Ashglade

We found the following examples of good practice.

The provider was in the process of adapting a conservatory to include a windowed partition and intercom, which will allow family and friends to visit without entering the main building.

People were supported to see their visitors via video call. The provider had introduced virtual consultations to reduce the need for external visitors to the home.

The provider had arrangements in place to test both people and staff for COVID-19, in line with the current guidelines on testing.

The provider had clear protocols for people who were infected with Covid-19. Staff were adhering to PPE and social distancing guidance. The provider had a designated area for donning and doffing PPE.

The home had a registered manager in post. 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.

This inspection was carried out on 19 March 2018. At our last inspection at the service on 25 May 2017 we found there were not always enough staff to meet people’s needs. At this inspection we found that improvements had been made and there were enough staff on duty to meet people care needs.

People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals.

Staff had the knowledge and skills required to meet people’s needs. 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 said they enjoyed the meals provided and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.

People needs were assessed before they moved into the home. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People’s privacy and dignity was respected. There was a range of activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on.

The provider recognised the importance of monitoring the quality of the service. They sought the views of people, their relatives and staff through satisfaction surveys. The registered manager worked with other care providers and professional bodies to make improvements at the home. Staff said they enjoyed working at the home and they received good support from the registered manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to them when they needed it.

Ashglade provides accommodation and residential care for up to 12 people. In this report, the name of a registered manager appears who was not managing the regulated activities, at this location, at the time of the inspection. Their name appears because they were still registered as manager on our register at the time. CQC is in the process of establishing the most appropriate means for their removal as the registered manager for this location.

At this inspection on 25 May 2017 there was a new manager in post who had started after our last inspection in January 2017. They were applying to register as the registered manager for the location at the time of this inspection. 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.’

At this inspection we looked at aspects of two key questions; Is the service safe? And is the service well led? This is because regulations were not being met fully in these areas at our last comprehensive inspection in January 2017. We found improvements had been made in these areas since our last inspection. However we also found a further breach in respect of staffing levels as there was not always enough staff deployed to meet people’s needs at all times. We found there was an absence of staff in the communal areas to support people when needed. Staffing levels in the day and at night had not been reviewed to consider increased dependency levels at the home.

You can see the action we have asked the provider to take at the back of the full version of this report.

We found considerable improvements had been made by the new manager at the home. Records of people's care had improved. Care plans and risk assessments were up to date and reflected people’s current needs. There was detailed guidance for staff which we observed was followed in relation to possible risks. Some improvement was still needed as we found two risk assessments for skin integrity had not been totalled correctly to identify the correct level of risk but this had not impacted on people’s care, as we saw there was guidance to reduce risk and suitable equipment in place.

Improvements had been made to the systems to monitor the quality and safety of the home. The manager had ensured audits were regularly carried out across aspects of the running of the home and we saw where they identified areas for improvement this work had been completed. Work was being carried out to improve the conservatory and garden areas that had previously been identified as needing improvement.

Improvements had been made to the way risk was monitored. However, some improvements were still needed to ensure that this was effective over all aspects of the home. For example the issues about staffing had not been identified by the provider and systems to identify possible new risks had not worked effectively at all times.

Although improvements have been made, the overall rating for the home therefore remains Requires Improvement in line with our characteristics for ratings.

Ashglade provides accommodation and residential care for up to 12 people. The registered manager was not managing the regulated activities at this location at the time of the inspection. 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 appointed and started work at the service after the inspection.

We found breaches of regulations at this inspection. We had concerns about the management and oversight of the service, and quality monitoring processes were not robust. Audits were not always completed and where they had been, they did not always identify problems or ensure action was taken to address issues. Recent audits had not identified inaccuracies in people’s risk assessments. People’s care plans and risk assessments were not always up to date or did not reflect their current needs. Accurate records of people’s care and treatment were therefore not always maintained. Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Improvements were required to ensure staff received adequate training, supervision and appraisal. Medicines were safely managed but regular assessments of staff to ensure they were competent to administer medicines were not always in place. Some people and their relatives did not feel consistently involved in reviews about their care, and records reflected this. The arrangements to meet people’s needs for stimulation and social engagement were not always personalised to meet their individual needs. However, a new activities coordinator had recently started and had plans to improve the activities provided. We will check on these aspects at our next inspection.

People told us they felt safe and staff treated them in a caring manner. People’s individualised needs with regards to their disability, race, religion and gender were identified and plans put in place to meet their needs. Staff were aware of the potential signs of abuse to look for and what action to take if they were concerned. People were supported to maintain a balanced diet and told us they enjoyed the range of meals on offer. People also told us that there were enough staff available to safely meet their needs, and we saw that staff were available to support people where required. Recruitment checks were completed before staff started to work at the home.

Staff had received training around the Mental Capacity Act 2005 (MCA); applications for authorisations under Deprivation of Liberty Safeguards (DoLS) were appropriately made. People had access to a range of healthcare professionals when required. A complaints procedure was in place and people told us they knew how to raise concerns if they needed to.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

At our last inspection on 12 December 2013 we found that the provider was not meeting the required standard in some areas. Risk assessments had not always fully identified the risk involved and care plans had not been observed to be fully followed.

At our inspection on 12 and 13 May 2014 we found the service had taken action to update their risk assessments and care plans and the service was now meeting the required standard. We tracked four people's care plans to check that the care plan reflected the care they received.

We spoke with six people who used the service and they told us that they felt well cared for. One person told us 'I have everything I need. It's just like being at home.' Another said 'I am encouraged to do what I can for myself but staff come quickly when I need them.' A third described the staff as 'friendly and gentle.' People we spoke with all said that their call bells were answered promptly.

Relatives we spoke with were also positive about the care they observed both for their family member and other people at the service. We observed people to be well dressed, comfortable and clean. We observed staff interacting respectfully with people at the service and treat them with care. They called them by their preferred name and understood the behaviour signals of those less able to express themselves.

Is the service safe?

We were aware of safeguarding concerns that had been raised about the service in November 2013 and investigated by the local authority. Some of these concerns were partly substantiated. The provider had participated in the safeguarding process and were waiting for the action plan from the local authority at the time of the inspection. They had also put in place their own management plan to address issues raised. No further safeguarding alerts had been raised.

People who could express their views told us they felt safe living at the service. We observed them to be relaxed when interacting with staff. One person told us 'I feel very safe here and well cared for.' The relatives we spoke with also felt that their family members were safe and well looked after. Some relatives had expressed these views at the time of the safeguarding concerns.

The service was clean on the day of the inspection and we could see an effective cleaning schedule in place that was monitored. However the arrangements for infection control did not reflect current guidance and there was a risk of health care infection spreading as a result. We found concerns about the safety of the premises which were not always adequately maintained. There were no identifiable plans to address some areas of concern. Recommendations from a fire risk assessment had not been completed and we were not satisfied that all fire safety precautions had been taken. We have referred our concerns to the Fire Safety office.

At our inspection on 12 December 2013 the service was not meeting the required standard regarding the recruitment of staff. At our inspection on 12 and 13 May 2014 we found that the service had updated their procedures and disciplinary process. Arrangements were in place to make appropriate checks on staff before they started work.

We have asked the provider to tell us what they are going to do to meet the requirements of the regulations in relation to infection control and safety at the premises.

Is the service responsive?

The service had been able to respond to someone's identified need to attend a local support group. We found people's care plans were updated as their needs changed and new risk assessments carried out when people had a fall or a new risk was identified.

Maintenance requests such as light bulb replacements from people at the service were responded to promptly.

Residents meetings were held where issues could be raised and some were responded to, such as the use of a mini bus for trips out, but other issues such as a wheelchair ramp for the entrance to the home had not been addressed.

Is the service effective?

The service was working closely with the district nurse and GP to provide care to someone with more complex needs. They also liaised closely with people's family members. Referrals to other health professionals were made when appropriate.

Audits were undertaken for some aspects of the service such as a cleaning audit, medication audit and care plan audit. However actions taken as a result were not always recorded. The provider and registered manager did not always evidence any learning or improvement in the delivery of the service.

There were systems in place to establish people's views and we saw that they and or their relative were involved in planning and reviewing their care. Some relatives we spoke with told us they felt the small number of people at the service helped staff to get to know people well and understand their needs.

Is the service well led?

An internal action plan for the registered manager had been put in place to address the issues that arose related to the safeguarding concerns in November 2013. This was in progress at the time of our inspection. Both the provider and nominated individual told us they felt things were improving and the registered manager felt they received more support and were working better together. We were shown the plan by the nominated individual and saw that it had timescales for completion and identified areas for improvement.

However during the inspection we found areas of the service provision including outdated policies and procedures and concerns about the safety of the premises that were either identified and not addressed promptly by the provider or not identified by either the nominated individual or the registered manager. Robust systems to monitor quality assurance were not in place.

We have asked the provider to tell us what they are going to do to meet the requirements of the regulations in relation to quality assurance.

There were nine people living at the home on the day of our inspection and we spoke with everyone. People we spoke with told us they were very happy with the care and that the staff were very good. One person said "it's lovely here and staff are very friendly and kind". We observed people being spoken to respectfully and in a pleasant manner. We were told that staff come quickly when call bell was pressed, except sometimes in the night because there is only one staff on shift.

We found that people were asked to consent to their care and that their relatives were involved where appropriate. Care was planned and delivered in line with people's individual needs and medication was administered safely. Staff were supported through training and supervision and people knew how to make a complaint and described the home's manager as approachable. However the provider had not taken steps to protect people from the risk of abuse because they had not always acted appropriately in response to allegations of abuse.

We returned to inspect the service on 23 January 2013 and found the provider had taken account of the views of people using the service and consulted with them about their care. The care plans and risk assessments reflected people's individual preferences and changes in their diet. The provider had reported a safeguarding issue to the police, social services and the Care Quality Commission. Staff were trained in safeguarding vulnerable adults and the provider had carried out appropriate recruitment checks. The provider had also implemented audits to check on the quality of the service provided.