Ashley Court Care Home

The care home accommodates people across two floors, and on each floor, there is a lounge and dining area.

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

At the last inspection we identified missing information in two new staff members files such as references, recent photo and previous work history; the provider stated they would put support in place to ensure compliance. However, at this inspection we also found missing information in the two recruitment files viewed, such as, gaps in education and work history that had not been explored during the recruitment and selection process. After the inspection site visit the registered manager provided us with the missing information and told us they had completed a full audit on all staff files.

Reports carried out on behalf of the provider in February 2022 had identified essential repairs were needed to upgrade the fire alarm system. Following the inspection, the provider confirmed in writing that works to upgrade the fire alarm system had been completed on 29 August 2022.

Systems were in place to ensure medicines were ordered and disposed of safely and securely. However, good practice was not always followed when storing medicines. The procedures and record keeping for administering external medicines such as topical creams were unclear. The registered manager took immediate action during and after the inspection visit to rectify the areas identified.

Potential risks to people’s care and safety were assessed and kept under review to promote their safety. For example, equipment such as floor sensor (alert) mats were used for people at increased risk of falls. Pressure relieving equipment was used for people with frailty and poor mobility to reduce the risks of skin damage.

People using the service and relatives confirmed there were enough staff available to meet the needs of people using the service.

People were protected from the risk of abuse and told us they felt safe. There was a positive inclusive culture in the home. Care was person centred and people's individual characteristics were considered and planned into care.

People and their relatives spoke highly of the staff and management team and felt included and well supported.

The registered manager and management team were open and transparent. They focussed on improving the service. They worked in partnership with other health care professionals to achieve positive outcomes for people.

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.

Rating at last inspection and update

The last rating for this service was good (published 15 February 2021).

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

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

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

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 staff recruitment.

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 to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashley Court is a residential care home providing personal care to 34 people aged 65 and over at the time of the inspection. The service can support up to 38 people.

The home is set over two floors. The second floor can be accessed via a lift. There is a communal lounge and dining room on each floor.

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

Assessing risks to people required some improvement to ensure that all risks were mitigated. A safety installation was required to windows to ensure they met health and safety executive requirements.

The providers policy and procedure for recruitment had not consistently been adhered to, though all staff had a disclosure and barring service (DBS) check.

Staff had received training, regular support and supervision.

Cleaning records had not consistently been completed to evidence good infection control practice. The home appeared clean and was free from malodour. Staff had access to personal protective equipment (PPE) and we saw this used appropriately throughout the inspection.

Systems and processes to manage the safety and quality of the service had not consistently identified gaps in record keeping found during the inspection. We have made a recommendation that current systems are reviewed.

Medicines were managed, stored and administered safely.

People were protected from the risk of abuse and told us they felt safe.

There was a positive inclusive culture in the home. People and their relatives spoke highly of the staff and management team and felt included and well supported. Care was person centred and people’s individual characteristics were considered and planned into care.

The registered manager and management team were open and transparent and focussed on improving the service. They worked in partnership with other health care professionals to achieve positive outcomes for people.

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.

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 4 October 2019)

Why we inspected

The inspection was prompted in part due to concerns received about the safety and management of the service. A decision was made for us to inspect and examine those risks.

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.

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.

The accommodation is on two floors. Communal areas included a lounge and dining room on each floor, and quiet areas.

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

Risks to people’s safety were assessed and reviewed. However, the service provides care for people living with dementia and at times having a heightened confused state. Thickening powder, (used to thicken liquids for people with swallowing difficulties) and denture sterilising tablets were found within people’s reach. This presented risks that people may accidentally ingest them. The registered manager had these items removed immediately and provided reassurances that all such products are now stored safely away.

People at high risk of falls that spent time in their bedrooms did not have staff call bells available. We also found floor sensor mats and a walking aid were not placed within easy reach. This meant falls risks were not being appropriately managed. This also increased the risk of social isolation as people in their bedrooms had limited means of summoning staff assistance when required. Soon after the inspection the registered manager confirmed that call bells had been installed in the bedrooms. In addition, an emergency staff meeting had taken place to stress the importance of people in their bedrooms always having access to call bells, floor sensor mats and walking aids.

People received support that was caring and compassionate. Staff received induction and ongoing training and had the skills and knowledge to provide good care. People were supported to eat and drink enough, have a varied diet and a positive mealtime experience. Staff supported people to live healthy lives and access health care services when required.

People were supported to have maximum choice and control in 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.

Staff were knowledgeable about people using the service, their needs and preferences. People and staff had good relationships with each other. People, and relatives where appropriate, were involved in the planning of their care and support.

Staff respected and maintained people’s privacy and dignity. However, no privacy locks were available on the doors of communal WCs, shower/bathrooms or en-suite toilet facilities. During the inspection this was brought to the attention of the registered manager. They immediately arranged for suitable privacy locks to be fitted to these areas throughout the home.

Care plans were comprehensive and supported staff to provide personalised care. A range of activities were on offer which people were encouraged to be involved in. Complaints were dealt with promptly and there was a system in place to support this. The service will further develop their end of life conversations with people and their relatives.

The service continued to be well managed. The provider had systems in place to monitor the quality of the service. Actions were taken, and improvements made when required.

There were positive working partnerships between the service and other health and social care agencies. Staff felt well supported by the registered manager. They were confident that issues arising would be addressed promptly.

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 21 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we received about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People continued to receive safe care. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the home. People, their relatives and other professionals told us that they had confidence in the manager’s ability to provide high quality managerial oversight and leadership to the home.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

The service had effective recruitment procedures but we asked the provider to note that professional references give more accountability than personal ones.

Assessments included identifying any risks to people and detailing how staff should care for people to support their safety and well-being.

Is the service effective?

People spoke highly of the service. One person living in the home said 'I can't complain' and told us that staff were helpful and available when they were needed. One relative explained the 'great relief to know (their relative) is being properly cared for'

Medication was being appropriately accounted for. We identified that it was not always clear whether prescription creams should be applied regularly or as needed. The manager took immediate steps to address this.

Is the service caring?

Staff had a good knowledge of people's needs and spoke with people in a kind and caring manner. People living in the home spoke highly of the staff.

Is the service responsive?

Assessments and care plans contained a good level of detail to make sure that staff had the appropriate information to meet people's individual needs and preferences.

People were consulted and supported to make decisions about their care. Where people were not able to make decisions for themselves decisions were made in their best interests.

Is the service well-led?

The service has a quality assurance system. Records seen by us showed that shortfalls identified via audits and other checks had been addressed.

People who used the service and their relatives were able to give feedback on the running of the home via regular satisfaction surveys. Staff were also able to give feedback so their knowledge and experience was taken into account.

You can see our judgements on the front page of this report.

We looked at the medication administration records. We saw that although staff signed for the majority medication given they did not sign for prescribed creams. This meant that it was not possible to determine whether creams were being administered as prescribed.

Staff told us they had regular supervision sessions and attended training to ensure that they had the skills and knowledge to do their jobs.

We saw that people using the service and their relatives had been able to give feedback about the service through regular satisfaction surveys. We looked at a selection of these and saw the feedback was positive.