Ashville Court

Ashville Court is a residential care home providing personal care to up to 29 people. The service provides support to older people living with dementia. At the time of our inspection there were 22 people using the service.

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

Improvements had been made since the last inspection which included completion of the refurbishment programme. One relative said, “The decoration is stunning in some of the lounge areas and visiting rooms and it’s a comfortable place.”

People received person centred care. People and their relatives were involved in planning and making decisions about their care. Staff understood how to manage any risks to people and knew the processes to manage any allegations of abuse. Care records provided detailed information about people’s needs and preferences. People received their medicines when they needed them. The home was clean and well maintained. Safe infection control procedures were followed.

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.

There were enough staff to meet people’s needs and staff worked well together as a team. Recruitment processes ensured staff were suitable to work in the care service. Staff were trained and said they felt well supported in their roles. They had the required skills to meet people’s needs.

Staff were kind, caring and compassionate and treated people with respect. One relative said, “They [the staff] go out of their way to make people happy.” Relatives and friends were happy with the visiting arrangements.

The service was well run. The provider and registered manager worked together to ensure improvements were made and sustained. The registered manager promoted good practice and worked alongside the staff supporting them and making sure the quality of care was maintained.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 August 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashville Care Home is a residential care home providing personal care for up to 29 older people living with dementia. There were 19 people living in the service when we inspected.

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

People and relatives were happy with the care provided. Comments included; “They look after me very well here. The food is very good. I cut the grass and prune the flower beds, and love going for a walk in the garden” and “The home? One word – fabulous.”

People looked well cared for and comfortable.

We assessed infection control procedures within the service and were assured appropriate systems were in place to help keep people safe.

Governance processes had improved and effective quality assurance systems were in place.

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

Rating at last inspection (and update) The last rating for this service was requires improvement (published 20 August 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the requirement notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on regulatory breaches or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

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.

Ashville Care Home is a residential care home providing personal care to 11 people aged 65 and over, at the time of the inspection. The service can support up to 24 people in one adapted building, over two floors. The service specialises in providing care to people living with dementia.

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

Following the last inspection, a number of improvements had been made to the service. Significant investment in the premises had taken place and the environment was now a pleasant and appropriate space to care for people with dementia.

Although governance systems had improved since our last inspection, greater oversight was needed of some equipment and the medicine management system to ensure consistent high- quality care and support.

People were protected from abuse. Overall risks to people’s health and safety were assessed and mitigated and staff knew people’s plans of care well. Medicines were managed in a safe way, although some improvements were needed to ensure consistent good practice. There were enough staff in the home.

People’s care needs were assessed and managed in line with guidance. Staff received a range of training relevant to their role. People had a choice of food and action was taken to address any nutritional risks. The service liaised with a range of professionals over people’s health needs.

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 were treated equally and fairly by staff. We observed staff treated people with kindness and compassion and listened to them. Staff knew people well and their individual likes and preferences.

People had a range of appropriate care plans in place which we saw staff following. There was a basic range of activities available to people. Staff took action to ensure people’s social needs were met. Complaints were logged, investigated and learnt from.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 19 December 2018)

The provider completed an action plan after the last inspection to show what they would do and by when, to improve.

At this inspection we found significant improvements had been made although some further improvements were still required to governance systems to ensure full compliance with the regulations.

This service has been in Special Measures since 19 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. In addition, this inspection followed up on action we told the provider to take at the last inspection.

Enforcement

We have identified one breach in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities 2014) Regulations.

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 for the provider to understand what they will do to further governance within the service. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 7 November 2018 and was unannounced. At the last inspection in September 2017 we rated the service Requires Improvement. We found further work was required to the environment to make it pleasant and staffing levels needed increasing as there was no activities co-ordinator and people lacked interaction and stimulation.

At this inspection, whilst activities staff had now been recruited, we found the quality of the environment had deteriorated. We identified a number of risks associated with the environment and which had not been identified and rectified by the provider. Risks associated with the environment had been a long-standing concern in the service, for example at the April 2016 and February 2017 inspection. We also found the quality of care planning and nutritional care planning needed improvement and some risks to people’s health and safety were not assessed and mitigated. Action was needed to improve governance and quality assurance procedures to help drive sustained improvement of the service. Because concerns over risk management and governance were long standing and demonstrated a lack of action to sustain acceptable practice, we rated the service ‘Inadequate’ overall and in the Is the service Safe? And Is the Service Well Led? domains.

A registered manager was in place. 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, relatives and health professionals provided positive feedback about the service and said it met individual needs. Systems were in place to protect people from abuse and improper treatment. Some risks to people’s health and safety were assessed and risk assessments put in place to guide staff. However, we found some instances where safe plans of care were not followed. We found numerous risks associated with the environment, including poor or defective lighting, and bathroom taps which were not working.

Overall medicines were managed safely. A new electronic system was in place which reduced errors and helped ensure people received their medicines as prescribed.

There were enough staff deployed to ensure people received appropriate care and supervision. Staff were recruited safely to ensure they were of suitable character to work with vulnerable people. Staff received a range of appropriate training and told us they felt well supported.

Overall people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, practices relating to covert (hidden) medicines needed review. People were given choices on a daily basis and people were listened to.

Some improvements were needed to the management of nutrition to ensure people’s needs were consistently met. Care planning around nutrition and the monitoring of people’s food input was not sufficiently robust. There was a lack of information to show why decisions relating to the consistency of people’s food and drink had been made.

Staff were kind and caring and treated people well. People were treated equality and we saw no evidence of discriminatory practices.

The service liaised with a range of healthcare professionals to meet people’s needs. Care plans needed to be made more person centred and consolidating to make them more accessible to people and staff.

A system was in place to log, investigate and respond to complaints. People, relatives and staff said the registered manager was approachable and listened to them.

Systems to assess, monitor and improve the service were in place but they needed to be more robust. Issues we found should have been identified and rectified through the operation of robust systems of quality assurance.

People’s feedback on the service was sought although there were no resident or relative meetings held.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 three breaches of regulation. You can see what action we asked the provider to take at the back of the report.

This inspection took place on 5 September 2017 and was unannounced. At the last inspection on 14 February 2017 we rated the service ‘requires improvement’ overall and rated the safe domain ‘inadequate’ due to concerns over medicines management, risk management, safeguarding and the premises. In total we identified four breaches of regulation and issued a warning notice for Regulation 17, Good Governance. At this inspection we found a number of improvements had been made and the service was no longer in breach of regulation. Improvements had been made to the safety of the service, supported by more robust systems in areas such as medicines management and governance. However further refurbishment and decoration work was required to bring the premises up to a good standard. We also found staffing levels were not always maintained at a level to ensure a person centred approach particularly in the absence of an activities co-ordinator. We would need evidence these issues were addressed and the other improvements made were sustained before we were assured the home provided a consistently good service.

A registered manager was in place. 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.

Medicines were safely managed. People received their medicines as prescribed and clear records were kept to demonstrate this.

People said they felt safe in the home. Risks to people’s safety had been assessed and plans of care put in place to keep people safe. Staff understood how to identify and act on any concerns. Incidents and accidents were recorded, investigated and analysed to help prevent a re-occurrence.

Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people. We noted staff did not always have time to spend quality time with people and interactions were very task based. The home was without an activities co-ordinator and we noted there was a lack of stimulation and activity available to people.

Since the last inspection a number of improvements had been made to the building to make it safer. Whilst we did not identify any safety concerns, further maintenance and improvement of the building was required to ensure the building was brought up to a good standard.

Staff received a range of training and felt well supported by the manager. Staff knew people well which helped ensure effective care was provided.

Overall, the service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

People were treated with kindness and compassion by staff. It was clear that good positive relationships had developed between people and staff. People were encouraged to maintain their independence around the home. People were listened to by staff and their opinions valued.

People’s needs were assessed and clear and person centred plans of care put in place. These were subject to regular review. People, relatives and staff told us they were satisfied with people’s needs were met by the service.

The registered manager was hands on and knew people well. They demonstrated a good knowledge of the topics we asked them about and were very involved in how the service operated. Staff praised the registered manager and said morale was good.

Systems were in place to assess, monitor and improve the service. These had been further refined and improved since the last inspection and were effective in identifying and rectifying issues.

We made two recommendations around ensuring staffing levels were maintained at a level that provided people with appropriate stimulation and interaction, and ensuring further improvements were made to the premises.

This inspection took place on 14 February 2016 and was unannounced. At the last inspection on 12 April 2016 we rated the service as ‘Requires Improvement’ and identified 3 breaches of regulations relating to ‘Safe care and treatment’, ‘Staffing’ and ‘Good Governance.’ At this inspection we found improvements had been made to staffing levels, however we identified four breaches of regulation.

Although we found some good areas of practice during the inspection, we rated the safe domain as ‘Inadequate.’ This was because a number of concerns were found relating to management of risk, the premises, ‘as required’ medicines and prescribed creams. Some of these concerns were similar or identical to issues raised at the previous inspection, meaning we did not feel assured that they would promptly resolved.

A registered manager was in place who had been in post for several years. 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 and relatives we spoke with provided good feedback about the home. They said staff were kind and treated people well. They said care and support met people’s individual needs.

Most people received their medicines as prescribed. However, ‘as required’ medicines and topical creams were not always managed in a safe or proper way.

Care records demonstrated a number of risks to people’s health and safety were assessed for example in relation to skin, nutrition and moving and handling. However, there was a lack of assessments in place relating to the safe management of bed rails. We identified a number of wardrobes in people’s bedrooms which were unstable and risked injury to people.

There was suitable space within the premises for people to spend time and some adaptions had been made to the premises to meet the needs of people living with dementia. However, we found a number of maintenance issues relating to the premises which required resolving to ensure people were cared for in a comfortable and well maintained environment.

People told us they felt safe in the home and comfortable in the company of staff. Safeguarding incidents were recorded and in some instances we saw records of action taken to keep people safe. However, referrals had not always taken place to the adult protection unit and care and support plans were not always updated following incidents.

During the inspection we found there were sufficient staff available to meet people’s individual needs and staffing levels had been increased since the previous inspection. However we had some concerns that staffing levels may not be sufficient during the overnight period. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards. DoLS applications had been made for a number of people living in the home. Staff respected people’s choices and gained consent before delivering care and support.

People had access to a range of suitably nutritious food. This included a choice of meals and snacks throughout the day. Action was taken where people were at nutritional risk.

Staff had access to a range of training relevant to their role. Staff said they felt well supported and had regular supervision and annual appraisal.

People and relatives said staff were kind, caring and treated them with dignity and respect. This was confirmed by our observations of care and support on the day of the inspection. Staff knew people well and their individual likes and dislikes. We saw good positive relationships had developed between people and staff.

Since the last inspection care records had been transferred to an electronic care recording system. We found electronic care plans lacked detail about people’s specific care and support needs. Care records were not always accurate and were not always updated when people’s needs changed.

An activities co-ordinator was employed who delivered a schedule of activities to people. This was appropriate for the needs and requirements of the people who used the service.

The registered manager was ‘hands on’ and regularly involved in care and support within the home. People, relatives and staff we spoke with spoke positively about the way the home was led and said they felt able to raise any problems or concerns with the registered manager.

Systems to assess, monitor and improve the service were not sufficiently robust as they had not been effective in driving the required improvement since the last inspection and had not prevented the breaches in regulation that we had identified.

We found four breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

Ashville Care Home provides personal care for up to 29 older people, some of who are living with dementia. There were 25 people using the service when we visited. Accommodation is provided on two floors with lift access between each floor. There are four communal areas on the ground floor which includes a large dining area.

The home has a registered manager. 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.

Although no concerns were raised with us about staffing levels, we concluded there were not always enough staff to meet people’s needs as there were only three care staff on duty during the day and two at night for 25 people. There were ancillary staff, an activity co-ordinator, an administrator and managers on duty at times in addition to these numbers. However, there was no system in place to calculate safe staffing levels or evidence to show that people’s dependencies and the layout of the building had been considered when determining staff numbers.

Overall we found the systems in place for managing medicines were safe, although some of the records required improvement.

Staff had a good understanding of safeguarding and knew the procedures to follow if abuse had occurred or was alleged. We saw safeguarding incidents had been dealt with appropriately.

Risks to people were not always well managed. For example, we found where incidents such as falls had occurred there was a lack of information to show what action had been taken to prevent a re-occurrence. There was also a lack of environmental risk assessments. For example, free standing heaters which were hot to touch had not been risk assessed, although immediate action was taken when we brought this to the registered manager’s attention.

The building was generally clean and well maintained. However, there were some issues relating to beds not being properly made and stained bed linen which had not been identified until we raised them. However, the deputy manager told us daily checks of rooms were being introduced to address this issue.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). People were cared for by staff who received the induction, training and support they needed to fulfil their roles and meet people’s needs.

People enjoyed the food and were offered a choice with drinks and snacks available and provided at any time. People had access to healthcare services and had input from professionals such as community nurses, GPs and dieticians. Complaint were managed and dealt with appropriately.

People and relatives praised the staff for their kindness and caring attitude. People were comfortable and relaxed around staff and we saw people laughing with them. We saw people enjoyed walking freely around the different communal areas on the ground floor. People’s privacy and dignity was respected and maintained.

People and relatives expressed satisfaction with the care provided. Yet we found improvements were needed to ensure the care documentation was person-centred and reflected people’s needs and preferences.

People, relatives and staff spoke highly of the registered manager and had confidence in them. Some of the systems and processes which audited the quality of care provided needed improvement. For example, there was no staffing tool, medicine audits had not identified the issues we discovered and there were no systems in place to audit the care records. Improvements were also required in documentation such as risk assessments, care plans and medicines recording.

We identified three 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 the full version of the report.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service 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 the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw risk assessments in place linked with peoples care plans. These identified potential risk areas and reduced or removed the risk. We saw sufficient staff to make sure people were safe and could be responded too in a reasonable time. We spoke with staff who informed us of safeguarding and how to report it.

Is the service effective?

We saw people had their needs assessed before entering the service and this was updated with any changes. We spoke with staff who told us the most recent changes for people. For example one staff told us one person recently obtained a pressure sore and now they need regular turns and an air cushion. We saw the care plans identified peoples likes, dislikes and preferences. We saw one person had end of life care plan in place.

Is the service caring?

We spent some time observing staff interacting with people who used the service. We found they treated people with respect by asking if people are ok, we saw one staff member ask someone, "Are you ok, would you like anything"? We saw when people were sitting down, staff would crouch to speak to them at eye level. Staff told us they had received training on dignity and respect. We saw a satisfaction survey had been carried out on an annual basis with people saying they were happy with how they were treated.

Is the service responsive ?

We spoke with family members who told us they get invited to reviews. We looked through peoples care files and saw evidence of people signing their own documents to show they had been involved. We observed people receiving correct care in line with their care plans. We spoke with staff who told us detailed information about the people using the service. This showed us staff were familiar with the care plans. When people had made suggestions in the annual survey, we saw these had been listened to and acted on.

Is the service and well-led?

The senior staff member told us they carry out regular audits on health and safety, medication and care plans. We spoke with the staff who told us they had confidence in the manager and would not hesitate to report anything to them. We saw evidence of regular supervisions and training plans in place to support the staff. We observed staff asking the senior for support and this being given.

Some people living at the home were less able to express their views about medicines handling due to a variety of complex needs. We spoke with one person who told us staff administered the medicines at the same sort of times each day and confirmed that they had enough support with their prescribed creams.

We found that one person's medicines records had not been promptly updated following their return to the home from hospital. Prompt action was taken when we drew this to the attention of the manager.

We found improvements had been made and people had experienced care and treatment which met their needs and protected there rights. We spoke with three relatives who told us they were satisfied with the care and treatment provided by the staff, they said the staff were respectful and the home met all of their relative's needs, they had no concerns to raise with us about the home.

We saw there were systems in place to protect people from abuse and to ensure that staff were recruited safely.

During this inspection we saw improvements had been made to the care records and the records we looked at were now appropriate. The provider has provided assurance that work will continue to ensure all the records are accurate and fully reflected people's needs.

People were not protected against the risks associated with medicines because the home's policy for medicines handling was not consistently adhered to.

We talked to four relatives, three told us the home was 'excellent' and one said it had been satisfactory. They told us people had received the care and treatment they needed.

However we found people were at risk because people's personal records were not accurate and not fit for purpose. People had not experienced care, treatment and support that met their needs and protected their rights. Also people were not protected against the risks associated with medicines because appropriate arrangements were not in place to manage medicines safely.