We carried out a review of the data available to us about Ashton Lodge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashton Lodge Care Home, you can give feedback on this service.
We found the following examples of good practice:
The whole staff team had reflected on there currently being no cure for COVID-19 and how this affects what they do individually, as a staff team, and collaboratively with residents. This approach encouraged best practice standards of infection prevention and control. For example, cleaning staff led by example to demonstrate the highest standards of cleaning "hands on", as more intensive cleaning schedules were implemented.
Staff and residents approached the pandemic as one community whilst encouraging and supporting each other through the various challenges. The home manager was an Infection Prevention and Control “Train the Trainer” and had specialist nursing and management expertise and experience. During our inspection it was evident through residents and staff feedback that the home represented a culture of inclusion, appreciation and positivity. The home manager acknowledged that all staff including the executive team had consistently gone the extra mile. For example, staff across all roles sustained rota cover and the executive team delivered PPE when the homes suppliers ran out.
The service ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Their temperatures were checked at the door. Personal protective equipment (PPE) including face masks, disposable gloves and aprons were provided for visitors before entering the home. Social distancing was observed. This was aimed at preventing and controlling the spread of infection.
Staff had a good understanding of infection prevention and control measures. They had been provided with infection control training and regular updates. The home had enough and appropriate PPEs. Staff changed into their working clothes at the home before starting their work, they changed out of their working before leaving the home.
Ashton Lodge Care Home is a nursing home providing personal and nursing care to 93 people who may have physical disabilities, dementia, end of life care needs or nursing care. Ashton Lodge Care Home provides accommodation on four floors.
People’s experience of using this service and what we found
The provider 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. Our own observations and the feedback the inspection team received supported this. People received good quality care that met their needs and improved their wellbeing from dedicated staff team. A member of staff told us, "I enjoy coming to work every day and we all make sure to provide the best care to our residents.” People were supported by a dedicated staff team and sufficient staff were deployed to ensure peoples complex needs were met. Medicines were managed safely.
People received high-quality person-centred care and support, which met their needs. The leadership team and staff ensured that people’s care, and preferences had met their expectations. People’s wellbeing, their independence, satisfaction and happiness was at the centre of the service. People and their relatives told us consistently how well the service responded to their individual needs. This gave people reassurance and also put their minds at ease, that their relatives were well cared for. One relative told us, “I know my [name] likes living at Ashton Lodge and the care they receive is much better than at home.”
Staff received a comprehensive induction and on-going training. They had attended a variety of training to ensure they were able to provide care based on current best practice when supporting people. They were also supported with regular supervisions and appraisals. People could make choices about the food and drink they had, and staff gave support if and when required to enable people to eat a balanced diet. People were supported to access a variety of health professionals when needed, to make sure they received additional healthcare to meet their 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.
Care was personalised and met individual needs. Staff knew people well, cared about them and understood their care and support needs. Care was not only focused on tasks, but was focused on what people needed, wanted and choose. People lived busy lives and took part in a wide range of interests, activities and parties. Staff supported people to be fully included in the local community and were always looking to build further social links. Staff were extremely skilled at helping people and their significant others to support them through the end of life journey. The service worked collaboratively with external health care professionals to achieve good outcomes for people who used the service.
The registered manager and clinical lead were experienced, skilled leaders who were committed to involving people, relatives and staff in the development of the service. People, their relatives, representatives, and staff were involved and enabled to make suggestions to improve how the service was run. Very effective audits and governance systems were in place to monitor the service and to drive forward any sustained improvements required. The registered manager and their staff team linked up, communicated and continuously worked with other organisations to ensure people's well-being.
Rating at last inspection
The last rating for this service was Good (published 30 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Ashton Lodge Care Home provides accommodation and nursing care for up to 92 older people. There is a garden to the rear of the premises. A large car park area is located at the front. The service is located close to Brent Cross shopping centre and public transport facilities.
The current registered manager had been in post for six month. 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 told us they felt safe at the home. Each care file included a dependency tool to calculate the level of need for each individual. This was used to inform staffing levels to ensure there were sufficient staff deployed on each shift. There were sufficient staff deployed on the day of the inspection. The recruitment process was robust to help ensure suitable staff were employed at the service.
Appropriate policies were in place with regard to safeguarding and whistle blowing. Staff had received training in safeguarding and those we spoke with were aware of the issues and confident of the reporting procedure.
Medication systems were robust and medicines were managed safely at the service. Individual and general risk assessments were in place.
Equipment was fit for purpose and was regularly serviced and maintained to ensure it was in good working order.
The induction programme helped ensure new employees were equipped with the skills, knowledge and competence to work at the home. Training was on-going and mandatory training was refreshed regularly.
The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.
People's nutritional and hydration needs were assessed and recorded appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals.
People we spoke with felt the care was good and staff were kind and caring. We observed good interactions between staff and people who used the service throughout the day. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people's dignity and privacy.
People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes. Staff had undertaken appropriate training in end of life care and people's end of life care plans were thorough and comprehensive.
Care files we looked at evidenced that care was delivered in a person centred way, taking into account people's preferences, likes and dislikes. People we spoke with said staff responded quickly to call alarms.
There was a programme of activities at the home and people were encouraged to participate if they were able to. One to one interaction was undertaken with people who were unable to participate in group activities.
There was an appropriate complaints policy and this was displayed throughout the home. Concerns were responded to in a timely and appropriate manner and the service had received a number of compliments and thank you cards.
People told us the staff and management were approachable. Staff felt the registered manager was supportive towards them. Regular team meetings were held, and staff were given supervisions on a regular basis. Residents' and relatives' meetings were also in the process to be arranged for the beginning of December 2016.
We saw evidence of regular checks and audits that took place at the service to help ensure continuous improvement with regard to care delivery.
We carried out an unannounced comprehensive inspection of this service on 23rd and 31st October 2014. A breach of Regulation 13 Management of medicines of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 was found.
We undertook this focused inspection on 26 March 2015 to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashton Lodge Care Home on our website at www.cqc.org.uk.
Ashton Lodge Care home is registered to provide accommodation and nursing care for up to 92 older people, people with dementia and people with physical disabilities. Medicines were administered by registered nurses or trained senior support workers.
During our focused inspection on 26 March 2015 we found that the provider had taken the necessary steps to ensure that medicines were recorded, stored and administered safely.
This inspection took place on 23rd and 31st October 2014 and was unannounced.
During our last inspection, which was carried as part of our Wave 1 pilot on 24 April 2014 we found the registered provider in breach of regulations 9, 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During this inspection, we found that the provider had made the required improvements and is no longer in breach of regulations.
Ashton Lodge Care Home is registered to provide accommodation and nursing care for up to 92 older people and people with physical disabilities who required varying levels of support to manage conditions such as diabetes, the after effects of stroke or accident and other illnesses associated with old age. Some people required support to move around. The premises are a purpose built property with accommodation arranged over three floors. There were a variety of communal areas where people could relax, have meals or take part in activities. Bedrooms were located on all floors and could be accessed via a passenger lift. People with physical disabilities accommodated the ground floor, older people who did not require nursing care the first floor and people with dementia and nursing needs accommodated the second floor. The home had two kitchens, one providing vegetarian food for Asian people and one general kitchen. These were located on the third floor. The home had an outdoor space; however, this was limited due to the urban location.
There was a registered manager at Ashton Lodge Care Home. 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 were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff knew how to safeguard the people they supported.
People told us they felt safe and we saw that people were treated with dignity and respect by staff and management. They said, “I am always treated with respect, they [care workers] always knock on my door and ask me what I want.” “I feel very safe here.”
Risks to people’s safety were identified and managed effectively and there were enough staff on each shift to make sure that people were protected from the risk of harm. Robust recruitment procedures were followed to make sure that only suitable staff were employed to work with people in the home.
People did not always receive their medicines correctly, staff had received training and appropriate systems and storage arrangements were in place. However there were not always risk assessments in place for people who chose to self-administer medicines.
The service was effective because staff had the information they needed to provide personalised care and support. People’s health and care needs were assessed with them, and people were involved in writing their plans of care. People told us they were very happy with the way they were cared for.
Staff received the training, supervision and support they needed to enable them to carry out their roles effectively. This included induction for new staff, key mandatory training and additional training in people’s specialist needs. This meant that staff understood and were able to meet people’s needs.
People told us there were no restrictions on their freedom. The management and staff had training and the home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so they knew how to protect people’s rights.
People told us they enjoyed their meals and there was always plenty to eat and drink. We saw that meals were home cooked, freshly prepared and well presented, and people were offered variety and choice. Special diets were catered for and people were involved in the assessment of and decisions about their nutrition and hydration needs. Professional advice and support was obtained for people when needed.
People’s health care needs were supported effectively through arrangements for them to see health professionals such as GPs, chiropodists, dentists, nurses and opticians as required. Health professionals we spoke with at the inspection said, “It’s a pleasure to visit this home” and “I wish they were all as good as this”.
The service was caring because people were listened to, valued and treated with kindness and compassion in their day to day lives. There was a calm and relaxed atmosphere in the home. We saw that staff and management knew people well. All the interactions we observed between staff, management and people who lived in the home were respectful and warm. People told us, “They are so kind here.” “They’ll do anything for you.” and “I’m treated very well here.” We also spoke with a visitor. They told us they were very happy with the way their relative was cared for and said, “They’re all very kind.”
Staff who we spoke with knew what people needed help with and what they could do for themselves. They encouraged and supported people to remain as independent as possible.
The service was responsive because people’s individual assessments and care plans were reviewed with the person concerned. These were updated as people’s needs changed to make sure they continued to receive the care and support they needed.
People were provided with the opportunity to take part in a wide range of activities. Outings and entertainments were also arranged as requested by people who lived at Ashton Lodge Care Home. People told us they enjoyed the activities and looked forward to the entertainer.
People told us they knew who to talk to if they had any concerns. They said, “I can’t find fault with anything.” “I’ve never had anything to complain about.” and, “I have no complaints whatsoever”. There was a complaints procedure displayed on the residents’ notice board on all floors and people were provided a copy during their admission.
There was an open and positive culture which focussed on people who used the service. The manager had an open door policy so that people who lived in the home, staff and visitors could speak with her at any time.
Staff told us, “You get great support.” “It’s such a good atmosphere, I enjoy coming to work.” and, “Strong management team, all of them are really approachable”.
People were actively involved in developing the service in a variety of ways, such as meetings, satisfaction surveys, forums and day to day contact with the management team. Suggestions made by people were acted on. This meant that people’s views were taken into account.
Throughout our visit the staff and management team showed us that they were committed to providing a good service. There were effective systems in place to monitor and review the quality of the service. The management team carried out regular audits to make sure that any shortfalls were identified and improvements were made when needed.
Ashton Lodge Care Home provides accommodation for up to 92 people who require nursing, personal care and support. The home is able to support people with physical disabilities, sensory impairments, and dementia. The home specialises in care for people over 65 years of age. At the time of our inspection 84 people were using the service.
People who used the service and their relatives were happy with the service received. Staff treated people kindly and with compassion. Staff were aware of people’s likes, interests and preferences, and their care and support needs. The relatives we spoke with told us staff kept them informed of people’s progress and any changes in their health.
Staff felt well supported by their manager. The team worked together and colleagues supported each other. Staff felt the manager was accessible, approachable and provided good leadership.
A manager had been recently appointed. They had submitted an application to become the service’s registered manager and it was in the process of being reviewed at the time of drafting this report.
In general, people felt safe at the service. Staff were knowledgeable in recognising signs of potential abuse and concerns were appropriately reported. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards.
Risk assessments and care plans were in place. However, we found that many of them lacked detail and there were some inaccuracies in the information recorded in people’s care records, particularly around pressure ulcer care, continence care and monitoring of food and fluid intake. This meant we could not be assured that care was always tailored to people’s individual needs and that preventative measures were put in place to protect people’s welfare and safety.
There was a lack of stimulation and activities on offer at the service. The activities that were on offer were not always tailored to people’s interests and there was a risk that people may become socially isolated. Activities were mainly task based and there was little interaction between staff and people who used the service outside of this. We found at times people were not treated with dignity and respect, during mealtimes and toileting.
Systems were in place to monitor and assess the quality of service provision. However, we were unable to evidence that appropriate action was taken in response to areas identified as requiring improvement through these systems.
The problems we found breached health and social care regulations and you can see what action we told the provider to take at the back of the full version of the report.
The people we spoke with told us that they were being well cared for and well looked after. One person said "I like living here. The staff are good and so is the food." Another person said "I join in the activities sometimes but I like watching the television. I like the food and the staff are helpful." Another person told us "The nurses are truly excellent, very caring, kind and a good laugh." Another comment made by a person "I would give the home ten out of ten, it is wonderful here."
One relative told us "We looked at six care homes, before we finally chose Ashton Lodge. The place is a god send, my relative has settled down and the behaviour has improved."
We found that the home was meeting the standards we inspected. People's privacy and dignity were respected. They received care and treatment that met their needs. There was a system for the safe management and administration of medicines and staff had been provided with relevant training and regular supervision so that they were competent in their roles.
There was a system to assess and monitor the quality of service. People's and their relatives' views had been sought, listened to and acted on.
During this follow up inspection we spoke with three people using the services, two relatives and four members of staff but on this occasion focused on whether the provider had met the compliance action in respect of Outcome 4 Care and welfare of people who use services, Regulation 9 (HSCA 2008 Regulated Activities) Regulations 2010.
We also looked at Outcome 13 Staffing, Regulation 22 (HSCA 2008 Regulated Activities) Regulations 2010 following concerns raised regarding staffing levels and Outcome 14 Supporting workers Regulation 23 (HSCA 2008 Regulated Activities) Regulations 2010 due to a recent change in management at the home.
At this inspection we found that the provider had taken proper steps to ensure that pre admission assessments had information about people’s behaviours. We also found that a dementia assessment had been carried out in respect of four care plans we looked at, which included details of people’s history, interests and social links. We noted that there was a variety of activities and that people were encouraged to participate.
You can see our judgements on the front page of this report.
We viewed three care plan files, various incident and accident records, complaint records and three staffing and recruitment records. Due to the allegations made we focused on the second and third floor of Ashton Lodge, which accommodated people with dementia and people who were more vulnerable due to their physical conditions.
Care workers knew how to respect people's privacy and dignity and told us that they would never enter a room without knocking first, a practice that we observed. The expert noted that she "observed staff treating people with care in a variety of situations."
One person told the expert, "that care workers take care of feet, hair and eyes and that care workers look after people well."
Relatives spoken with told us that their relative 'is safe' at Ashton Lodge and they would talk to the manager if they had any issues. A person using the service made the following comment to the expert when asked what he would do if he had any concerns, "I would see the nurse." The expert observed staff to be busy, but available to sit down with people for a chat and provide reassurance.
We asked relatives if they knew how to make complaints, we were told that they "would complain to the manager."
People using the service told us that they felt safe and protected at Ashton Lodge. Comments made by people using service included "I am safe here" and "staff look after our relative well".
Staff were allocated according to the needs of people using the service and we observed staff attending to peoples' needs and while being busy did not appear to be too rushed. Relatives told us that there was "enough staff available" and "care workers know what they were doing".
Regular health and safety and equipment checks ensured that people using the service and visitors were safe.
People were positive about the care and support they received at the home. People spoke of the staff being 'good', 'friendly',' nice', and approachable. They told us they felt safe living in Ashton Lodge Care Home. People knew who to talk to if they had any worries or concerns, and told us they felt that staff would respond to these in an appropriate manner.
People spoke about being able to make choices about their lives.
People confirmed they attended healthcare appointments and saw a doctor when they needed to. They told us they had contact with a variety of health and social care professionals.
People were positive about the environment of the home and were happy with their bedrooms. Some people told us they had personalised their rooms.
Comments from people included; 'I am happy with my room', 'I choose what to do', 'It's fine here', 'the staff are nice', 'approachable and kind', staff 'ask me want I want', 'I enjoy the food', 'I can choose what to eat', 'we have snacks', 'I have my hair cut', 'I have seen a doctor', 'I have my toenails cut', 'I saw the dentist', and I am 'happy living here'.
Comments from staff included 'I like working at Ashton Lodge' Care Home, 'there is good team work', 'I like caring for older people', 'It's a nice place to work', and the 'management staff are approachable'.