22 March 2017
During a routine inspection
Ashlea Mews Residential Home provides personal care and accommodation for 40 older people. The service was supporting 39 people at the time of this inspection.
The service 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.
Food and fluid charts were not fully completed, target amount of fluids were not recorded. Where people had refused meals, there were no records to suggest staff had returned at a later time to offer food again.
We have made a recommendation about maintaining records regarding people’s nutritional needs.
There were robust recruitment processes in place with all necessary checks completed before staff commenced employment.
There were systems in place to keep people safe. We found staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Accidents and incidents were recorded and monitored as part of the registered manager’s audit process.
The registered provider used a dependency tool to ascertain staffing levels. We found staffing levels to be appropriate to meet needs of people who used the service. These were reviewed regularly to ensure safe levels. Call buzzers were answered in a timely manner and staff were visible throughout the building.
Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records (MAR) were completed with no gaps, medicine audits were completed regularly. Policies and procedures were in place for safe handling of medicines for staff to refer to for information and guidance.
Staff training was up to date. Staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss their performance and development.
People were supported by kind and attentive staff, in a respectful and dignified manner. Staff discussed interventions with people before providing support. Advocacy services were advertised in the foyer of the service accessible to people and visitors. Staff knew people's abilities and preferences, and were knowledgeable about how to communicate with people.
People’s nutritional needs were assessed and we observed people enjoying a varied diet, with choices offered and alternatives available. Staff supported people with eating and drinking in a safe, dignified manner.
Care plans were individualised and person centred focussing on people's assessed needs. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date.
People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.
The registered provider had an activity planner with a range of different activities and leisure opportunities available for people.
The registered provider had a quality assurance process in place to ensure the quality of the care provided was monitored. People and relative’s views and opinions were sought and used in the monitoring of the service. Processes and systems were in place to manage complaints.
The service adhered to the principles of the Mental Capacity Act and had made applications to the appropriate agencies to deprive people of their liberty and keep them safe.
The registered provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and electrical wiring test had been completed.
A business continuity plan was in place to ensure staff had information and guidance in case of an emergency. People had personal emergency evacuation plans in place that were available to staff.