Ashbourne House Care Home

About the service

Ashbourne House is a residential care home which provides accommodation and personal care for up to 35 people. At the time of the inspection 25 people lived at the service. The accommodation is provided in one building with bedrooms across two floors and communal areas on the ground floor.

People’s experience of using this service and what we found

Relatives spoke positively about the home and the care and support provided by staff. They told us they felt their loved ones were safe living at Ashbourne House. The recruitment process was robust and there were enough staff to care for people safely. Medicines were managed correctly. A minor issue with medicines records was brought to the attention of the registered manager during the inspection and dealt with promptly.

Infection control practices were in place and the home was generally clean. However, we found the flooring and fittings of the downstairs shower room were in a poor condition and difficult to clean. The provider has agreed to refurbish the room within a specified time frame.

Since our last inspection there had been a change in the management of the home, with a new registered manager in post, who worked closely with the area manager. Staff spoke positively about the management team and were happy with changes that had been recently implemented. Staff told us they felt morale and team working had improved and that they felt valued and supported.

There had been an improvement in the quality assurance systems used to monitor the service. Relatives we spoke with were happy with the way the service communicated with them and kept them informed. Regular monthly contact with relatives had recently been introduced to ensure they had an provide an opportunity to discuss any concerns and to provide feedback.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 June 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will review the service to ensure the refurbishment of the downstairs shower room is completed. 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.

Ashbourne House is a residential care home providing personal care to 35 people. At the time of the inspection 24 people lived at the service. The accommodation is provided in one building with bedrooms across two floors and communal areas on the ground floor.

People’s experience of using this service and what we found

Systems were either not in place or robust enough to ensure accurate records were maintained. Documentation was poorly maintained. Body maps showing where prescribed creams should be applied had information missing, such as the person’s name and the name of the cream. Prescribed creams did not have opening dates documented.

Cleaning regimes had increased and some checklists were used, however, a specific checklist for high touch surfaces was not in place.

Governance systems failed to identify some of the issues we found during the inspection. Timely action was not always taken post findings on audits. We received negative feedback from relatives about how the service was keeping relatives informed.

Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults. Staff received regular mandatory training and regular refresher training where required. There were enough staff to support people. People were protected from the risks of abuse and harm and people said they trusted staff to keep them safe.

Some improvement had been made from the last inspection. The provider had implemented a premises improvement plan and was on track with updating the building and redecorating bedrooms and communal areas. Staff felt supported and praised the acting manager.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continuing breach in relation to record keeping and the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashbourne House is a residential care home providing personal care for up to 35 people. At the time of our inspection there were 32 people living at the home.

People’s experience of using this service and what we found

The environment was generally well-maintained and there was an on-going redecoration programme. Staff followed good infection control practices. However, we found some areas of the home would benefit from better cleaning. Some routine maintenance checks had not been completed regularly.

There is an ongoing investigation into financial impropriety at the home.

New staff received an induction to the service and all staff received regular supervision. This provided them with an opportunity to discuss their work performance and training needs. However, we found some staff had not completed all their mandatory training.

Risk assessments had been completed. These helped identify if people were at risk from everyday harm, such as falls or poor nutrition. Care plans contained information to guide staff with how people wished to be cared for. However, we found some lacked detail and were not person-centred, particularly in relation to how people needed to be supported with their behaviour.

Medicines were administered safely and as prescribed, although greater detail was required in ‘as required’ medicines protocols.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff helped people to access healthcare services and receive ongoing healthcare support. The service met people's nutritional needs and people were provided with a good choice of food.

People were supported by staff who were kind and caring. People were encouraged and supported to be as independent as they could. A range of activities were provided for people to take part in.

There were systems in place to ensure only staff who were suitable to work with vulnerable people were recruited. There were enough staff to provide the appropriate level of support to people.

Some quality assurance processes, such as audits, were in place. However, they had not identified the concerns we found during our inspection. The area manager had identified that improvements were needed with oversight and management of the service, and had started to make some changes.

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

Rating at last inspection

The last rating for this service was good (report published January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led relevant sections of this report.

We have identified breaches in relation to staff training and oversight of the service.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected Ashbourne House Care Home in October 2014, at which time the service was compliant with all regulatory standards inspected.

Ashbourne House is a care home in Oldham, providing accommodation and personal care for up to 35 older people. There were 31 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 sufficient numbers of staff on duty in order to safely meet the needs of people who used the service. The registered manager assessed people’s dependency to ensure there were sufficient staff to meet people’s needs.

All areas of the building were clean and well maintained, including external areas. Where refurbishment was required, we saw this had been incorporated into an existing action plan.

Staff demonstrated a good knowledge of safeguarding principles and what they would do should they have any concerns. People who used the service and their relatives confirmed they felt safe.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service (DBS) checks, references and identity checks.

The storage, administration and disposal of medicines was safe, in line with guidance issued by the National Institute for Health and Care Excellence (NICE) and supported by clear lines of accountability and auditing.

Risk assessments identified individual needs and staff displayed a good knowledge of the risks people faced, such as tripping, and how to reduce these risks.

People received the treatment they needed via prompt and regular liaison with external healthcare professionals such as GPs, nurses and specialists.

A training matrix was used to ensure staff refreshed their knowledge regularly. Staff had received training in Safeguarding, First Aid, Fire training, Moving and Handling, Deprivation of Liberty Safeguards/Mental Capacity Act, Equality and Diversity, Infection Control, Medication, Health and Safety and Dementia Awareness.

Staff received regular supervision and appraisal as well as the opportunity to raise any issues at regular team meetings.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service was working within the principles of the MCA.

The atmosphere at the home was welcoming and vibrant. The strong consensus of opinion from people who used the service, relatives and external stakeholders was that staff always behaved patiently and in a dedicated manner. We observed people who used the service interacting with staff in a relaxed and comfortable manner with staff during our inspection.

Staff had recently been trained in end of life care and external professionals confirmed the service was well prepared to provide such care, although no one was receiving end of life care at the time of our inspection.

Person-centred care plans were in place and staff also had regard to individualised signs on each person’s door, which gave their name and one thing special to them. We saw regular reviews of care plans took place with the involvement of people and their family members.

Group activities took place regularly, such as in-house entertainment and parties. There was an opportunity to improve the way person-centred activities were planned and documented. The registered manager and other staff agreed the recruitment of a dedicated activities coordinator would help the service improve in this area. Relatives and people who were able to communicate their preferences confirmed they enjoyed the group activities.

People who used the service, relatives and external professionals we spoke with were generally extremely complimentary about the registered manager and the staff team as a whole. We found morale to be good and a strong team ethic in place that valued providing a good standard of care to people who used the service.

We found the registered manager undertook a range of audits and unannounced spot checks to ensure standards of care were maintained.

to answer five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with 3 people who use the service, 4 visitors, the

registered manager, the registered provider and 5 care staff. We also reviewed records

relating to the management of the home which included, 5 care plans, daily care records,

medical administration records and 6 staff records.

Below is a summary of what we found. The summary describes what people using the

service, their relatives and the staff told us, what we observed and the records we looked

at.

Is the service safe?

The premises were clean, well maintained and had procedures in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage of medication.

We saw safe techniques were used by staff when helping people with mobility difficulties.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A person living at the home told us 'There is always someone around and if you call for help they respond to you in time.'

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about people's diagnosed health conditions and also their preferences. This meant they received care that protected their welfare and safety.

People and their relatives told us the food was good and there was a choice at meal times. One person said, "Mum is always pleased with the food."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "It is absolutely brilliant, can't fault it. The carers, cooks, cleaners and handyman are all lovely." We observed that staff providing people's care were gentle and encouraging.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person's dignity. One told us, "I always knock on the door before entering and ensure curtains are closed.' Another told us 'Dignity is about talking to people and asking them about what they would like.'

Is the service responsive?

People's records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a general practitioner or district nurse.

People who lived at the home and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive and she was always around.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager.

Staff had an induction programme and appropriate recruitment checks were in place. Staff felt listened to and supported by their senior carer or manager.

People using the service, their relatives and other people involved with the service had completed satisfaction surveys and records showed action was taken where any improvements were required.

One person living at the home told us the 'The staff are very kind and always polite. I'm well looked after here'. Another told us 'I like to stay in my room, I'm happy with my own company and have everything I need'. Two people living at the home told us they couldn't manage to live independently but felt 'safe' at Ashbourne House.

Approximately three times each year people living at the home, relatives and stakeholders were asked to complete satisfaction questionnaires. The vast majority of responses we reviewed were positive. One relative commented 'Staff couldn't do a better job. All the staff were excellent'. A GP who visited the home described the standard of care as 'often to a higher standard than would be expected'.

The provider had a complaints policy in place. One person using the service told us 'I've no complaints. If I did have I'd tell the staff and they'd sort it out'.

The care records we saw had been reorganised and provided clear information about people's care and support needs. This information was updated regularly. People were involved in their care planning and were appropriately asked to consent. If it was thought that they may not be able to make their own decisions a mental capacity assessment was carried out.

Staff files had also been reorganised and contained clear up to date information about all aspects of their employment.