Archived: Ashgrove Residential Care Home

Ashgrove Residential Care Home is a residential care home for up to 26 older people. At the time of the inspection, the home was supporting 19 people with personal care.

People’s experience of using this service

Improvements had been made with medicine management. Systems were in place for effective temperature control and staff that administered medicines had their competencies checked. For people that received medicines when needed, protocols were in place to administer them safely. However, we found instances where medicines stock did not correspond to people’s medicine records. We made a recommendation in this area.

Improvements had been made with risk assessments. Risk assessments included mitigation to minimise risks in relation to people’s health conditions and circumstances.

Quality assurance systems were in place to ensure people received high-quality care that included auditing care plans and medicine management. However, audits for medicine management would need to be made more robust as this did not identify the shortfalls we found at the inspection.

Pre-employment checks were carried out to ensure staff were suitable to care for people safely. Safeguarding procedures were in place and staff were aware of these procedures.

Systems were in place for quality monitoring to ensure people’s feedback was sought to improve the service. Staff were positive about the management of the service.

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 home was requires improvement (published 12 April 2019) and there were breaches of regulation in relation to risk assessments, medicine management and good governance.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 March 2019. Breaches of legal requirements were found. As a result, we served a warning notice to ensure the home was compliant with risk assessments, medicine management and good governance.

We undertook this focused inspection to check to confirm they now met legal requirements. This report only covered our findings in relation to the Key Questions, Safe and Well-led, which contained those requirements.

The ratings from the previous comprehensive inspection for those Key Questions were looked at on this occasion and were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. 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 Residential Care Home on our website at www.cqc.org.uk.

Follow up:

We will speak with the management team prior to 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 any concerning information is received, we may inspect sooner.

Ashgrove Residential Home is a residential care home providing accommodation and personal care to 21 people, at the time of the inspection.

People’s experience of using this service:

• Medicines were not being managed safely. We found some people had missed their medicines and some staff competency was not assessed to identify if they were competent to manage medicines.

• Risks associated with some people’s needs had not been assessed.

• There was not an effective system in place to quality assure risk assessments and medicine management to ensure shortfalls could be identified and action taken.

• Some people and relatives raised concerns with staffing levels. There were no systems in place to calculate staffing levels contingent with people’s support needs. We made a recommendation in this area.

• Some staff had not completed essential training to perform their roles effectively.

• Staff felt supported by the management team.

• People were supported with their nutritional needs and had choices with meals.

• The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required.

• People continued to receive care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy.

• Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

• People’s independence was promoted.

• Care plans were person centred and detailed people’s support needs.

• More information is in our full report.

• We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Rating at last inspection:

• At the last inspection on 21 July 2016 the service was rated ‘Good’. At this inspection, the rating for the service has reduced to ‘Requires Improvement’.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Ashgrove Residential Care Home provides accommodation and support with personal care for up to 26 older people. The service supports people living with dementia. On the day of our visit there were 24 people using the service. The service had a registered manager. 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 told us they were cared for by staff who were friendly, polite and respected their wishes. They told us they were treated with dignity and respect and felt safe living at Ashgrove. We found some concerns with the environment; however these were addressed straight away. We recommended best practice guidelines to be followed in relation to health and safety and maintenance.

Medicines were managed safely with the exception the medicine room temperatures not always being recorded as checked although there was a room thermometer. The proprietor ensured a new record sheet was in place and informed staff on the need to check this daily.

Staff had attended relevant training and were aware of the procedures in place to protect people from harm. They knew how to recognise and report abuse. Staff were aware of the procedures to follow in the event of a fire or a medical emergency. They explained the regular health and safety checks in place, the incident and accident procedure and the risk assessments in place in order to mitigate risks such as falls, pressure sores and choking.

People told us that there were enough staff during the day but said at night the staffing was sometimes challenging depending on the needs of people using the service. We reviewed Rotas and found that the staffing levels were currently two staff at night which was usually ok but sometimes difficult if someone was unwell. The manager said they lived close to the service and could be called upon if needed out of hours.

There were safe recruitment practices in place to ensure that only staff who had undergone the necessary checks and had suitable skills and experience were employed. Staff underwent a comprehensive induction and annual training program was offered to keep staff up to date with practice. Regular supervision and annual appraisal was in place to ensure staff had the opportunity to reflect on practice and identify any personal development needs that would enable them to deliver safe and effective care.

People told us they were happy with the food choices available and told us that the chef had been changed last year as they were not happy. They told us they felt free to express any concerns or issues they may have related to the care received.

Care plans were person centred and reflected people’s preferences. These were reviewed and updated regularly. Where people lacked capacity to consent appropriate guidelines were followed based on the Mental Capacity Act (2005).

People told us the registered manager was approachable and that they thought the service was well run. There were systems in place to ensure the quality of care delivered was maintained and improved. People were given the opportunity to be involved in running the service at regular “resident meetings.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us the food was good and that they were provided with a choice of food. One person said they had 'lovely food' and another said 'the cook always asks what I want for dinner.'

We found the physical environment was suitable to meet the needs of people who used the service. Steps had been taken to ensure the premises were safe. For example fire exits were free from obstruction and clearly signed. The service had a complaints procedure in place. We found that complaints received were responded to appropriately.

Medications were stored securely. However, we found errors with the recording and administration of medication, which could impact on people's health, safety and welfare. This must be addressed.