This inspection was unannounced and took place on the 8 and 9 August 2016. At the last inspection on 19 and 28 May 2015 we found that the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). The provider had not ensured that sufficient numbers of suitably trained and skilled staff were delivered. They had also not ensured that people’s care records were accurately and contemporaneously completed. We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that improvements had been made with regard to each of the breaches identified and the provider was now meeting the legal requirements of the Regulations.
Ashcombe is a home which provides nursing and residential care for up to 33 older people who have a range of needs, including those living with dementia, epilepsy and diabetes. At the time of our inspection 27 people were living in the home.
Ashcombe is a two storey building set in grounds on the outskirts of Basingstoke town centre. The home comprises of both single and double sized bedrooms, some with washing facilities such as wash basins. There is a small secure garden to the rear of the home and sheltered seating area to the front of the home allowing people to enjoy sitting in the garden patio area in all weather conditions.
There was no registered manager at this location. 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 HSCA and associated Regulations about how the service is run. A new manager had been appointed by the provider two weeks before the inspection and they were in the process of becoming registered at the time of the inspection.
The provider ensured there were sufficient numbers of staff deployed to meet people’s individual needs. Processes had been put in place to regularly review the required level of staff deployed to meet people’s need. However these processes required additional time to ensure they remained embedded in working practices.
The home provided both long term and short term care for people and to those living with dementia however the environment did not always support people to move around the home safely enabling them to remain independent. Corridors were often used to store moving and handling equipment, handrails were not in place to aide people who were able to walk and appropriate signage was not always available to help people to orientate themselves around the home.
We have made a recommendation that the provider seeks further guidance on the environmental factors which can be adapted to meet the needs of those living with dementia.
Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place and regularly reviewed to keep people safe.
Thorough recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. Induction training for new staff was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence to support people safely.
Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented, known by staff and practiced to ensure people were kept safe.
People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received additional training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.
People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these and the food was pleasantly presented.
People were supported by staff who had received an effective induction and period of support from more experienced members of staff. This enabled them to acquire the skills and confidence to deliver safe effective care. Regular supervisions had been delayed due to a change in management but documented processes were in place to ensure these were competed. Staff were happy to raise any concerns with their colleagues and senior staff and they felt supported as a result.
People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.
The staff and manager promptly engaged with other healthcare agencies and professionals to ensure people’s safety and wellbeing
Staff demonstrated they knew and understood the needs of the people they were supporting and people told us they were happy with the care provided. The manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.
People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.
People told us they did not always know how to complain however all said they would speak with senior staff if required. Procedures were in place for the manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings and participation in the completion of annual survey questionnaires.
The provider’s values were displayed within the home but were not immediately known by staff. However staff were able to describe how the manager wanted people to treat people. We could see these standards were evidenced in the way care was delivered.
The manager and staff promoted a culture which focused on providing care in the way that staff would wish to provide to their family members. The manager was newly in position but in the process of providing strong leadership and had fulfilled the requirements of their role as a manager. The manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. They had also included taking positive action to address areas which had previously been identified as requiring action including conducting regular staffing rotas reviews and seeking feedback to improve the quality of service delivery.