This was an unannounced inspection that took place on 18 August 2015.
Ashton Lodge Nursing Home is owned by Ashton Lodge Limited and is registered to provide accommodation with nursing care for up to 100 people. At the time of our visit, there were 93 older people living at the home. The majority of the people who live at the home are living with dementia, some have complex needs and the service also provides end of life care. The accommodation is provided over two floors that were accessible by stairs and a lift.
At the time of the inspection there was not a registered manager in post. 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 manager who was previously the home’s dementia manager had been promoted to the home’s manager two weeks prior to the inspection. The manager informed us they had begun the application process to become the registered manager.
We found there were not always enough staff effectively deployed to meet people’s needs. People and staff we spoke with told us they did not feel there were enough staff on duty to meet people’s needs. This had an impact on the care and support people received.
People were at risk as their medicines were not administered or managed safely. We found some concerns around the storage of medicines that required refrigeration and the recording of medicines. Although risk assessments were in place we noted inconsistencies in the recording of information on risk assessments which could put people at risk of harm.
Staff had understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.
We noted that there were inconsistencies in the way people’s care and support needs were met.
People were not always treated with dignity. However people’s privacy was respected and promoted. We did see examples of caring practice from staff. People’s preferences, likes and dislikes had not always been taken into consideration and support was not always provided in accordance with people’s wishes.
Staff did not always respond to people’s needs in the right way and information for people around their care was not always detailed with the correct information. Staff did not always have access to appropriate equipment to respond to people’s needs. There were not sufficient activities to always meet people’s needs. However some people did enjoy the activities and events that were on offer.
People’s care and support needs could be affected due to records not being fully completed or kept up to date. The effectiveness of medicines were not appropriately monitored. There were not robust or effective systems in place to regularly assess and monitor the quality of the service provided.
People told us that they felt safe at Ashton Lodge. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from abuse.
Although the provider had systems to ensure appropriate standards of cleanliness were maintained, we still found some issues. We raised concerns about the carpets and chairs and some bedding in the home. We made a recommendation that the provider reviews their arrangements and implements current guidelines in regards to infection control.
The manager ensured staff had the skills and experience which were necessary to carry out their role. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.
People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. We found that some people had to wait quite a while for their lunch. We made a recommendation that the provider review their meal scheduling to ensure that people did not wait too long for their meals.
People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of people’s health. The service worked effectively with health care professionals and referred people for treatment when necessary.
People’s relatives and friends were able to visit at any time.
People told us if they had any issues they would speak to the nurse or the manager. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard.
The provider had sought, encouraged and supported people’s involvement in the improvement of the service. Action taken had been recorded to make people aware of the concerns raised and how these were being addressed.
People told us the staff were friendly, supportive and management were visible and approachable.
We found a number of 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 this report.