Ashwood Rest Home

Ashwood Rest Home is a 'care home' which can accommodate up to 39 people in one adapted building. At the time of inspection there were 19 older people living at the service, some of whom were living with dementia.

People’s experience of using this service and what we found

Since our last inspection, the provider had made improvements to quality and safety which meant they were no longer in breach of regulations.

The provider had introduced a new medicines management system in the home. This helped ensure there were safe arrangements in place for the ordering, storage, administration and disposal of medicines.

The provider had effective systems to manage environmental risks such as fire safety, legionella and maintenance of equipment.

The registered manager had improved systems and processes to monitor the quality of care. This included developing audits and action plans to help ensure any areas of improvement were implemented and sustained.

The provider worked in partnership with other stakeholders to help ensure their policies and procedures were in line with best practice guidelines.

Safeguarding concerns were investigated and reported appropriately by the provider. Changes had been made to improve people's safety in response to incidents or when concerns about their welfare were raised.

Staff ensured people lived in a clean environment. Infection prevention and control measures followed government guidance.

There were enough staff in place to meet people’s needs. Staffing arrangements were regularly reviewed when people’s needs changed.

The provider had made appropriate recruitment checks for new staff and provided them with training to help them meet people’s needs.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 24 October 2018) where we identified three breaches in regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashwood Rest Home on our website at www.cqc.org.uk.

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.

Ashwood Rest Home is a 'care home’ which can accommodate up to 19 people in one adapted building. The service was undergoing extensive renovation work. Since our last inspection, an extension had been built at the back of the property, where people now lived.

At the time of inspection, the older part of the building was being renovated and was not accessible to people. The provider told us that both parts of the building would be available to accommodate people once completed. There were 12 older people living at the service at time of inspection, some of whom were living with dementia.

People’s experience of using this service:

The provider did not have robust systems in place to manage risks associated with the environment. This included risks around fire safety and legionella. The provider did not always ensure that instructions around the administration of medicines were clear and the systems to monitor safe storage of medicines were not always consistently followed.

Key documents in relation to the running of the service were either not available or easily accessible. This meant that records were difficult to follow and not always clear. Audit processes were in place but did not always effectively identify where and how improvements could be made.

The home was undergoing extensive renovation work. The provider had worked to minimise the disruption this had on people. However, aspects of the décor and decoration remained unfinished. This had a minor impact on how communal spaces were used as some areas were cluttered with furniture or other items.

The registered manager was responsive to feedback from the inspection and took immediate action to put measures in place to ensure people were safe.

Staff were caring and knowledgeable about people and were responsive if they were confused or distressed. People were treated with dignity and respect. People and their relatives told us they were involved in making decisions about their care. 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.

People had access to healthcare services and the provider worked with other stakeholders when risks were identified around people health and wellbeing. People were supported to have enough to eat and drink.

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

Rating at last inspection:

The service was rated good at our last inspection (published 9 June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches of regulations in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

There was a registered manager at the service. 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.

At our last inspection in January 2016, we identified a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in the area of ensuring the mental capacity and best interests of people who lacked capacity was assessed. At this inspection, we found that improvements had been made and the provider had taken steps to meet the requirements of this regulation.

The registered manager had implemented a system to assess people’s capacity and make best interests decisions for people who were unable to consent to specific decisions around their care. The system was well embedded, with staff knowledgeable about applying the principles of The Mental Capacity Act (2005) into their daily working practice. These systems helped to protect people’s rights and freedoms. Staff understood the need to obtain consent from people before delivering care. Staff treated people with respect and dignity, with their wishes around their care arrangements at the end of their life documented to help ensure their choices were respected.

At our last inspection in January 2016, we identified a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in the area of ensuring the premises and equipment were clean, secure, suitable for

purpose and properly maintained. At this inspection, we found that improvements had been made and the provider had taken action to meet the requirements of this regulation.

The registered manager had implemented systems and processes to ensure the service’s environment was clean and safe for people to live in. They had introduced a regular series of audits and checks to ensure that staff maintained required standards. The service was undergoing building work at the time of inspection. The registered manager regularly carried out risk assessments and management plans to ensure that the building work caused minimal disruption to people living at the service and the environment remained safe and comfortable.

The registered manager gave strong leadership to the service. People, staff and social care professionals told us the registered manager approachable, caring and operated an open door policy. The registered manager sought feedback about the service and the quality of care that staff provided. People told us they understood how to complain and felt the registered manager would take their concerns seriously.

Staffing levels were sufficient to ensure that people’s needs were met. The service followed safe recruitment processes to help ensure that suitable staff were employed to work with people. Staff received training in safeguarding and understood their responsibilities in keeping people safe from harm. Staff received effective training and ongoing supervision to help enable them to be effective in their role. People told us that staff were caring and considerate in the way they supported people and staff were motivated within their role to provide good quality compassionate care.

Staff managed risks to individuals to help protect people from harm. Where people were involved in accidents or incidents, staff reflected on events to put measures in place to reduce the likelihood of the incident reoccurring. There were safe systems in place to ensure people received their medicines as prescribed. People had access to healthcare services as required to help them maintain their health and wellbeing.

People’s care plans reflected their choice about how they would like to carry out their daily routines and how they wished to remain independent in some areas. People ate a diet which reflected their preference. People were given a choice about what they ate and were consulted about menu options. There was a programme of activities in place which was flexibly adjusted according to people’s likes and preferences.

Ashwood Rest Home provides care and accommodation for 18 older people some of whom were living with dementia. The home is situated in Shirley, Southampton and is near to the main high street with shops and restaurants.

The home did not have a registered manager: however, the provider had appointed a manager who was undergoing the process of registering with the CQC. 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.

The environment and equipment were not always clean, secure, well maintained or suitable for use. No hand washing sink was available in a toilet, which presented an infection risk. Windows were not secure or safe as they did not have restrictors fitted to stop them from being opened fully. The lift and a bathroom were out of order and in need of repair.

People’s needs were assessed and some risks were identified in people’s care plans. However, there were no risk assessments in people’s care records.

Mental Capacity Act assessments of people’s capacity to make particular decisions were not being completed on behalf of those people who did not have capacity. Records did not always show how decisions were made or why they were in the person’s best interest.

People did not have access to activities within the home as often as they would like. People and staff told us there was not enough to do and people were often left to watch television.

The provider had not regularly audited the service to assess, monitor and identify where the quality of the service could be improved. The manager was developing systems and processes to support staff and improve the quality of the service. An effective complaints procedure was in place and concerns were listened to.

All staff had received safeguarding training and knew how to identify, prevent and report abuse. The manager was aware of how to report and manage any safeguarding concerns. Recruitment practices were safe and ensured suitable staff were appointed to work with people. There were enough staff to meet people’s needs at all times. Staff received appropriate training and supervision.

Medicines were stored, administered and monitored appropriately. We observed people receiving their medicines safely. Staff received training to administer medicines and were assessed as safe to do this.

People received sufficient food and drink and could choose what they wanted to eat. People were supported to access health professionals and treatments both in the home and in the community.

People and their families felt staff treated them with kindness and compassion. People were involved in planning their care and were encouraged to remain as independent as possible. Their dignity and privacy was protected at all times.

People received personalised care from staff who were able to meet their needs. Care plans provided comprehensive information and were reviewed monthly. People and staff described a positive culture that was personalised and included people in their care.

We identified two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.