Archived: Ascot Lodge Nursing Home

We found the following examples of good practice:

• Staff were wearing the required levels of personal protective equipment (PPE) and they disposed of used PPE safely in line with the relevant guidance.

• The home had a testing programme in place ensuring all people living there and staff were regularly offered a test.

• Staff supported family and friends to safely visit their loved ones in accordance with the relevant guidance.

• People living at the home were supported to isolate when necessary.

• Measures were in place to minimise risk, including staff changing from their outdoor shoes at the start of a shift and uniforms laundered in the home.

• Frequent cleaning was carried out throughout the day.

Ascot Lodge is a small ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ascot Lodge is registered to provide accommodation with nursing and/or personal care for up to 18 older people. At the time of the inspection there were 16 people living in the home. Accommodation includes a TV room and dining room, 12 single bedrooms and two double bedrooms which can all be found across four floors. The home had been adapted for people with limited mobility. There is an enclosed garden and patio at the rear of the building and a small car park at the front.

At the time of the inspection there was 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in September, 2017 we identified breaches of Regulations 10, 11, 12, 17 and18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Ascot Lodge was awarded an overall rating of ‘Requires Improvement’. Following the inspection we issued a warning notice regarding Regulation 17 and asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found that people who lived at Ascot Lodge did not always have their dignity and respect preserved. People's privacy was not always maintained and care was not always provided in a dignified way. During this inspection we found that people were treated with dignity and respect. People and relatives we spoke with expressed their satisfaction with the provision of care which was provided. We found that improvements had been made and the registered provider was no longer in breach of this regulation regarding ‘Dignity and respect’.

At the last inspection we identified that the registered provider was not complying with the principles of the Mental Capacity Act, (MCA) 2005. Consent was not gained in line with the MCA. People living in the home were not being appropriately assessed, assessments were not decision specific and 'best interest' processes were unclear. During this inspection we found that improvements had been made and the registered provider was no longer in breach of this regulation regarding ‘Need for consent’.

At the last inspection we found that the registered provider was in breach of regulation in relation to ‘Safe care and treatment’ This was because people were exposed to unnecessary environmental risks and the delivery of care and support was not always safely managed. We found the environment posed significant risks to people who were being supported, medication management systems were unsafe and accidents and incidents were not being sufficiently monitored. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe care and treatment’.

At the last inspection, we found that staff were not receiving adequate supervision or annual appraisals. Staff expressed that they felt supported but were not receiving formal supervisions or appraisals to help develop them further in their roles. During this inspection we found staff received regular supervisions and annual appraisals were taking place. The registered provider was no longer in breach of this regulation regarding ‘Staffing’.

At the last inspection we found that local audit and governance systems were ineffective. The systems which were in place did not effectively monitor and assess the quality and standard of care people were receiving. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. Audits were routinely completed, the quality and standard of the care being provided was being assessed and improvement action plans were in place. Although the registered provider was no longer in breach of regulation in relation to ‘Good governance’ further improvements were required.

We have recommended that the registered provider reviews some of the systems further to improve the quality and standard of care being provided.

People and relatives told us that the service was safe. Staff were knowledgeable around the area of safeguarding and whistleblowing procedures; they knew how to report any concerns and who to report their concerns to.

We found that there was sufficient numbers of staff on duty to meet the needs of people in a timely way. We received positive feedback from people, relatives and staff about the staffing levels at the home. Staff were visible throughout the inspection and were responsive to people’s needs.

Accidents and incidents were routinely recorded and analysed. We found that all accidents/incidents were being recorded in care records, the necessary care plans and risk assessments were being updated and trends were being established in order to mitigate further risk.

We found the home to be clean, hygienic and odour free. Communal areas, toilets, bathrooms and bedrooms were well maintained. Staff had access to personnel protective equipment (PPE) such as gloves, aprons and hand gels.

We reviewed health and safety audit tools which were in place to monitor and assess the quality and standards of the home. There was a variety of different audits/checks being conducted which meant that people were living in a safe environment.

People’s nutrition and hydration support needs were safely managed. People were regularly assessed and measures were in place to monitor and mitigate risk. We found that appropriate referrals were being made to external healthcare professionals and the guidance which was provided incorporated within care plans.

Recruitment was safely managed. People who were employed had undergone the necessary recruitment checks. We found suitable Disclosure Barring System checks (DBS) in place and appropriate references had been sought prior to employment commencing.

Reasonable adaptations and adjustments had been made to the environment to support people who had limited mobility. People were appropriately supported and independence was encouraged.

People living at Ascot Lodge told us that staff were kind, caring and friendly. Interactions we observed between staff and people living in the home were warm, sincere and familiar. It was evident that staff were familiar with the people they were caring for.

Confidential information was stored securely. People’s personal information was appropriately protected and sensitive information was not unnecessarily being shared with others.

A person centred approach to care was evident; newly revised paperwork was being implemented to further improve person centred care people received. It was clear that staff were familiar with the people they were supporting and how the support needed to be provided.

A complaints policy and procedure was in place. People and relatives told us that they knew how to raise any concerns if they ever needed to.

The range and variety of activities had improved since the last inspection. People and relatives told us they enjoyed the activities available and were able to choose whether or not they wanted to join in. There was a schedule of different activities advertised around the home and people were encouraged to express what activities they wished to engage in.

Systems were in place to gather feedback regarding the provision of care being provided. People, staff and relatives were encouraged to share their views, opinions and thoughts around the standard and quality of care people received. These included staff and ‘resident and relative ‘questionnaires’, resident/relative and staff meetings, meal experience forms, dignity activity surveys.

Following the last inspection the registered provider submitted a number of different action plans to evidence how they were progressing with their improvements. During the inspection we identified that actions were being completed and the quality and standard of care being provided had improved.

The registered manager had notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with our statutory requirements and ratings from the last inspection were displayed within the home and on the registered provider’s website as required.

Ascot Lodge Nursing Home is situated in a residential area of Southport. The home is close to local amenities and local public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes two lounges, 12 single bedrooms and two double bedrooms which can be found across four floors. The home has been adapted for people with limited mobility. There is an enclosed garden and patio at the rear of the building and a small car park at the front.

At the time of the inspection there was 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.

At the previous comprehensive inspection which took place in September 2016 the home was rated ‘Good’. This inspection took place due to a number of concerns which had been reported in relation to the safety of care and treatment being provided at the service.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We are taking a number of appropriate actions to protect the people who are living in the home.

There were a number of identified concerns in relation to the environment and the health and safety standards within the home. The safety of people living within the home was being compromised and health and safety audit systems were not being effectively carried out.

Care records were not being reviewed to ensure that they were an accurate reflection of the support that a person required. This meant that there was a risk that staff, less familiar, with the person may not provide the right level of care and treatment.

During the inspection we found the area of ‘staffing’ to be a concern. Routine supervisions and appraisals were not taking place and were not being carried out in line with the provider’s policy.

Audits were not being effectively completed and action plans were not being followed up on. This meant that people were exposed to unnecessary risk as the quality of service delivery was not being monitored. Accidents and incidents were being recorded however there was little evidence to suggest these were being investigated, analysed or lessons were being learnt.

Specific policies and procedures were available to guide staff practice. However, some of the policies and procedures which were in place did not reflect current legislation, policy or best practice guidance.

Staff were seen to be attentive and offered kind and compassionate care. However, people who used the service were not always treated with dignity and respect. People’s privacy was not protected whilst personal care was being delivered. People were not always kept comfortable within their own bedrooms.

During the inspection we found that people’s private and confidential information was not being securely stored away. We found sensitive information available throughout the home which should have been protected and not available for others to read.

The feedback we received about the range and level of activities was poor and observations supported this. There was no activities timetable in place and there was no activities co-ordinator in post.

There was evidence to suggest the home was not operating in line with the principles of the Mental Capacity Act, 2005 (MCA) When able, people must be involved with the decisions which are taken in relation to the care and treatment which is provided, records we reviewed suggested that the principles of the MCA were not being routinely followed.

The management of medicines was not always safe. We found that people did not always get their medicines as prescribed. Weekly and monthly audits were carried out but were not effective and did not identify areas of concern identified during the inspection.

Ascot Lodge was rated as ‘Inadequate’ in 2015 but following a period of sustainable change and positive improvements the previous inspection which took place in September 2016 found Ascot Lodge to be ‘Good’. However, during this inspection we found that the standards and quality of care has deteriorated and the level and provision of safe care and treatment was not of a ‘good’ standard.

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

There was no dependency assessment scale in place at the time of the inspection. This meant there was no system in place to determine if the staffing levels were appropriate enough to support the people living in the care home. We have made a recommendation regarding staffing levels and the dependency needs of the people who are being support.

Staff received an induction package and training was offered as part of their on-going training. However, there was no evidence to suggest that staff had completed or had been enrolled on to the Care Certificate. We have made a recommendation regarding staff training and on-going development.

The day to day support needs of people living in the home was being met. External healthcare professionals were involved with the health and well-being of the people living in the home. Appropriate referrals were taking place when needed and records were being maintained in relation to external healthcare involvement.

There was a formal complaints policy in place and people knew how to make a complaint. There was evidence of how complaints were being responded to which were in accordance to the organisational policies.

Recruitment was safely and effectively managed within the home. Staff personnel files which were reviewed during the inspection demonstrated effective recruitment practices were in place. Staff who were working at the service had suitable and sufficient references and disclosure barring system checks (DBS) in place.

The registered manager was aware of their responsibilities and had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with the CQC’s statutory notifications procedures. Ratings from the previous inspection were on display within the home and these were also available for the public to review on the provider website, as required.

Ascot Lodge Nursing Home is situated in a residential area of Southport and is close to local amenities and public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes two lounges, 12 single bedrooms and two double bedrooms. A nurse call system is in place along with facilities to accommodate wheelchair access and for people with limited mobility. There is an enclosed garden and patio at the rear of the premises and car parking space to the front.

A registered manager was 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.

People said they felt safe living at the home and were supported in a safe way by staff. This view was supported by relatives we spoke with.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the Local Authority’s safeguarding procedure was available for staff to access.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

Systems were in place to ensure medicines were managed safely. People told us they received their medicines on time. Staff were trained to administer medicines safely to people.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

There were adequate numbers of staff on duty to provide care and support to people when they required it and wished to receive it. Calls for assistance were answered promptly.

Staff received training and support so that they had the skills and knowledge to care for people safely and in accordance with their individual need. People we spoke with and relatives confirmed this when discussing staff expertise.

People’s care needs were recorded and care documents provided information for staff to follow to ensure people received the care and support they required.

Risks to people’s health and wellbeing had been assessed and measures were in place to minimise risks to people’s safety. Risk assessments and associated care plans were reviewed each month to reflect people’s changing needs.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff made referrals to healthcare professionals for advice and support at the appropriate time.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and genuine warm engagement between people living at the home and the staff throughout the inspection.

People told us they enjoyed the meals. The provision of more fresh produce was discussed on inspection along with the provision of more social activities for people to join in with. The management team has responded positively advising us of the purchase of more fresh food and introducing a new activities calendar.

There was a maintenance programme and arrangements in place for checking the environment and equipment was safe.

The culture within the service was open and transparent. Staff told us management was both approachable and supportive and that they felt listened to and involved in the development of the service.

A procedure was established for managing complaints. Complaints received had been responded to and appropriate actions had been taken.

Quality assurance systems were in place to ensure people received a well-managed service. This included audits (checks) on how the service operated. Feedback from people living at the home and relatives was also obtained by meetings, satisfaction surveys and daily discussions with the staff; people told us they were invited to share their opinions and views about the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and well cared for at Ascot Lodge Nursing Home. Effective recruitment processes were established and necessary checks were carried out as part of this process. This helped to ensure staff were suitable to work with vulnerable adults.

The home was clean, hygienic and odour free.

Measures were in place to ensure the environment was safe and suitable for the people who were living there. We did, however, find that some improvements were needed to the fabric of the laundry room to ensure good infection control measures were in place. The provider [owner] has provided us with dates when this work will be carried out. Following a check of the home by the fire authority, we saw the provider had been given by the fire authority an action plan to complete. At the time of the inspection we saw that the provider was working through the required actions to ensure the service was compliant with fire safety. Two follow up visit are planned by the fire authority to ensure the required actions have been completed. We have asked the provider to keep us informed of timescales for completion of this work in accordance with the dates stated on the action plan. These measures are needed to ensure people's safety.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection there was a Deprivation of Liberty Safeguard [DoLS] in place to keep a person safe. DoLS is part of the Mental Capacity Act [2005] and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People's health and care needs were assessed with them and/or with a family member and/or health professional. People and family members told us the staff communicated well with them about their care needs and also preferences around daily living and how they wish to be treated. Care plans reflected current care needs and people told us they had been asked if they were in agreement with the care provision.

Where specialist support was needed, for example, with a person's nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people's health, well-being and independence

Is the service caring?

The people we spoke with told us the staff were kind and helpful. People's comments included, 'The staff look after me well', 'They make sure I get the meals I like'. Relatives supported this view and said the staff were very good.

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people's comfort and dignity at all times.

Staff had a good knowledge about people's care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

Family members told us staff communicated well with them and they were consulted about their relative's care and involved in making decisions when needed.

People who lived at the home and their relatives were able to complete an annual satisfaction survey to enable them to provide feedback about the home. We could see where a change had been made in response to comments received.

Is the service responsive?

People and family members knew how raise a concern if they were dissatisfied with something. A relative said they knew if they had concerns they could come straight to the staff and/or manager and they would be listened to.

From our discussions with people and family members and through looking at a number of care records we could see that people's plan of care was revised to meet any change in need. For example, deterioration in a person's medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that actions were taken where changes were needed to ensure people's safety. We discussed with the manager the frequency and detail of the audits [checks] on the service to help improve the auditing systems in the home.

Staff told us they were able to speak with the manager and their views and experience were taken into account.

At the time of our inspection the home did not have a Registered Manager in place. We informed the manager of the importance of being registered with the Care Quality Commission [CQC]. They agreed to submit the application as soon as they were able to do so.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

People living in the home spoke positively about the care they received. One person told us; 'The food is excellent, you always get a choice. There are great parties for us and our families at birthdays and Christmas. The staff are very kind.'

During our visit we found the atmosphere in the home was relaxed. We observed care and support being delivered and there was good communication between people and staff. Relatives we spoke with were knowledgeable about the care plans in place to support their family member and told us staff discussed how the care was delivered.

We checked the care records of three people and they included care plans related to the medication they required. We looked at the medication administration records (MAR) for those people and found that they were in keeping with the care plans.

People living in the home told us there were enough staff on duty to meet their needs, in a timely manner. Comments included; 'Mornings are very busy but staff always have time for you,' and 'If I need help at night they come quickly.'

On this inspection we found the home now carried out regular audits [checks] in key areas such as infection control, the administration of medicines and the records kept about the care and support provided to people living in the home.

We observed care being delivered and there was good communication between people and staff. Those people who could not communicate verbally were approached sensitively and the staff we spoke with were knowledgeable about their care needs

The staff we spoke with were knowledgeable about how they would identify abuse and described appropriate actions they would take if they had any concerns. They told us about the safeguarding training they had received and knew where the home's safeguarding policy, procedures and key contact details were located. .

During our visit we saw that the home had systems in place to support staff to be suitably skilled to meet people's needs.

We saw that incidents and accidents were recorded, however it was not evident what the outcome had been and if any changes had been made to prevent them happening again. The records we looked at showed appropriate assessments and monitoring had been undertaken of potential risks associated with the home environment.