inspection we found the provider remained in breach of regulations.

Why we inspected

When we last inspected this service breaches of legal requirements were found. The provider was issued with a Warning Notice in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and given a specific date by which to be compliant with the law.

We undertook this focused inspection to follow up the Warning Notice and to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

At this inspection we found the Warning Notice had been met, however the provider remained in breach of regulations.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Ashton Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashton Lodge Residential Home is a care home that provides personal care and support for up to 27 people. The service supports older adults and people who have mental health or physical disability support needs. There were 21 people using the service at the time of the inspection.

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

People’s needs were not assessed before they were admitted to the service. People’s safety was not promoted through the layout and hygiene practices of the premises and fire drills were not completed in line with the provider’s policy. People were supported by enough staff to meet their needs; however, their needs were not always made a priority. Safe recruitment checks were in place; however, the provider did not always update DBS checks as per their policy. People were not always protected from avoidable harm when incidents occurred. People were supported to take their prescribed medicines safely.

People’s relatives were not always involved in their care and people’s personal mealtime preferences were not always adhered to. People’s living environment needed some redecoration and people’s private bedrooms lacked personalisation. The garden was unkempt and had a large pile of rubbish requiring disposal. One person told us they required access to ongoing physiotherapy, and they were not receiving this support. People were supported by staff who had not received the necessary training to meet their identified care needs.

Quality assurance processes were not always effective and there was minimal engagement from the registered manager who is legally accountable for the safety of the service. Daily walk rounds were unstructured and undocumented. There was no oversight of staff DBS checks and DBS checks had not been updated in line with the provider’s policy.

The provider had not always ensured the culture was person-centred. The service lacked leadership. One person told us, “I very rarely see [registered manager] or [the provider] and there is no management on at the weekend.” The provider and registered manager were open and transparent during the inspection process.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 11 June 2019).

Why we inspected

This inspection was prompted in part by a review of the information we held about this service. We also received concerns in relation to the management of safeguarding incidents, condition of the premises and staff training. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashton Lodge Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person centred care and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We found the following examples of good practice.

• Enhanced cleaning and disinfection took place to reduce the risk infection spread. This included high touch areas such as door handles and hand rails. Checklists were used to record and monitor cleaning tasks.

• There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. Staff had received training in infection prevention and control. Posters were on display about good hand hygiene. These measures helped keep people and staff safe.

• PPE was kept in and near people’s rooms for staff to easily access when they were supporting people. PPE was disposed of in clinical waste bins which helped reduce the risk of cross contamination.

• A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This included weekly testing for all staff along with twice weekly rapid lateral flow tests. This meant swift action could be taken if any positive results were received.

• Infection prevention and control audits took place which ensured the registered manager had oversight of all aspects of infection control. Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff keep people safe.

• The registered manager had undertaken a review of 2020 to consider and reflect upon changes implemented in the area of infection prevention and control. This showed how staff and management had responded to the challenges of the pandemic in order to help protect people and keep them safe.

• In addition to the good practice in place, the registered was going to review the staff changing area and uniform policy to reduce the risk of cross contamination. We saw not all staff wore their uniform properly. Some wore jewellery and were not ‘bare below the elbows’.

• The laundry area was clean and organised although space was limited. The provider planned to look at options to extend laundry space in order to keep clean and dirty linen as separate as possible. This would further reduce the risk of infection spread.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashton Lodge on our website at www.cqc.org.uk.

People’s experience of using this service:

People lived in an environment that met their support needs. However, bath and shower hot water presented a potential scalding risk to people. The provider told us that they would take action to set water temperatures at safe levels.

The provider’s arrangements relating to infection control and hygiene monitoring could be improved.

We have made a recommendation about infection control arrangements.

People were protected from fire by the provider’s safety checks and personal evacuation plans were in place. However, some fire exit doors were fitted with keypad locks. We have made a recommendation about the fire exit arrangements.

People told us they felt safe. Care staff knew how to safeguard people from the risk of abuse.

People received kind and caring support from staff who knew how to meet their needs in line with national guidance and legislation. There were enough care staff to be able to support people safely.

People were supported to access healthcare in a timely manner and to take their medicines safely. We have made a recommendation about the storage of controlled medication.

People had personalised plans of care which care staff used to develop their knowledge about people’s needs and preferences. The provider assessed, reviewed and managed risks associated with people’s individual care needs. The registered manager supported staff to provide person centred support and care in line with local and national guidance and best practice guidelines.

People had the choice to engage in a variety of activities if they wished.

People were supported with their dietary needs. People were positive about the choice of food although some said they would like more variety.

The registered manager worked in partnership with others to ensure people received safe care and support.

Provider had a plan in place for the refurbishment of bedrooms and the provision of a smoking shelter in the garden.

People’s bedrooms were personalised although bedroom doors did not have distinguishing features other than room numbers. We have made a recommendation about dementia friendly environments.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were regularly asked about the care they received and the registered manager implemented changes to care plans accordingly.

Resident’s meetings took place, which people could attend if they wished, and action taken by the registered manager in respect of the things discussed.

Privacy and dignity was maintained when care staff supported people with personal care.

People, and their relatives, told us that the registered manager was approachable, and that any concerns they raised had been dealt with effectively. Care staff told us they felt supported by the registered manager.

The registered manager had quality monitoring systems in place. They were aware of their responsibilities and worked in partnership with others to ensure people received safe care and support.

More information can be found in the detailed findings below.

Rating at last inspection: Good (7 October 2016).

We previously rated the service as ‘Requires Improvement’ in respect of ‘Effective’’. This related to people not having a mental capacity assessment in place. Also ensuring people were supported to consent to their care and treatment.

During this new inspection we found that the provider had made the required improvements in that respect.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

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

Ashton Lodge Residential Home provides care and accommodation to older people including people recovering from mental health issues and some who are living with dementia. Ashton Lodge is registered to provide care for up to 27 people. At the time of our inspection there were 26 people using the service.

A registered manager was 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.

People felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People told us staff were kind and caring and ensured they remained safe. Staff mostly understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives. Some improvements were needed to the way staff implemented this legislation

People’s care and support needs had been assessed and people were involved in the review of their care plans, or when appropriate, happy for their relatives to be involved. Care plans included changes to peoples care and treatment, and people attended routine health checks.

We observed staff offered people choices and respected their decisions. Staff had access to people’s care plans and received regular updates about changes to people’s care needs. Visiting health professionals were complimentary about the staff and the care offered to the people using the service. There were enough staff available to meet people’s care and support needs and staff worked as a team in order to do this.

Medicines were ordered and stored safely and staff were trained to administer the medicines to people as they were required. Staff sought medical advice and support from health care professionals.

People were provided with a choice of meals that met their dietary needs. Staff were provided with up to date information about people’s dietary needs, and sought people’s opinions to meet their individual meal choices. There were sufficient personalised activities provided on a regular basis. Staff had a good understanding of people’s care needs, and people were able to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

The building was well maintained and staff were aware of the reporting procedure for faults and repairs and were able to arrange emergency repairs when necessary.

The provider had a clear management structure within the home and staff knew who to contact out of hours. The provider undertook quality monitoring in the home supported by the registered manager and their deputy. The provider had developed opportunities for people, relatives and health and social care professionals to express their views about the service including an annual questionnaire. We received positive feedback from visiting professional and the contracting staff from the local authority with regard to the care and service offered to people.

Staff felt confident they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. We found that people were confident approaching staff and that carers were responsive to people's needs.

We looked at the records of four people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons' care should be delivered.

However, we found that the home did not have suitable arrangements in place for acting in accordance with the best interests of the person when they were unable to consent to the care and treatment being provided.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

We briefly spoke to some people using the service and asked them about their experiences of the home. People were positive and told us they liked the decorating and refurbishment that had recently been carried out. We saw that people were involved in making plans for Christmas arrangements at the home. Our brief observations showed people were comfortable and confident with staff. At our inspection of 28 May 2012 we spoke to a number of people in more detail. Please see our previous report for further details.

At this inspection we found that the service had made significant improvements. There were now effective systems in place to reduce the risk and spread of infection. In addition, we saw that the service had commenced a planned and ongoing programme of maintenance. We found the service had made improvements to its quality monitoring system. There was evidence that the provider and manager were assessing and monitoring the quality of the service provided to ensure people were protected from the risk of inappropriate or unsafe care.

We briefly spoke to some people using the service during this inspection and asked them about their experiences of living at Ashton Lodge. They all were positive in their responses and said they were looking forward to the Halloween party. At our last inspection we spoke to a number of people in more detail. Please see our previous report for further details.

We found the service had made improvements to peoples' records and care plans. Care plans we looked at gave clear guidance to staff about how care should be provided and records showed that people's health was monitored.

The service had made improvements to some areas of the property and gardens but we found the standard of cleanliness and maintenance was still poor. We found

the home was still not clean or hygienic and there were risks to people using the service getting or passing on infections because of this.

We found the service had not made improvements to its quality monitoring system. There was limited evidence that the provider or manager were assessing and monitoring the quality of the service provided to ensure people were protected from the risk of inappropriate or unsafe care.

We are following up areas of non-compliance identified during this inspection and will report on any action taken when it is complete.