Ashleigh Court Rest Home

Ashleigh Court Rest Home is a residential care home providing personal and nursing care up to up to 22 people. The service provides support to people 65 and over. At the time of our inspection there were 9 people using the service.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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

Systems in place to monitor medicines had not been effective in identifying the areas for improvement found at this inspection. There was a new management structure in the home which had driven improvements in the areas identified in our last inspection. People told us they were asked for their feedback on care. We saw that the provider had worked with other agencies.

People told us they felt safe living in the home however medicines were not always stored safely. Risks to people were identified and mitigated through comprehensive risk assessments. The staff team were experienced with a varying skill mix benefiting the complex needs of people. Infection control procedures were in place and all staff were aware of these. When incidents occurred, lessons were learned.

The staff team made every effort to know and understand each of the people living in the service. The staff and registered manager considered the service users equality, dignity and respected people. People’s views were actively sought by which were listened to and actioned.

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 found the meals were nutritious and varied to their preferences.

The staff team were trained and skilled in relation to the needs of the people living there. People’s needs were detailed and care planned for. Care was personalised with a focus on the individual needs and goals of the service users. While no-one was receiving end of life care there were end of life care plans in place. The complaints and compliments procedure was displayed and discussed with people, all complaints had been responded to and actioned appropriately.

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 May 2021).

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 regulation 9 (Person-centred Care) and regulation 11 (Need for Consent). We found the provider remained in breach of regulation 17 (Good Governance).

The last rating for this service was requires improvement (published 10 May 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25 February 2021. Breaches of legal requirements were found. The provider completed an action plan and submitted a monthly report after the last inspection to show what they would do and by when to improve person-centred care, the need for consent and good governance.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the oversight and governance of service delivery at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashleigh Court Rest Home is a residential care home providing personal and nursing care to 17 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

Risks to some people’s safety had not been assessed as the information about people’s needs was conflicting. Although medicines were given safely, staff were not always aware of guidance available on when to give ‘as and when required’ medicines. People were supported by staff who knew how to identify and report concerns of abuse. There were sufficient numbers of staff to support people safely. Actions had been implemented to improve infection control practices.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some staff training had not been updated for a number of years. The provider had identified this but action to make improvements had not been effective. People were supported to have choice at mealtimes, although there was a lack of interaction between people and staff during meals. People’s healthcare needs were met.

Although staff had friendly relationships with people, this was task focussed and opportunities to engage with people outside of their care delivery was missed. People felt they had been involved in their care and people’s independence was encouraged.

The care provided was not consistently person centred, although work was ongoing to improve the personalised information held about people. People did not always speak positively about the activities provided. End of life care plans were in place, and people knew how to make a complaint if needed.

Systems in place to monitor quality had not been effective in identifying the areas for improvement found at this inspection. The culture at the service was not consistently person centred. People told us they were informally asked for their feedback on care. We saw that the provider had worked with other agencies to drive improvements in some areas.

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 18 February 2021) and there were three breaches of regulation. At this inspection enough improvement had not been made/ sustained, and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 18 February 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part by a notification of a specific incident following which a person using the service sustained a serious injury. This inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of sudden injuries. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to ensuring people’s rights are upheld in line with the Mental Capacity Act 2005, the provision of person centred care and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashleigh Court Rest Home is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

The care home accommodates people over three floors which were accessed by a lift in one adapted building. It provides care to older people, some of whom are living with dementia and mental health needs.

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

People were not consistently protected from the risk of abuse. The service recorded incidents and accidents however failed to effectively monitor these. Risks to people had been assessed and measures were in place to mitigate, however, this had not consistently been put into practice. People told us, and we observed there were enough staff on duty to meet the needs of people. People received their medicines as prescribed.

People were not supported by staff who had received on-going training. We received mixed feedback from people in respect of meals. People did not have a pleasant meal time experience. People were given meal choices that were not in line with their cultural and individual preferences. People’s oral health care plans and diabetes care plans needed developing to ensure staff had guidance to follow. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People said staff were kind and caring and they had good relationships with staff. There were times, however, during our inspection we felt staff did not engage with people as much as they could have. People’s dignity and privacy were compromised on occasions.

People did not consistently receive personalised care that was responsive to their needs. People told us they did not contribute to the planning and reviewing of their care. There were limited opportunities for engagement and stimulation for people daily and within their local community. People could not be confident that their wishes during their final days and following death would be understood and followed by staff.

The provider's systems for identifying, assessing and mitigating risks had not always been operated effectively. The registered manager carried out audits of the service, but these had failed to ensure that people were always safe and that their needs were being met.

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

Rating at last inspection

The last rating for this service was good (published March 2017). We rated Safe, Effective, Caring and Responsive as good and the key question Well-led requiring improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the relevant key question in the safe, effective, caring, responsive and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to safeguarding people from abuse and improper treatment, person-centred care and the governance of the service.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The registered manager was present during our inspection. 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 we spoke with told us that they felt safe living at the home. Risks to people’s safety had been identified and staff had received training in how to recognise and report any concerns of abuse. People told us there were enough staff available to support them safely with their needs. People had their medicines when they needed them and there were effective systems in place to ensure the management of medicines were safe.

People were supported by staff who received regular training and staff told us they felt supported by the registered manager. Staff were aware of how to support people’s rights, seek their consent and respect their individual choices. People told us that they were happy with their choices of meals and had been supported to access healthcare services when needed in order to promote their health and well-being.

People received some caring and compassionate support and most staff demonstrated a positive regard for people they were supporting. People were involved in making decisions about their well-being. People told us they were treated with dignity and their privacy was respected by staff.

Care provided to people was personalised and staff understood people’s preferences and choices. Activities were provided but improvements were planned to ensure people had the opportunity to participate in activities of interest to them. People and their relatives knew how to complain. The registered manager had effective systems in place to support people to complain.

Notifications of concern had not always been sent to the Care Quality Commission as required. The registered manager sought feedback from people but had not used this information to drive improvements. People, their relatives and staff described the registered manager as approachable and supportive. Systems were in place to monitor the quality of the service and where shortfalls had been identified, plans were in place to improve these.