Ashton Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Ashton Court Care Home accommodates 42 people in one adapted building, across four floors. There were 34 people using the service at the time of our inspection, including some people living with dementia. This unannounced comprehensive inspection took place on 31 July and 1 and 2 August 2018. This meant that neither the provider nor the staff knew we would be visiting the home.
This was the first inspection since the provider registered with the CQC.
The previous registered manager of the service had formally de-registered with CQC in June 2018. A new manager had been employed and supported the inspection process.
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 who used the service and relatives told us staffing was not adequate to run the service safely, particularly the first floor and other floors during certain times of the day. During the inspection we confirmed this to be the case. However, the regional manager confirmed they had increased staffing levels in the 1st floor of the service and provided a ‘floating’ (additional) member of staff to cover during break times and other busy times.
Medicines management had areas which needed to be improved, including timing of administration, disposal and recording. Staff had received training in medicines and competencies had been completed.
We could not always confirm if people were supported to have maximum choice and control of their lives and that staff supported them in the least restrictive way possible. Although documents showed consent was gained. Other issues demonstrated that people were at risk of receiving care and treatment which was not lawfully consented to, for example, lasting power of attorney documentation was not always in place to show those authorised to act on people’s behalf’s. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied, however, the service was not clear on the number of people who had been authorised until they liaised with the local authority after our inspection.
Whilst there was evidence that some of the shortfalls we identified had been highlighted through audits and checks, we noted the issues were still on-going in some cases.
Staff were knowledgeable about the safeguarding process. Accidents and incidents were recorded and monitored to determine if any trends were occurring.
Risks to keep people and staff safe were managed, although we did find some gaps. Health and safety checks on the building and equipment were regularly carried out and we were told that in a recent visit from the fire service they were happy with fire safety. We noted that personal emergency evacuation plans needed to be updated, but the manager was going to address this.
Recruitment processes were undertaken, including pre-employment checks. However, we have made a recommendation in this area as the provider had not always followed best practice in reference requests.
Staff training was mostly up to date. Staff received regular supervision and the manager was working to ensure that annual appraisals were completed. New staff completed an induction and had opportunities to shadow more experienced staff.
Feedback about the food on offer was positive. Where required, people were not always provided with a visual choice so they could decide what they would like to eat. Where people needed support to eat, this was given in a dignified way.
People had access to a range of healthcare professionals to maintain their health and wellbeing. Referrals and appointments had been made with GPs, podiatrists and district nurses. Any advice had been built into care records.
Most care plans in place were person-centred and included details about people's life histories and what was important to them. People’s individual needs were assessed and care plans were put in place and reviewed regularly. However, we did find some care records that needed improved and the manager was already in the process of reviewing these.
People told us staff were friendly and caring. They told us they were treated with dignity and respect. We saw that regular staff knew people well, and we observed positive interactions between people and the staff who supported them. Relatives told us they were welcome to visit at any time.
There were activities planned within the service, however the manager was in the process of reviewing these.
Complaints had been responded to in line with the provider's policy.
Feedback about the management team was positive. Staff described the current management team as supportive. Meeting took place for staff and residents/relatives alike. Minutes were recorded which showed feedback was sought and opportunities for discussion were given.
The service had built links with the local community, including church groups and local schools.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, consent and good governance. You can see what action we told the registered provider to take at the back of the full version of this report.