This inspection took place on 10 April 2017 and was unannounced. At our last inspection on 17 and 19 May 2017 there were three breaches of the Regulations. These were for Regulation 18, Staffing; Regulation 9, Person-centred care; and Regulation 12, Safe care and treatment. During this visit we found some improvements had taken place, but there were areas which continued to require improvements from out last visit, and other concerns identified.Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to a rating of ‘good’.
Ardenlea Court is a ‘care home’ which provides nursing care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The home provided support to people with physical disabilities and people who live with dementia. The ground floor provided permanent residency to eight people, and an Intermediate Care Unit (ICU) comprising of 18 beds. The ICU provided beds contracted by the NHS for people who were ready to leave hospital but required further assessment to determine their longer term needs. These are termed 'discharge to assessment' beds. The first floor provided a maximum of 29 beds for people who lived with dementia. On the day of our visit 51 of the 55 beds were occupied.
The home 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. The registered manager was new in post and had been registered with the CQC in February 2018.
Since our last inspection the management team at the home had changed. The previous registered manager and deputy manager left at the end of 2017, and a number of staff left around the same time. Up until the departure of the previous registered manager and deputy manager, we were informed there had been improvements at the home; but on the departure of key people, the standards of care and treatment had again slipped.
At our last inspection the provider breached Regulation 9 of the Health and Social Care Act, Person Centred Care. This was because people who lived on the first floor dementia unit had little engagement with staff and limited opportunities to be involved in activities that reflected their interests and hobbies. During this visit we found some improvements had been made, but not enough to achieve compliance of this regulation. This was because whilst some people were receiving a responsive service, a number of people with more complex needs on both floors were not receiving the responsive service they needed. Care records often provided just adequate information about people, and some information was difficult to read.
At our last inspection the provider breached Regulation 12 of the Health and Social Care Act; Safe care and treatment. This was because medicines on the Intermediate Care Unit were not always managed safely and risks to people’s health and welfare had not always been appropriately assessed. Prior to our visit we had been informed there were concerns with medicine management on the intermediate care unit. This was particularly around the management of medicines for people newly admitted to the home and nursing staff ensuring that people received the correct medicines when their prescription had changed. At the time of our visit this had started to improve, but there continued to be issues. We found some improvements in the areas of risk management identified at our last inspection, but during this inspection we found that people’s risks had still not always been appropriately identified or acted on. This meant the provider continued to be in breach of the regulation.
At our last inspection the provider breached Regulation 18 of the Health and Social Care Act; Staffing. This was because nursing staff on the Intermediate Care Unit did not have time to undertake their roles and responsibilities systematically and safely. There were not enough care workers deployed on the first floor to ensure people's safety without restricting their freedom or independence. During this visit we found there was enough time provided for nursing staff to undertaken their roles safely, but since our last visit there had been a high level of staff leave the home, and the provider had used agency nurses to cover the rota. This meant people had not always received continuity of care. We found on the first floor dementia unit, people were not having their freedom restricted as we had previously seen; but the level of staff or staff deployment meant not all people on the floor had their complex needs supported well. This meant the home continued to be in breach of the regulation.
After our inspection visit we were informed that both the registered manager and clinical lead for the ICU had resigned. This meant the home was being managed on an interim basis by the senior management team. The ongoing breaches of the Regulations, and the shortfalls in some of the service checks meant the provider was in breach of Regulation 17 of the Health and Social Care Act; Good Governance. This is the second time the home has been rated as requires improvement.
Staff had received enough training to meet people's personal care needs and most had undertaken training in dementia care, although not all had undertaken specialised dementia care training. Where staff had received training, they did not always have time to put their training into practice. Staff had not received training in' end of life care', yet supported people and their family members during this time.
The provider supported staff with training on the Mental Capacity Act; and had submitted Deprivation of Liberty safeguards where people's liberty was restricted and they did not have capacity to consent to restrictions. Staff understood the importance of gaining people's consent when undertaking care tasks to support their well-being. However, some capacity assessments were not accurate.
Staff tried to be kind and caring to people. On the intermediate care unit, people did not stay long periods of time and received support from NHS staff as well as the provider’s care and nursing staff to meet their needs. However, on the other side of the ground floor and on the first floor dementia unit, people’s care was provided by the provider’s staff or agency staff only. People and relatives told us that whilst staff were kind and caring, they often did not have time to do anything other than personal care. All staff supported people with their dignity and privacy. Visitors were welcome at the home.
The provider had a complaints policy and procedure and actively addressed any complaints they were made aware of. Verbal concerns and written complaints had previously been looked at separately; but the provider was merging the two into one reporting tool so they could identify more effectively emerging themes or trends.
The menu for the home offered people a choice of meal each day. People with dementia were seen being offered two choices in a way they could understand. People enjoyed their meals. The home catered for people with specific diets and nutritional needs and some concerns had been raised that staff did not always attend to these.
Checks were carried out prior to staff working at the home to reduce the risk of employing staff unsuitable to work at Ardenlea Court. Staff understood how to safeguard people from abuse, and were aware of the provider's policy and procedure to report any concerns.
Premises and equipment were safe for people to use. The home was mostly clean and staff understood the importance of infection control.
People were supported to access other healthcare services when they needed medical attention.