Archived: Hopwood Lodge (MCR)

Ashbourne House Nursing Home is based in Middleton and is registered to provide care and accommodation and nursing care for up to 29 older people. Accommodation is provided on two floors, accessible by a passenger lift. The home is on a main road, close to public transport and the motorway network. There is a small parking area to the front of the property or on road parking. At the time of the inspection there were 16 people living at the home.

The service has a registered manager however they were not in day to day responsibility for the home. We had been informed the registered manager had transferred to another service owned by the provider. 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.

During this inspection we identified further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Following the conclusion of a local authority safeguarding investigation allegations of organisational abuse and neglect had been upheld. A second investigation involving the police had yet to conclude. We found people were not protected against the risk of abuse as effective as systems and process to guide staff were not in place.

The provider and registered manager had again failed to implement effective systems to continually monitor and improve the service so people experienced good quality care, which met their individual needs.

We found the system for managing and recording the administration of medicines was not safe. This placed the health and welfare of people at risk of harm. Stocks of prescribed medicines were not always available, a prescribed medicine was given to two people it was not prescribed for and one person was not given their medicine as prescribed It was not always possible to ascertain if people were having their prescribed creams applied where and when they should.

People’s personal care was not delivered in a thorough and dignified way. We evidenced institutional practice of staff routines in getting people ready for bed in their night clothes early evening regardless of their wishes, poor personal care routines in that some people did not receive sufficient bathing or daily washing, some people did not receive basic care such as teeth being cleaning, hair washed, and a daily shave.

Care records showed that risks to people's health and well-being had been identified and plans to reduce or eliminate the risk were put into place. It was not possible however, due to the incomplete or inaccurate records in relation to the administration of prescribed thickeners, to see if staff had followed the guidance and the action required to prevent people from choking.

At our last inspection the provider could not demonstrate that appropriate action had been taken to address the work required to the main electric circuits. Further requests for this information were made however no evidence was provided to show the system was now safe and people were protected from harm or injury.

Recruitment checks were made when appointing new staff. However we again found the provider and registered manager had not gathered robust information to check the suitability of applicants as outlined in the internal policy and procedure. A recommendation made at our last inspection had not been acted upon.

Arrangements were in place for the recording and responding to people’s complaints and concerns. However visitors told us they had not always felt their concerns were listened to and acted upon. People had also approached CQC and the media to raise concerns, which suggested they were not confident the provider and registered manager would listen and respond appropriately.

Appropriate arrangements were in place for those people being deprived of the liberty ensuring their rights were protected. Staff told us they had yet to complete training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) to help develop their knowledge and understanding so that people’s rights were promoted.

We found staff had not received all the necessary training and opportunities for development essential to their role to help ensure the current and changing needs of people could be met in a safe and consistent way.

The programme of redecoration and refurbishment had yet to be completed. Fabrics, such as bedding were worn and in need of replacing.

We again found that activities offering stimulation and variety to people’s day were poor. There was no evidence to show that work to improve opportunities for people, as recommended at our last inspection, had been considered or acted upon.

People's care plans contained enough information to guide staff on the care and support required and reflected people’s preferences. Whilst people’s records were stored securely they were not easily accessible to care staff delivering people’s care.

Systems were in place for the management of cross infection. Sufficient supplies of personal protective clothing and cleaning aids were available in all areas where personal care was provided.

Suitable arrangements were in place to meet the nutritional needs of people living at the home. Where people’s needs had changed we found that advice and support had been sought from relevant health care professionals.

Sufficient numbers of staff were available to meet the current needs of people. Staff shifts were being reviewed so that staff were available at those times when additional support was required. The manager was also actively recruiting new staff to fill current vacancies.

Staff and visitors told us they were happy with the new management arrangements and felt their views were listened to. We were told that opportunities for people, their visitors and staff to comment about the service were to be developed by the new management team.

Staff were described as caring and made visitors feel welcome. Staff were seen to speak with people in a friendly and kind manner and were quick to respond to people’s needs and requests.

The overall rating for this provider was 'Inadequate'. This meant that it was placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use of enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by

adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration.

Ashbourne House Nursing Home is based in Middleton and is registered to provide accommodation and nursing and personal care for up to 29 older people. Accommodation is provided on two floors, accessible by a passenger lift. The home is on a main road, close to public transport and the motorway network. There is a small parking area to the front of the property or on road parking. At the time of the inspection there were 17 people living at the home.

The service is managed on a day to day basis by the 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.’

We identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found systems were not in place to demonstrate all areas of the service were monitored and reviewed. Records about people’s care were not maintained in full providing an accurate record of when people received the care they needed.

Although the overall system in place for managing oral medicines was safe, the inadequate administration of prescribed skin creams placed people at risk of harm.

The provider could not demonstrate that appropriate action had been taken to address the work required on the 5 year electrics check to ensure the system was safe and people were protected from harm or injury.

People’s care monitoring charts were not always clearly dated to show that people were receiving the care and support they require.

Opportunities for people to participate in a range of activities needed enhancing to meet the individual needs of people. We have made a recommendation about the type of opportunities made available to people to promote their well-being and encourage their independence.

Recruitment procedures did not address all areas of the homes policies and procedure ensuring detailed information about the suitability of candidates was gathered. We have made a recommendation about the provider referring to good practice guidance so that they system in place is robust and helps keep people safe.

We were aware that there were two on-going safeguarding investigations in relation to Ashbourne House. Policies and procedures were in place to guide staff in safeguarding people from abuse and whistle blowing. Staff spoken were aware of what to do if they were concerned about people. Whilst those staff we spoke with said that training had been received, training records showed that some staff required up to date training in this area. This training is important to help staff recognise signs of abuse and know what action to take where necessary.

Some opportunities for staff training and development were provided. Staff spoken with confirmed they had completed some training and felt supported by the manager. However systems to monitor the completion of training was not effective as we found some staff required updates in training.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People’s care plans contained enough information to guide staff on the care and support required. Records showed that risks to people's health and well-being had been identified and plans to reduce or eliminate the risk were put into place. We saw people were supported to access health care professionals, such as GP’s, community nurses and dieticians so their current and changing health needs were met.

Suitable arrangements had been out in place to support people where additional needs had been identified. People told us and we saw that sufficient staff were available to respond to people’s needs. People’s visitors were complimentary about the staff and the care and support offered to their family member. Staff were seen to be polite and respectful towards people, offering assistance when needed.

People were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. We saw that food stocks were good and people were able to choose what they wanted for their meals.

A programme of redecoration and refurbishment was in place to enhance the standard of accommodation and facilities provided for people. Hygiene standards had been improved; minimising the risks of cross infection.

The registered manager had a system in place for reporting and responding to any complaints brought to their attention. People’s visitors told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people were treated with dignity and respect. People told us they felt safe. One person said, 'The staff are good, but I would complain if necessary.' Two visitors told us their relative with a dementia was safe at the home and said, 'She always smiles at the carers. Everyone is friendly towards her.' Safeguarding procedures are robust and members of staff understood their role in safeguarding the people they supported. Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Medication was managed and administered by registered nurses who knew how to safely give medicines to people who used the service.

Is the service effective?

People's health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people's changing needs.

We found that people's weight and appetite was monitored. When any problems were identified advice was sought from the doctor, speech and language therapist and dietician. We saw that care workers were attentive to people's needs at lunch time and sat next to the people who required assistance to eat their meal.

Discussion with care workers and examination of records confirmed that a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that members of staff were attentive to people's needs and offered appropriate encouragement and assistance when necessary. People who used the service told us they liked living at the home and received the care and support they needed. One person said, 'The staff are pretty good.' One visitor said, 'They (the staff) can't do enough for you.'

People's personal preferences, interests and diverse needs had been recorded in their individual care plans.

People who used the service and their representatives were given the opportunity to complete annual satisfaction questionnaires. However, the survey completed in July 2013 had not been evaluated in order to identify any areas for improvement.

Is the service responsive?

Leisure activities were routinely organised at the home. These included arts and crafts, armchair football and aerobics, singing and board games. Outside entertainers also regularly visited the home. One person told us they had been taken out for a walk.

People knew how to make a complaint if they were unhappy. One person said, 'I would tell the staff if I wasn't happy about something.' The relatives of one person said, 'We've never had any major issues and any minor problems have always been resolved. We would complain to the manager if necessary.'

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Discussion with members of staff confirmed that they had received appropriate training and understood their roles and responsibilities. This helped to ensure that people who used the service received the care and support they needed.

The nurse on duty said, 'The manager is approachable and has a lot of knowledge and experience.'

Our inspection identified that overall the provider was meeting the essential standards of quality and safety in the outcomes areas that we inspected. It was identified however that the care records we looked at did not have the information in place that was necessary to safely support and care for people.

We found that people using the service were well cared for. We spoke with one person using the service and they told us they were well looked after. They told us, 'I am fine, they are looking after me well and I have no complaints'.

We saw that people had access to other health care services and systems were in place to make sure that information was passed on when a person's care was transferred to another service.

We saw that systems were in place to keep the home clean and help control the spread of infection.

We found that people using the service were cared for by sufficient numbers of experienced staff.

The people we spoke with told us the staff were caring, helpful and always asked for their verbal consent before carrying out their care tasks.

We found that staff had been appropriately recruited. We saw the staff on duty represented the number of staff as scheduled on the rota; however, people felt that sometimes staff were rushed. One person said 'The staff never have time to sit down and talk with us, they are always on their feet.' Another person told us 'The staff do a good job but they are always hurried.'

The people we spoke with were satisfied that if they made any complaints they would be dealt with. A number of people told us 'There is an unpleasant odour in the home' on the day of inspection. We revisited a week later and found that the owner had dealt with this issue satisfactorily.

One person said 'The staff are caring and helpful.'

The visitors were complimentary about the food their relatives received.

One person said 'The food is good and the cook does a wonderful job.'

The visitors told us that they felt their relatives were safe and they were confident that any concerns would be addressed immediately.