Ashgrove Care Home - London

Ashgrove Care Home provides personal and nursing care to people aged 65 and over. The service can support up to 50 people. Care is provided over two floors. The service is managed by HC-One Limited, a national provider of nursing and care homes. There were 33 people using the service at the time of our inspection.

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

There were systems in place to protect people from the risk of infection and staff had received appropriate training in this. However, there were areas of the kitchen which were unclean and required deep cleaning although cleaning schedules indicated these tasks had been carried out.

Risks to people’s safety and wellbeing were overall appropriately assessed and mitigated, however, on the day of our inspection, two bathrooms containing tools, stored items and a wet floor had been left unattended and unlocked. This presented a risk to people who used the service.

People’s records were not always completed correctly, appropriately and in a person-centred way.

There were systems in place to monitor the quality of the service and these were mostly effective. Although the provider had made improvements, monitoring checks had failed to identify some of the issues we found during the inspection.

People’s healthcare and nutritional needs were met. People were supported to access healthcare professionals and to attend appointments as needed.

Medicines were managed safely and people who used the service received these as prescribed.

The provider sought feedback from people. People and staff were confident they could raise any concerns they had with the provider and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

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.

The management team were responsive to and worked in partnership with other agencies to meet people’s needs.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 31 March 2022) and there were multiples breaches of regulations. We issued the provider Warning Notices for Regulations 12 and 17. 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. However, we found some areas which required further improvement.

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, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to regulation 12 (safe care and treatment) and regulation 17 (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 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.

Ashgrove Care Home provides personal and nursing care to people aged 65 and over. The service can support up to 50 people. Care is provided over two floors. The service is managed by HC-One Limited, a national provider of nursing and care homes. There were 46 people using the service at the time of our inspection.

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

Risk assessments contained guidelines and plans for staff on how to minimise risks for people using the service. However, we observed that staff did not always follow these.

Although people told us they felt safe when receiving care, we found that some practices were putting people at risk of avoidable harm. Staff did not always have the right information about people and this meant people’s needs were not always met safely.

We found evidence that clinical checks were sometimes recorded in advance so we could not be sure people were monitored appropriately and this put them at further risk of harm.

People’s needs were recorded in their care plans but these did not always contain accurate information or were not always updated following healthcare professionals’ advice. This meant there was a risk that people’s needs might not be always met.

The provider had processes in place for the recording and investigation of complaints and incidents and accidents.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The management team did not always communicate well where there were concerns. This contributed to delays investigating concerns raised. The provider had monitoring systems in place, but these had not been effective as they had failed to identify the issues we found during our inspection.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles. However they said supervision was mainly carried out as a result of a concern raised rather than a regular occurrence.

The provider sought feedback from people. People and staff told us they could raise any concerns they had with the registered manager and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to investigate concerns and make improvements.

Medicines were managed safely to ensure people received their medicines as prescribed and in line with national guidance.

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 8 June 2021).

Why we inspected

We received concerns in relation to people’s care needs not being met. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

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 breaches in relation to safe care and treatment, person-centred care, receiving and acting on complaints and good governance at this inspection.

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

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 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.

Ashgrove Care Home is a care home providing personal and nursing care to up to 49 people aged 65 and over. At the time of our inspection, there were 28 people using the service. Care is provided over two floors. The service is managed by HC-One Limited, a national provider of nursing and care homes.

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

The provider had made improvements to the management of medicines since the last inspection. We found a minor issue which we discussed with the registered manager, and prompt action was taken to rectify this. Overall, we found people’s medicines were managed safely to ensure people received their medicines as prescribed and in line with national guidance.

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’s needs were recorded in their care plans and met. Staff knew people’s needs and how to meet these in line with their care plans.

People told us they felt safe when receiving care and relatives agreed with this. The provider had processes in place for the recording and investigation of complaints and incidents and accidents. Risk assessments contained guidelines and plans for staff on how to minimise risks for people using the service.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

The provider sought feedback from people. People and staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

The provider had monitoring systems in place, and these were regular and effective.

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 requires improvement (published 22 February 2020) and there were multiple breaches of 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.

Following a COVID-19 outbreak at the home, we also carried out a targeted inspection on 6 January 2021 looking at the infection prevention and control practices the provider had in place.

Why we inspected

The inspection was prompted in part due to concerns received about poor care and the provider’s lack of responsiveness. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well-led 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 COVID-19 and other infection outbreaks effectively.

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.

We found the following examples of good practice.

Following a recent outbreak where both staff and people who used the service became unwell, the provider had responded appropriately and promptly to contain the infection and prevent further spreading.

There were effective systems in place for infection control and prevention. These included a decontamination program and effective cleaning regime, supply of personal protective equipment (PPE) for staff, and regular audits. The management team undertook unannounced checks day and night to help ensure staff followed procedures.

The environment was suitable to help reduce the risk of the spread of infection. Care was provided over two floors, and staff worked exclusively on a specific floor. People and staff were reminded to social distance where possible, and information about this was displayed. There were appropriate systems in relation to laundry and the disposal of clinical waste.

People who were unwell were cared for in their rooms for a period of isolation. Guidance for staff about following good infection control when entering and leaving the rooms were displayed clearly on bedroom doors.

Each person using the service had a comprehensive COVID-19 care plan and risk assessment in place. These outlined how to support the person according to their individual needs, and how to minimise risks to their safety and wellbeing.

The provider undertook regular testing for staff and people who used the service. They had introduced a Lateral Flow test. This is a test which gives a result within 15 minutes. This meant they could ensure visitors had tested negative before being allowed to enter the premises.

At the time of our inspection, families were not allowed to visit. However, the staff facilitated telephone and video calls so people could maintain contact with their relatives.

The provider liaised regularly with healthcare professionals and sought advice where necessary, to help ensure people who used the service received the care they needed. Staff carried out frequent checks and observations such as temperature checks and these were recorded. They knew how to recognise symptoms of COVID-19 and what action to take if someone became unwell.

Ashgrove Care Home is a care home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 50 people. Care is provided over two floors. The service is managed by HC-One Limited, a national provider of nursing and care homes.

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

Medicines were not always managed safely to ensure people received their medicines as prescribed and in line with national guidance. The provider’s medicines audits had failed to identify the issues we found.

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’s needs were recorded in their care plans but not always met. Staff did not appear to understand fully how to meet the needs of people who displayed behaviours that may challenge others. Care records were written using terminology which was not always respectful when describing people’s needs.

The provider had monitoring systems in place, but these had not been effective as they had failed to identify the issues we found during our inspection.

People told us they felt safe when receiving care. The provider had processes in place for the recording and investigation of complaints and incidents and accidents. Risk contained guidelines and plans for staff on how to minimise risks for people using the service.

There were enough staff to support people and meet their needs. Staff were recruited appropriately, and all checks were in place. Staff received an induction, training and supervision and felt supported in their roles.

The provider sought feedback from people. People and staff were confident they could raise any concerns they had with the registered manager and felt they would be listened to. We received positive feedback from people who used the service. People said staff were caring and treated them with dignity and respect.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to 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

The last rating for this service was good (published 26 July 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care, need for consent 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 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.

Ashgrove Care Home – London is a nursing home for older people who are living with the experience of dementia. The home is registered for up to 50 older people. At the time of our inspection 47 people were living at the service. Care is provided over two floors. The provider employs nursing and care staff to support and care for people. The service is managed by HC-One Limited, a national provider of nursing and care homes.

At the last inspection of the service on 7 October 2014 we rated the service Good. The key question of Caring was rated Requires Improvement. We did not find any breaches of Regulation.

This was a comprehensive inspection of the service which took place on 4 July 2017 and the service remained Good.

People were happy and comfortable living at the service. They appeared relaxed and were unrestricted in their access to parts of the home and garden. The staff were attentive and caring and people had plenty to do. They were offered a range of food and drink and were able to make choices about how they spent their time, what they ate and where they went. There was a range of organised activities which people were able to participate in. There was also a number of games, puzzles, toys, colouring books and pens and other resources which people were able to help themselves to and the staff offered them.

Visitors were happy with the service, they felt people were safely cared for. They were free to visit the home whenever they wanted and they felt well informed.

The staff were recruited in a suitable way and they had training and information to help them to understand their roles. They felt well supported and told us they could speak with the registered manager about any concerns they had or any questions about their work.

The staff worked well as a team helping each other to make sure people's needs were being met.

People's needs were assessed and planned for. There was clear information about how to meet these needs. This information was regularly reviewed and updated when needed. The staff worked with other healthcare professionals to monitor and meet health needs.

The environment was kept safe and clean, with the exception of a small number of areas which needed deep cleaning. The environment did not meet best practice guidelines in respect of orientation and meeting the visual and sensory needs of people living with the experience of dementia. We made a recommendation in relation to this.

The registered manager knew the needs of the service well. They were familiar with all the staff and people who lived there. People felt comfortable talking with the registered manager. There were good systems for monitoring the quality of the service and making sure improvements were made where needed. These systems included audits and checks by the staff and the provider.

We saw that the provider listened to the views of people who used the service, their visitors and the staff and they made changes when people asked for these.

The inspection was carried out by an inspector during one day. This helped answer four of our five questions;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

During this inspection we did not review any information in relation to the question 'Is the service effective?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our inspection we noted that there was a strong malodour which was noticeable around the ground floor lounge and reception area. The armchairs in the ground floor lounge were stained and had an odour. We saw the toilet seat in a ground floor bathroom was broken and this was repaired before the end of our inspection.

We saw that the fluid balance and food charts for people using the service had been regularly completed and were up to date for the day of the inspection. We did note that some of the records did not have the total fluid balance for each day calculated or details of what food was eaten.

We saw two electronic keypad access systems, one on the door to the ground floor lounge and one between the corridor with bedrooms and the reception area. This restricted people's access to the lounge or their bedrooms. These keypads were removed the day after our inspection after we discussed risk assessments in relation to their use with the management of the service.

Is the service effective?

We did not review information in relation to this question.

Is the service caring?

We saw that most people were supported by kind, attentive staff who treated them with respect and dignity. We carried out a SOFI (short observational tool for inspectors) over the lunch period at the home where we observed that one member of staff was responsible for providing support for five people in the ground floor dining room which resulted in their independence not being promoted and dignity not being maintained. Some of the people in the ground floor lounge were unable to choose where they ate their lunch.

Is the service responsive?

During our last inspection in February 2014 we found that people were not kept occupied and stimulated as fully as they could have been. The people we spoke with told us they were sometimes bored in the home and there was not much to do. During this visit we saw the activity coordinator supporting people who had chosen to take part in different activities. The activities coordinator told us they were in the process of developing a range of new activities. One relative said "I think the activities have improved over the last few months but things could still be better. The colouring activity is not really appropriate for everyone".

During our previous inspection in February 2014 nursing staff were unable to tell us about people on their floor receiving treatment for pressure sores. During this visit nursing staff were able to tell us how many people on their floor had a pressure ulcer, the grade and the treatment being provided. We also saw up to date records detailing their care.

Is the service well led?

The service had provided a nurse's office on each floor where the records including care plans and risk assessment were kept securely. The fluid balance and food charts were located in a cupboard in each lounge so staff could assess them easily.

The care records appropriately addressed people's needs and had been reviewed at least monthly to ensure they reflected people's needs. The care records were drawn up with people or their relatives. However, we found that people were not always involved in their reviews every three to six months according to the home's policy on the review of people's care records.

Other records had been completed to describe the care people received or to monitor their oral intake. Some records were stored safely but a few were not stored that safely which meant people's records could be accessed by other people not entitled to see them. We found that some of the records about people's oral intake were not completed in a timely manner and were completed retrospectively bringing in a possibility of inaccuracies.

Where required various healthcare professionals were involved in people's care and treatment and appropriate records were kept to describe their input into people's care and treatment. We found that communication and handover in the home did not work so well, because on the day of the inspection nursing staff did not know that a person had a grade 3 pressure ulcer. This meant that they could not monitor or give nursing care and treatment to the person in relation to the pressure ulcer.

Medicines management was generally carried out to a good standard to ensure people were protected from the associated risks.

People said they were treated well and staff were nice to them. Relatives confirmed this. Staff received ongoing training, regular supervision and appraisal and had the opportunity to attend monthly staff meetings.

The service had some arrangements in place to gain people's and relatives' views of the quality of the service provided. There were also other processes in place to monitor and assess the quality of the service so people received appropriate care and treatment.

People said they were involved in discussions about their care and treatment and were happy with the care they received. We observed staff supporting and assisting people during the inspection and they were communicating effectively with people. One person said, 'I am very pleased to be here'.

Input from health and social care professionals was easily accessible and was documented. One healthcare professional confirmed the staff followed their instructions so people received the treatment they needed for their conditions to improve.

Overall medicines were well managed at the home and the registered nurses explained people's medication to them when they administered it.

At the time of inspection there were enough staff on duty to meet people's needs. The majority of staff spoken with felt the home was being staffed to meet people's needs. One person said, 'the staff are very good to me' and another said, 'staff are brilliant'.

There was a complaints procedure in place and staff said if anyone wanted to raise a concern they would listen to them and ask them to speak with the registered nurses or the manager so that the complaint could be addressed. People said they would feel confident to discuss any issues, and one person said a concern had been addressed promptly when raised.