Archived: Ashley Arnewood Manor

We found the following examples of good practice.

Measures were in place to prevent the potential spread of infection by visitors. The service had developed a visiting policy based on national guidance. A visitor's pod had been built which visitors accessed from the garden without the need to walk through the home. All visits were scheduled and included time in between each visit to allow for staff to clean the pod. Staff also ensured that people had opportunities to maintain contact with their family members through the use of social media, video and telephone calls.

People who were newly admitted to the home were tested for Covid 19 prior to their admission and were then required to undergo an isolation period in line with national guidance. A contingency plan was in place, including for loss of staffing and isolating residents in case the home identified any positive cases of Covid 19.

The home took part in the whole home Covid 19 testing programme. People living at the home were tested monthly for Covid 19 and had daily observations, such as temperatures, taken to help identify any potential, early signs of the virus. Staff were tested weekly for Covid 19, with additional twice weekly rapid flow tests. Any staff testing positive would be required to stay away from work and self-isolate in line with Government guidance. The home had remained infection free at the time of the inspection.

The home looked clean and hygienic. Domestic staff hours had been increased and routine cleaning schedules had been enhanced with increased cleaning of contact points, such as doors, handles, handrails, and light switches. Designated staff took the lead in infection, prevention and control (IPC) and ensured checks were carried out and IPC guidance was followed. Staff had received specific and ongoing training including IPC, personal protective equipment, and handwashing.

The registered manager took part in a care home manager's forum which enabled them to share ideas and learning. They had good relationships with other agencies and had sought advice when required. The provider had an IPC policy, which included guidance around Covid 19, which had been regularly reviewed and updated in line with changing national guidance.

Ashley Arnewood Manor is a residential care home. It provides personal care and accommodation for up to 20 older people. There were 17 people living at the service at the time of inspection, some of whom were living with dementia.

People’s experience of using this service:

Some aspects of the homes décor and decoration required refreshing an updating. There were plans in progress to prioritise where this was most needed.

The processes for assessing people’s capacity to make decisions about their care were not always clearly documented. The registered manager had started to make improvements.

Processes for monitoring aspects of people’s heath, such as eating, and drinking were not always completed effectively.

People told us they were happy with the care they received at Ashley Arnewood Manor. There was a homely atmosphere at the service, where people shared a good rapport with staff and their relatives were made to feel welcome.

There were effective systems in place to monitor the quality and safety of the service. The registered manager was open to feedbacks and complaints to improve the quality of care. The registered manager had acted pro-actively to address issues highlighted by our inspection.

People’s care reflected their individual needs. This included their preferred daily routines and preferences. People were treated with dignity and respect.

Risks to people were assessed and there were systems in place to protect them from the risk of suffering abuse or avoidable harm. People were involved in planning and reviewing their care needs.

There were enough staff in place, who received appropriate training and support in their role.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The service was rated good at our last inspection (published 4 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection was unannounced and was carried out on 1 and 3 February 2017.

At our previous inspections in July and December 2015, we found the home needed to make significant improvements to meet all of the regulations. Following the inspections, the provider sent us an action plan telling us the steps they were taking to make the improvements required.

At this inspection we found significant improvements had been made and all regulations had been met.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and relatives told us they felt the home was safe. People were protected from abuse. Staff had received safeguarding training, understood types of abuse and the action they would take if they identified any concerns.

People received their medicines safely. Staff were trained and their competency assessed to administer medicines. Systems were in place for the storage and administration of medicines, including controlled drugs.

There were sufficient staff deployed to meet people’s needs. People were engaged in planned activities throughout each week.

People were supported by staff who had received an induction into the home and appropriate training and professional development to enable them to meet people’s individual needs. Staff meetings took place and staff said these were helpful and enabled issues to be discussed. Staff felt supported by the registered manager and were confident to raise any issues or concerns with them.

Staff followed legislation designed to protect people’s rights and ensure decisions were made in their best interests. The registered manager understood Deprivation of Liberty Safeguards and had submitted requests for authorisation when required.

People were supported to maintain their health and well-being and had access to healthcare services when they needed them. People had enough to eat and drink and their specific dietary needs were met.

Staff were kind and caring, had time for people and sat and listened to them when they wanted to talk. Staff treated people with dignity and respect and ensured their privacy was maintained.

Initial assessments were carried out before people moved into Ashley Arnewood Manor to ensure their needs could be met. Information was used to develop person centred plans of care for people.

The service was responsive to people’s needs and staff listened to them. People and, when appropriate, their families or other representatives were involved in decisions about their care planning.

People and relatives were encouraged to give their views about the service. People and relatives confirmed they knew how to make a complaint and would do so if they had cause to.

There was an open and supportive culture within the home. The registered manager provided leadership and guidance to staff who felt supported.

Systems were in place to assess and monitor the quality of people’s care and health and safety within the home. Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. The environment and equipment was regularly checked and servicing contracts were in place, for example for the hoists and stair lift. Incidents and accidents were recorded and actions taken.

Plans were in place to manage emergencies including alternative accommodation should the home need to be evacuated.

We had inspected Ashley Arnewood Manor on 24, 25 and 31 March 2015. This was an unannounced inspection to check they had made improvements to comply with the breaches of regulations we had identified at our inspection on 26 June 2014. At the inspection in March 2015, the provider had not improved the safety and quality of care people received. The provider had appointed two people to jointly manage the service. They had given appropriate support and guidance to the new managers and as they had not attended the home regularly had not been able to assure themselves that people were safe and the home was being managed appropriately.

Following the inspection in March 2015, the provider kept us informed of actions they were taking, including appointing an interim manager whilst recruiting a new manager to oversee the improvement and development of the home.

At this inspection (December 2015) we found improvements had been made. However, there were areas that needed further improvement and some areas that remained in breach of regulation since our inspection in June 2015.

Ashley Arnewood Manor is a small home in New Milton and provides care and support for up to 20 older people, some of whom are living with dementia. Each person has their own room which is personalised with their own belongings and furnishings.

The home does not have 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.

There were not always sufficient numbers of staff deployed at all times. Staff recruitment procedures were robust and ensured only those considered suitable to work in social care settings were employed.

Staff received training, supervision and appraisal to support them in their role. New staff received an induction when they started work and received regular training to enable them to carry out their duties safely. However, the manager and some staff did not fully understand the Mental Capacity Act 2005 or when to apply for a Deprivation of Liberty Safeguards (DoLS) authorisation.

Staff understood their responsibilities to report any concerns of possible abuse. People’s medicines were managed safely although we identified some issues in relation to the administration of medicines. Infection control procedures within the home had improved, although there was still work to be done.

People were treated with respect and compassion. Observations showed staff knew people very well and considered their emotional wellbeing, choices and wishes and promoted their independence. People’s hobbies and interests were documented and staff encouraged people to take part in activities.

Care plans and risk assessments had been reviewed regularly. Although some care plans did not accurately reflect people’s support needs. Referrals to health care professionals were made quickly when people felt unwell and advice was acted upon, although some on-going conditions required closer monitoring.

Surveys were in place to gain feedback from people and relatives, who told us they felt able to voice their opinions about the quality of care provided and any concerns they might have.

Systems were in place to monitor the quality of the service. Health and safety checks were completed to ensure the environment was maintained to a safe standard. Records relating to the management of the home, such as policies required updating and improving.

We found two breaches of the Health and Social Care Act 2008 Regulations (Regulated Activities) 2014. You can see the action we have asked the provide to take in the main report.

The managers told us they had already met with the owner and administrator and had written a service development plan, which we saw. They told us that due to the amount of work that needed to be done, they were prioritising their improvement actions. They were in the process of reviewing all of the service users' care plans, service policies, recording systems, staff training and appraisals and supervision. We found the managers to be responsive to our feedback. All of the staff we spoke with told us that they were already seeing improvements. They told us they had confidence in the new managers to support them and to make the improvements required.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found some aspects of the service were not safe. People told us they felt safe and that staff were kind. One person told us 'Safe, I should say so. I've been here a long time.' Throughout our visit we saw that staff treated people kindly.

Staff understood how to safeguard people they supported and knew about the whistleblowing policy. However, the provider's safeguarding policy did not include details of how to contact external agencies if they had concerns about people.

There were no environmental risk assessments and the provider had not identified areas of risk to people, such as uneven floors and poorly signed fire evacuation routes. There were no risk assessments for infection control or for the Control of Substances Hazardous to Health (COSHH).

Systems were in place to make sure that managers and staff recorded events such as accidents and incidents, complaints and concerns. However, the provider could not always show that these had been reviewed and actions had been carried through.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Relevant policies and procedures were in place. However, the managers were not aware of recent changes to the legislation.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding, DoLS, infection control, learning from incidents and events and identifying environmental risks.

Is the service effective?

The service was not always effective. We saw that people were referred to other health care professionals, when necessary, for specialist advice and treatment. People's health care needs and associated risks were assessed. However, this information was not always used to inform the planning of people's care. Most care plans and risk assessments were reviewed on a monthly basis, but did not always reflect people's changing needs.

Most people we spoke with could not remember if they had a care plan, but most remembered being asked questions about their care. People told us 'I tell them [staff] what I like' and 'I like to stay up late and that's ok'. However, when we viewed people's care plans there was not always evidence that they, or their relatives, were involved in the planning of their care.

Where people did not have capacity to consent the provider had not acted in accordance with legal requirements. There were no mental capacity assessments for the people whose records we viewed. Best interest decisions had not always been carried out in line with the Mental Capacity Act 2005. Staff we spoke with had little or no understanding of the requirements of the Act.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in their care and assessing people's mental capacity.

Is the service caring?

The service was caring. People told us that staff were kind and caring. We heard that staff were 'Very kind' and 'So careful'. One person said 'I like it here. They are very, very good'. We observed that staff spoke to people with kindness and respect.

We saw care and support being provided to people in a kind, patient and considerate manner. Staff used gentle encouragement with people to ensure they received the care they required.

Is the service responsive?

We found that staff were responsive. We saw that most of the time there were care staff on hand in the lounges and staff responded to people in a timely way. We observed staff supporting each other to achieve positive outcomes for people. For example, if one staff member could not encourage a person to have a bath, another member of staff was called to see if the person would respond to them. This was undertaken in a sensitive and compassionate way.

Most people told us they knew how to make a complaint if they were unhappy. We saw that the service had responded positively to ideas from people at a recent residents meeting.

Is the service well led?

We found the service was not always well led. The managers had started to carry out a programme of supervisions (Observed care practice) with care staff. They had reviewed each staff member's training needs and training was in the process of being booked. Staff told us that they felt supported and listened to by the new managers and that there was an open door policy for them to talk to the managers when they needed to. Staff were confident that ideas and suggestions for improvements would be actioned. They received training which supported them to carry out their roles. Staff meetings took place which enabled staff to discuss and plan improvements within the service.

There was a quality assurance system in place to identify and address issues and inform improvements. However, actions had not always been followed up. For example, on the day of inspection we found that not all issues identified by the Fire and Rescue Service in April 2013 had been addressed. We have shared this information with the Fire and Rescue Service. Staff told us they are confident that monitoring will improve under the new management. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

We were assisted by the registered manager for part of the inspection and by the deputy manager for the remainder of the visit. We looked at the care records for three people and spoke with eight people who lived at the home. Some people were not able to tell us about their experience of the home because of dementia. We also spoke with one visiting relative and with four members of staff.

We found that people's care and support needs were being met. Their needs had been assessed and care plans put in place to inform staff of how to support people. Staff were knowledgeable about people's care needs and any medical needs had also been addressed with appropriate referrals to health professionals.

The home had robust recruitment procedures in place and we found that these were being followed. Recruitment regulations had been complied with for the recruitment of new members of staff.

There were suitable staffing levels maintained to make sure that people's needs were being met.

The home had good systems in place to monitor the quality of service of being provided.

People we spoke to said they felt respected by staff, one person told us that staff "always knock on my door before entering". One person we spoke to said they felt they could live their life as they wished, commenting that the staff "respect my wishes".

We found that people experienced safe and effective care based on personalised individual care plans and risk assessments.

We found an effective system was in place to monitor the administration of medication.

We found that people were protected against the risk of abuse because staff had undertaken safeguarding training. Staff demonstrated and awareness of safeguarding and understood what their duties were if they had concerns and who they should contact.

We found the provider had a thorough recruitment and selection process in place. Staff said that they received disclosure and barring checks and reference checks before commencing employment.

The provider had a twelve week induction program and ongoing mandatory training was provided to ensure staff maintained their skills to perform their job properly.