Archived: Ash Court Care Home

We found the following examples of good practice.

Appropriate measures were taken to avoid staff, residents and visitors to the home from catching or spreading infection. There were designated areas for relatives and friends to visit or visitors could see people in their own rooms if preferred.

There was adequate room in the home for people to socially distance and to minimise close physical contact with others. New people were admitted safely and people in isolation did not use communal areas. Staff maintained communication and activity with people in their rooms when isolating.

All staff and residents had been vaccinated and there was a regular testing regime in place. The use of agency staff was kept to a minimum to maximise infection control of people living and working in the home.

At the time of the inspection we were told that all staff had undertaken appropriate infection control training and there were two infection control leads. However, at the time of writing the report we had not received the infection prevention and control policies, procedures and audits requested.

Stocks of the right standard of personal protective equipment (PPE) were well-maintained and staff used and disposed of it correctly. Most staff were observed to be wearing appropriate PPE throughout the inspection. However one member of staff was seen not wearing a mask.

We were told that the home was in the process of recruiting for a new housekeeper and we observed the home to be mostly clean and hygienic throughout. However, we did observe some areas of the home were not as visually clean as would be expected. We pointed these out to the home manager at the time.

Ashcourt Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashcourt is a purpose-built care home with bedrooms over two floors in a suburban neighbourhood of Liverpool. The home had 42 en-suite bedrooms, all for single occupancy. The home had two lounge areas, a dining area, accessible gardens, a conservatory, a smoking room and accessible bath and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 42 people. At the time of our visit 38 people were living at the home. Ashcourt Care Home provides residential care for older people.

The home required 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. A new manager had been in place for two months, they had not yet applied to become registered with the CQC.

During our previous inspection in October 2016 we had found breaches of regulation 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service was ‘requires improvement’. Following the inspection, we issued a warning notice for the breach of regulation 12. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions; ‘Is the service safe?’ ‘Is the service effective? ‘Is the service caring? ‘Is the service responsive?’ and ‘Is the service well-led?’ To at least a rating of good.

At the previous inspection there were concerns with risk assessments and some of the safety checks of the building were also not kept up to date. Some people’s care plans did not reflect their support needs, reviews of the care plans did not show involvement from people or their relatives. Activities at the home were limited. Management’s audits had not highlighted these problems and the service provided to people did not follow the principles of the Mental Capacity Act 2005 (MCA).

At this inspection we saw that there had been improvements made in these areas and the service was compliant with all of the health and social care regulations. The breaches we identified in October 2016 had been addressed, the overall rating is now ‘good’.

People and their relatives told us that they felt safe living at the home. One person’s relative told us, “I feel mum is safe when I am not with her. I feel confident that they care as I would.” Feedback from people’s relatives and visiting health care professionals was that staffing levels had improved. During our visit we saw that there was enough staff to meet people’s needs safely.

People told us that the staff were caring and friendly towards them. One person told us that they thought the staff were, “Very good and friendly.” Another person told us, “They have all been very nice.” A third person told us that staff stop and take the time to ask people how they are.

Staff received training appropriate to their role. They told us that they felt well supported and effective in their roles. We saw that trained staff administered people’s medication safely.

We saw that the service had appropriate safeguarding policies in place, new staff were recruited safely and staff received training in safeguarding vulnerable adults.

People told us that the home’s environment and their rooms were nice, clean and well kept. There was ongoing improvements being made to the home’s communal areas. There was also a series of health and safety checks in place to ensure the building was safe.

People had an individualised care plan which reflected their needs and preferences. Appropriate risk assessments were in place along with plans to reduce any risks identified. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their relatives praised the quality and variety of activities available at the home.

During mealtimes there was a relaxed and unhurried atmosphere. However, feedback about the food was mixed. There had been a series of temporary staff in the kitchen, however permanent staff had recently been appointed.

The manager at the home undertook a series of daily and periodic audits and checks of the quality of the service provided to people. People and their relatives were consulted in a variety of ways.

Ashcourt Care Home is a residential care home situated in Knotty Ash, a residential area in the suburbs of Liverpool. The bedrooms are all single occupancy with ensuite facilities and there is ample parking and large well-kept gardens to the front and rear of the building. There are several lounges, a dining room and a number of bath and toileting facilities on both floors.

There was a registered manager in post at the time of our inspection. This person was on annual leave. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Care plans contained risk assessments related to people’s care and support needs, however these were not always completed fully clearly identifying the nature of possible risks or how care and support should be provided in ways which minimised the risk. For example, in all care plans we looked at the falls risk assessment did not draw any conclusion about the level of risk or how this risk could be reduced.

Care plans were reviewed at monthly intervals, with notes to confirm what, if anything had changed. However, we did not always see evidence of people’s involvement in the review process.

The monitoring tools used to identify people at risk of malnutrition were being used to record people’s weights on a monthly basis but we saw someone had lost ten percent of their body weight over two months, but there was no identification of risk or evidence any action had been taken.

We saw fire alarm tests and the servicing of the fire extinguishers were overdue. Staff told us they had received fire safety training, and records we looked at confirmed this.

We saw staff followed the correct procedure for administering medicines and supported people well. However some staff who administered medicines had not had their competency assessed checked regularly. Staff applied cream and lotions to people when this was required. There were no record to show where on the body this should be applied and how often.

Staff told us communication was a problem, for example a person had shingles and this information was not relayed to all concerned.

Appropriate background checks were carried out before new staff began working in the service.

The deputy manager and staff did not fully understand the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. We found staff did not fully understand capacity, which meant people may not be receiving appropriate support to make decisions.

We saw there was a programme of training in place which included mandatory training. A programme of regular supervision meetings and annual appraisals was in place.

The catering staff had a good understanding of people’s dietary needs. We saw the food looked appetising and was well presented. People we spoke with told us they enjoyed the meals provided and there was always a good choice. Comments included, “The food is very good and there is always a good choice” and “The food and service is first class.”

People told us they were treated with kindness and compassion. One person said, “Very happy. The staff are very kind. It’s not what I thought it would be like, much better.” Another person said, “Staff are very courteous. I’m happy with everything.”

People told us activities were limited in the home. One relative spoken with said they had selected the home on the basis of its cleanliness and the range of activities apparently offered from Monday to Friday.

We saw the provider had systems in place to ensure any complaints or concerns were recorded and investigated. We received consistently positive feedback about the registered manager. There was an audit programme in place, however the provider did not always take robust action to make any necessary improvements.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

'It's very good here, I'm very happy'.

'It's lovely here, like a hotel'.

'I came from another place which was horrible, this is like a palace'.

'The meals are excellent'.

There were enough skilled and experienced staff to be able to meet the needs of the people who lived at Ashcourt in a timely manner. The organisation had systems in place to keep the people who used the service safe and monitored the quality of the service provided on a regular basis.