Ashton House

Updated 25 April 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of three inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses care services. In this instance services for older people.

The service is required to have a registered manager:

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The service type:

Ashton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection:

We did not give the provider any notice of this inspection.

What we did:

Before the inspection we reviewed the information, we held about the service and the service provider, including the previous inspection report. We looked at the action plan provided to CQC following our last inspection. The registered provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law.

During the inspection we spoke with:

• 30 people and observed care and support given to people in the dining room and lounges

• Nine people’s relatives and visitors

• 15 members of staff

• Four external healthcare professionals

We also reviewed the following documents:

• Eight people’s care records

• Records of accidents, incidents and complaints

• Four staff recruitment files and training records

• Audits, quality assurance reports and maintenance records

Updated 25 April 2019

About the service:

Ashton House accommodates up to 100 people across two separate units, each of which have separate adapted facilities. One of the units, Hazelwood, specialised in providing care to people who lived with dementia. The main house supported people who lived with a wide range of health problems, such as strokes, heart problems, Parkinson’s disease and general frailty. At the time of the inspection there were 75 people living at the home. It is a large, detached home with accommodation across three floors.

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

People’s experience of using this service:

• People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “This is a good place to live, I feel safe,” and “The staff are very kind.”

• The service had made improvements since our last inspection. This meant people’s outcomes had improved. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. For example, the current systems for checking that air flow mattresses were set accurately as per manufacturers’ instructions for prevention of pressure damage were not effective. We found six air flow mattresses set incorrectly.

• Risk assessments had been undertaken for prevention of pressure damage. Some risk assessments had identified that people needed two hourly repositioning whilst in bed. Records confirmed these were undertaken during the day but there was no record of those people being repositioned between 9pm and 7am. There was no explanation why this was not necessary.

• Daily notes and behavioural charts were not always detailed and lacked meaningful information that told staff of actions that may be required.

• These were areas that required further improvement.

We have made a recommendation about seeking expert advice about the administration and use of medicines given covertly (disguised in food/drink).

• There were sufficient staff to meet people’s individual needs who had passed robust recruitment procedures that ensured they were suitable for their role.

• There were systems in place to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, these incidents and accidents were recorded and lessons were learned.

• Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “Staff are really helpful and efficient, look after my relative really well,” and “The staff team are wonderful.”

• People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave very positive feedback about the food. Comments included, “The food is good,” “Very tasty, good quality,” and “Good food”

•Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.

•People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

• People's care was now more person-centred. The care was designed to ensure people's independence was encouraged and maintained. Staff supported people with their mobility and encouraged them to remain active.

• People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

• There were positive changes to the management team. Improved audits and checks were put in place to ensure the service was continuously striving to improve. Areas identified as needing improvement during the inspection process were immediately taken forward and action plans developed.

• There was a happy workplace culture and staff we spoke with provided positive feedback and told us they were proud of the service and enjoyed their work.

The service met the characteristics for a rating of ‘Good’ in four of the five key questions we inspected, with the well-led question remaining ‘Requires Improvement.’ Therefore, our overall rating for the service after this inspection has improved to "Good".

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (report published 09 April 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will follow up on our recommendations at the next scheduled inspection.