Ashley Gardens

We found the following examples of good practice.

At the time of our inspection only one person newly admitted to the home was required to isolate in their room. People who had been living at the home during the COVID-19 outbreak had completed their period of isolation. Due to people’s dementia and memory loss it was not always possible to ensure people remained socially distanced. Staff were supporting people to make use of a variety of communal spaces, the registered manager had made some environmental changes to communal areas by removing some seating and rearranging the dining area, this encouraged people to sit socially distanced when possible.

The registered manager had implemented COVID-19 policies and procedures. Staff had been kept updated by regular emails and during handover at the start of each shift, this ensured staff were aware of any changes to guidance. Information was also displayed around the home in relation to Personal Protective Equipment (PPE) how to put on and remove PPE safely and correct handwashing procedures. PPE stations were located around the building with plenty of excess stock available for staff to access if needed. Alongside normal cleaning routines, the registered manager had implemented enhanced cleaning schedules to incorporate regular cleaning of high touch areas.

Risk assessments and infection prevention control audits had been completed. These included environmental and individual risks for visitors, people and staff. Individual COVID-19 risk assessments considered each person’s associated risks. These included physical and mental health and wellbeing, as well as any underlying health conditions, for example diabetes, ethnicity and pregnancy. Risks had also been considered in relation to staff who lived together and safe travel to and from work.

The home had experienced a high number of people and staff with COVID-19. The registered manager was particularly proud of how supportive and resilient staff had been throughout the COVID-19 outbreak at the home. Despite a large number of people and staff being affected, staff had remained committed to providing care and support to people. The registered manager had worked closely with the local authority and market support team and taken steps to ensure staffing levels were maintained. This included moving into the service and working alongside current and agency staff to provide care to people whilst high numbers of staff were unwell or isolating.

A programme of regular COVID-19 testing was in place. Measures had been implemented to ensure people and staff entering the home did so following current guidance. This included temperatures being taken on arrival, Lateral Flow COVID-19 testing when appropriate and PPE being used.

Ashley Gardens is a care home registered to provide care and accommodation for 47 older persons. There were 38 people living at the service on the day of our inspection. The service specialises in providing care for older people, some of whom were living with dementia. The service is a purpose-built care home providing private rooms and communal space and gardens for people.

People’s experience of using this service:

• People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

• Our own observations supported this, and we saw friendly relationships had developed between people and staff. A visitor told us, “I know my friend is safe because she tells me she has every confidence in the staff”.

• People enjoyed an independent lifestyle and told us their needs were met. The enjoyed the food, drink and activities that took place daily. One person told us, “In my last care home, I fell and lost my confidence. Now I have regained it”. Another person said, “They bring drinks round every hour”.

• People felt the service was homely and welcoming and their health and wellbeing needs were met. One person told us, “They know about my health needs. A carer took me to the optician”.

• Staff had received essential training and it was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “Induction and training is good. There is a positive atmosphere here, with good support and we are helpful and patient”.

• The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement. These systems also supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way and that the provider learned from any mistakes.

• People told us they thought the service was well managed and they enjoyed living there. One person told us, “The care comes from the heart”.

• Our own observations and the feedback we received supported this. People received high quality care that met their needs and improved their wellbeing from dedicated and enthusiastic staff.

Rating at last inspection: Good (report published 25 August 2016).

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

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.

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

Ashley Gardens specialised in providing care for people who had memory loss or dementia. The home is a purpose built care home providing communal areas and private rooms for people. The home has a passenger lift and wide stairways to assist people to access areas of the building.

This was an unannounced inspection which took place on 14 and 15 July 2016.

Ashley Gardens had a registered manager. 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.

The registered manager was fully involved in all aspects of the day to day running of the home supported by the provider, deputy managers and senior care, administrative and support staff.

Equipment was in place to support people to stand if they were able to weight bear, and emergency equipment was in place to assist people from the floor in the event of a trip or fall. However we found one person whose support needs had recently changed and they were now unable to weight bear. This meant that staff would not be able to assist this person to get out of bed if they requested it or in the event of an emergency. We discussed this with the registered manager who immediately assessed that the home needed a full lifting hoist. This was ordered immediately and staff training arranged to ensure people remained safe. We have made a recommendation about this.

Staff received support, training and supervision to ensure that they were able to provide safe and effective care for people. This included training to support them in meeting the needs of people with dementia. Staff demonstrated a clear understanding around how to safeguard people from abuse and told us the actions they would take if they had any concerns. Policies and procedures were in place to support staff, they also received a staff handbook which contained all relevant policies and guidance to support them in their role.

Staffing levels were assessed and staffing numbers adapted to ensure there were enough staff to meet people’s needs. People were supported by kind and considerate staff who had an excellent understanding of dementia and memory loss. This meant that people received care in a way that supported their needs. Management and staff were open and engaging, examples of this were seen throughout the inspection. Visitors and relatives were welcomed into the home and relatives felt that the consistency of regular staff meant that they knew people really well.

Pre-admission assessments were completed. This information was used to formulate care plans and risk assessments. These were reviewed monthly or more frequently if changes occurred. Any changes were discussed with people or their next of kin if appropriate. Care plans and documentation was person centred, staff had access to relevant information about people, including their life and medical history, significant life events and likes and dislikes. This meant staff were supported by clear and relevant information to enable them to provide good care for people.

People were involved in day to day choices. When people were assessed as lacking capacity this was followed up with referrals to other professionals if required. For example Mental Capacity Assessments (MCA) were completed and Deprivation of Liberty Safeguards (DoLS) applications were submitted when it was identified that a person may be at risk.

Dignity and privacy were maintained, people were supported to dress in the way they chose and involved in day to day choices and decisions. People were spoken to respectfully at all times and staff demonstrated a good understanding of how to respond if people became distressed or anxious.

Nutrition was well managed and people were offered a variety of food and drinks to help maintain good nutritional and fluid intake. People’s weights were monitored and any changes or concerns reported to appropriate healthcare professionals.

Medicine procedures were safe and systems were in place to ensure staff giving medicines were appropriately trained and their competencies regularly assessed.

There was a robust and thorough system in place to assess and monitor the quality of service within the home. This included auditing and reviewing falls to identify any themes or trends. There was a clear response to any falls or injuries and the home liaised with other healthcare professionals, with referrals seen to community nurses, dietician, GP and mental health teams as required.

There were appropriate systems in place to ensure that the environment and equipment were regularly maintained. This included fire safety equipment, electrical (PAT) testing, legionella and water safety testing.

Feedback was sought from people. All feedback was used to continually improve and develop Ashley Gardens and the results from surveys and further feedback was shared with people and staff. This meant that people’s views were considered and valued.

The registered manager worked collaboratively with other healthcare professionals and sourced information to ensure the service was meeting best practice guidelines and regulatory requirements.

There was a daily programme of activities and people gave positive feedback about the entertainment and activities provided.

A complaints procedure was in place, and people felt they could speak openly to the registered manager or staff if they needed to. There were no on-going complaints.

Notifications had been completed to inform CQC and other outside organisations when events occurred.

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and what we learnt from the records we looked at. We spoke in detail with four people who lived in the home and two people who were visiting relatives. We talked with three care assistants, an activities coordinator and the office manager. Records we looked at included five care records, staff training records, management audits and the service's quality assurance documentation.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People living in and visiting the home told us they considered Ashley Gardens provided a safe environment. A visitor said 'Safety comes from staff availability and awareness.' Another visitor said staff showed a constant level of respect for the people they cared for. All staff undertook annual refresher training about safeguarding vulnerable people, provided by an external trainer. They had separate annual training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The home had experience of obtaining advice from DoLS advisers from the local authority, although no applications had needed to be submitted. Staff we spoke with demonstrated an understanding of working with people's consent, and how to record in detail when care was delivered on the basis of 'best interests'.

All care staff were trained in working with people with dementia type conditions. Care plans were clearly written. They directed staff how to minimise the risk of people becoming distressed and how to manage behavioural issues should they arise. There was a system in place to ensure staff were aware of people's whereabouts and wellbeing throughout the day and night.

Is the service effective?

People received a thorough assessment of need before moving into the home. They and their families were involved by staff in developing care plans to meet identified needs. Planned care interventions were based on reducing risk and enhancing wellbeing and choice. Care plans were reviewed monthly. Reviews showed evidence of care objectives being met. However, we identified activity coordinators were not as involved in planning and reviewing individual activity needs as their expertise would allow them to be. However, activities provision was planned in such a way as to ensure a variety of activities was made available every day. A visitor said they saw their relative was supported to experience a daily routine, and stimulation from activities, despite worsening dementia.

Records showed people received medical attention in a timely way when needed. Visiting relatives we spoke with told us the staff were quick to observe and act on any indicators of ill health, including obtaining a GP visit promptly when necessary. A person living in the home told us 'Staff are very attentive, they notice if you're not so well and get the doctor if necessary, but they're good at looking after you anyway.'

Care staff were well aware of the content of care plans. Shortened versions of the plans were kept with care assistants' daily records and in people's bedrooms. Staff always began work with receipt of a handover of information, including updates to care plans. Staff were supported in delivering care by an organised training programme, which included dementia awareness and meeting privacy and dignity needs. They were subject to frequent 'spot check' supervision, to ensure they were effective in putting their training and the provider's policies into practice.

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's preferences, interests and diverse needs had been recorded and care and support were provided in accordance with people's wishes. People told us staff were very respectful of their privacy and dignity needs.

A visitor told us the home provided a caring, calm environment. They said 'I see lots of one on one interactions and people are never ignored.' We observed that as care staff went about their work in the home, they acknowledged all people and engaged verbally with them. Daily records showed all people were regularly seen and therefore were not isolated or overlooked. When people were involved in group activities with an activities coordinator, a care assistant remained immediately available to meet care needs arising. This meant the activity was not disrupted by care issues and people were supported if they wished or needed to leave the group.

People told us they consistently enjoyed their meals and the way they were served. In the dining room, staff were attentive and gave people time to eat at their own pace. In a response to the service's own survey of relatives who visited the home, one person had written 'All staff seem to have unlimited patience and provide excellent care. The home provides a loving environment.' Care records showed people were supported to continue to receive foot, eye and dental care from practitioners of their choice or as arranged by the home.

Is the service responsive?

Care plans were reviewed every month, or more often in response to events or needs arising. We saw that issues raised by family members received immediate attention, people being invited to enter into discussion about best ways of addressing their concerns. The survey of views of relatives of people living in the home had been analysed and gave rise to an action plan, to ensure matters raised were investigated and shortfalls addressed.

Staff and management were readily available to people in the home, and to visitors. Staff responded readily to requests to move by people who were not independently mobile. Specialist health, mental health and social care resources were accessed when necessary. Care records showed specialist advice and care directions were incorporated into care plans and were followed by staff.

Is the service well-led?

The provider maintained oversight of and support to the home by regular visits. The registered manager and deputy managers carried out a series of regular audits that checked standards were maintained, for example in medicines practice and infection control. Action plans were developed and monitored for any area of shortfall.

Staff we spoke with said they were strongly supported by the management team. Records of staff meetings, supervision and information circulated to staff showed they were kept informed of all developments in the home and their views were valued. Material improvements to the home were carried out on a planned basis and to a high specification. This showed management took account of the wellbeing of those living and working there.

Staff told us they were clear about their respective roles and responsibilities. A care assistant told us, 'You're never alone with any situation, there's always someone who will support you.' There was a strong sense of working as a team to help ensure people received a good quality service at all times.

When we inspected this service in September 2013 we found that people were not always protected against the spread or risk of infection as they were not cared for in a clean, hygienic environment.

Following our inspection we received an action plan from the provider that told us processes were in place that ensured compliance with this standard. This inspection was carried out to check that the home had complied with the compliance action made at our previous visit.

We found that the home had put in place new systems for monitoring cleanliness in the home. The new systems were working well and records demonstrated that the home was continually reviewing and improving upon the service it provided.

Those who could speak with us told us that the care was good. One person said, 'I can't fault the staff they look after us well.' Another person said, 'I have everything I need in my room and the food is excellent.'

We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.

The systems in place to ensure the cleanliness of the home were not always effective. The home had a thorough recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We found that care plans clearly documented the needs of people and how they should be met. Care was based on the individual needs of people and where appropriate, specialist advice and support was obtained. People using the service and/or their representatives were involved in decisions about their care and treatment.

We examined the systems and processes in place for the safe management of medicines and found they were in order. We assessed that there were sufficient staff on duty to meet the assessed needs of the people living in the home.

We looked at the systems and processes the home had in place to respond to complaints and to protect people from abuse. These processes ensured complaints could be raised and that they were fully investigated. Staff knew what constituted abuse and what to do if it was suspected.