Ashbury Lodge Residential Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 5 quality statements relating to safeguarding, involving people to manage risks, safe and effective staffing, infection prevention and control and medicines optimisation. Staff were able to tell us how to keep people safe from harm and abuse. Staff had received relevant training in relation to their roles. We observed there were enough staff to meet people’s needs. However, staff told us there was not enough support when medication was being dispensed. We observed the home was clean and staff were adhering to infection prevention and control practices. There were safe practices in relation to safe and effective staffing. People were given their medicine in a timely manner and administration of medicines was appropriately recorded. There were processes in place to support good medicines optimisation. We observed people’s individual risks were being managed and people had accessed external support to meet their needs. However, we found concerns around people’s access to dental services, which was discussed with the provider. To mitigate risks, the service commissioned additional training for staff around oral health care. We also found evidence of one person not being repositioned in line with their care plan. Other care plans reviewed were also not accurate and had conflicting information about people’s needs, which could impact on people receiving safe care and treatment.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe at the service. Relatives did not raise any safeguarding concerns about the home.

Staff and leaders understood their responsibilities to keep people safe. The peripatetic manager told us they were looking to nominate a safeguarding champion to increase awareness of safeguarding within the home.

We did not observe any safeguarding concerns during the on-site assessment.

There was a safeguarding policy in place and a safeguarding log which identified all safeguarding cases with actions and outcomes. All safeguarding concerns had been reported to the relevant authorities. Staff had received training in safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS had been applied for appropriately.

People were not aware of their care plans or risk assessments, but they told us they felt safe and received support from staff when needed. Relatives gave mixed feedback about their involvement in people’s care plans and risk assessments. Some relatives told us they had been consulted about people’s support plans; others told us they had not been involved. The provider told us they consulted with people about their care plans and risk assessments during resident of the day meetings.

Staff showed awareness of people’s individual risks. However, one staff member told us care plans could be reviewed more effectively. Another staff member told us they thought risks were managed “quite well” but there was “confusion in care plans with managers coming and going, views were different on what is a good care plans, different styles.” The peripatetic manager told us they completed an analysis of falls within the home and there was evidence to support this. They also told us they completed monthly audits of care plans and senior care workers updated care plans. However, we found that the care plan audits were not effective as they had not identified some of the concerns we found. The provider had implemented training and support to help drive improvement.

We observed equipment being used appropriately to reduce people’s individual risks, such as pressure cushions and crash mats. We also observed an occupational therapist (OT) visiting a person as a result of a recent fall. We observed staff supported people to manage their individual risks.

Some risks associated with people’s care had been identified and assessed. There was evidence that people were being referred for the appropriate support in areas such as occupation therapy (OT) and speech and language therapy assessments (SALT). We found people had not been accessing dental services which the peripatetic manager told us was due to lack of services and appointments available. To mitigate the risks, the provider had put in additional training for staff on managing oral care. Care plans were not always completed fully and information was missing. For example, 1 care plan did not have a person’s falls history completed. There was also conflicting information in 2 people’s care plans around their needs in areas such as skin integrity and mobility. One person was not always being repositioned in line with their care plan. Staff did not always have care plans to guide safe practice. For example, 1 person’s care plan had conflicting information throughout in relation to their mobility. The care plan stated a person was unsteady on their feet, partially able to bear weight and walked inside the home independently with a frame. However, it also stated the person was no longer able to mobilise, was being cared for in bed and required staff to assist with manual handling. When discussed with the peripatetic manager they told us the person was “fluctuating at present and they were waiting for an OT assessment.” The provider took steps to address the concerns during the assessment and had implemented training and support to help drive improvement although this had not been fully embedded yet. We have asked the provider for an action plan in response to our concerns.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from relatives regarding staffing levels. Some relatives told us they felt there were enough staff, comments included “Always seems enough staff about when I visit.” and “[person] is very happy with the staff and care she receives, always seems staff about to help her. She always looks smart and clean, and she’s put weight on and is all round in a better place health wise than she was.” Other family members told us there were not enough staff to support their family member, comments included “There is never enough staff about” and “Never enough staff about and no stimulation is a big concern.”

Staff told us there was not enough staff to meet people’s needs. Comments include “I would say on my shift no” and “Not really, not currently” and “some of the time but not all the time though.” Staff told us they needed more staff on duty when medication was being dispensed. They told us they had to answer call bells as a priority and therefore medication for people was sometimes delayed or there was a risk of errors happening. Most staff told us they had regular supervisions. One staff member told us “I’ve had a few supervisions, but I don’t know the time difference between them as we have had so many different managers recently, it’s all up in the air.” Most staff told us there were daily flash meetings where they shared information and knowledge about people living in the service. One staff member told us “Team meetings, we could do with more of, they don’t happen too often.”

We observed staff knew people well and understood how to manage their individual risks. Staff did not seem rushed and were able to meet people’s needs.

Staff had received a contract of employment. They had clear job descriptions and had completed an induction. Health questionnaires were being completed by employees. Disclosure Barring Service (DBS) certificates were appropriately applied for. Staff had the appropriate checks for the right to work in the United Kingdom (UK). There was a supervision and appraisal policy in place. We reviewed 3 staff files and there was evidence of recent supervisions. There was a supervision schedule for staff but not all staff had dates in the first quarter of 2024. The peripatetic manager told us they were aware of gaps in supervisions and appraisals for staff and they provided us with an updated matrix planner. There was a dependency tool for staffing and rotas which reflected staffing dependencies. However based on feedback from staff we were not assured this process was implemented effectively.

Relatives told us the home was generally clean however they raised concerns about bad odours upstairs and in their family members rooms.

Staff told us they had received training in infection prevention and control (IPC). There had been a recent infection outbreak in the home which affected 1 floor and impacted some people living in the home. The peripatetic manager liaised with the local infection control team to ensure people and staff were safe.

There were some areas of the home that needed updating in order to be effectively cleaned, however there was a renovation project in place, and we observed that contractors were working on some of these improvements during the day of our onsite visit. The home was generally clean and free from odours. We observed staff using appropriate personal and protective equipment (PPE) when supporting people and when serving food.

There was an IPC policy which was up to date. IPC audits were being completed with clear actions and outcomes identified. There were individual room cleaning checklists which identified areas of the room to be cleaned. Staff training in IPC was compliant with the providers training expectations.

People had their preferences in relation to how they take their medicines considered and this was recorded in the care plans. However, one relative told us a person had been given a double dose of medication due to the lack of appropriate administration recording. In response to this incident, the provider had learned lessons and implemented additional checks to prevent a recurrence.

One staff member told us there were not enough staff to support people when medication rounds were being completed and this affected their ability to complete medicine administration effectively. Regular meetings took place with senior support workers and staffing concerns around medication administration had not been reported.

There were policies and processes in place to for staff to ensure people received their medicines safely. People seemed to be given their medicines timely and where they weren’t reasons were recorded. Medication Administration Record (MAR) charts were well completed with no obvious gaps in administrations, including topical preparations. Medication errors were being reported and investigated. There was appropriate 'when required' (PRN) protocols in place and relevant risk assessments for medications with an associated fire hazard. Staff training records were up-to-date and completed, and a recent pharmacy audit was completed satisfactorily. We reviewed records of fridge temperatures which stored people’s medication safely.