Ascot Lodge Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the time of our visit the service was moving towards using a new electronic care recording system. A transition plan was in place which included updating the current paper care records into a new format prior to information being uploaded to the new system. Recently revised records were found to be more comprehensive and detailed. However, further work was required across all care files to ensure all information was up to date, detailed and accurate as some information reviewed provided conflicting advice to staff where needs had changed or not enough detail when additional support should be provided. We found some concerns around the management of medicines. Action was taken immediately to address the issues raised. Notifications of significant events had not always been submitted to external parties. The provider was now aware of their responsibilities to inform all parties within appropriate timescales. People were supported to have choice and control of their lives and staff knew to support them in the least restrictive way possible. However, we found that records of best interest decisions for some restrictions in place were not always completed. Action was taken at the time of our visit to rectify this. We shared some feedback about the recruitment procedures at the service. Progress was being made against the Infection Prevention and Control (IPC) action plan initiated by the Integrated Care Board (ICB) but some areas were still to be addressed. Staff received regular training to ensure their skills and knowledge were up to date and enable them to provide safe care. Staff competencies in areas such as Moving and Handling had recently been introduced with some staff still to complete. Staff were able to recognise possible signs of abuse and knew how to report such concerns promptly. Staff told us they felt supported and felt confident to raise any concerns and that concerns raised would be acted upon.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives we spoke to told us they comment on the service as they visit and if there are any changes that need to be made, they are usually dealt with quickly. Some relatives were not aware that relatives’ meetings were taking place but those that did felt they were informative. One relative commented, “I attend the relative’s meetings regularly. The last one the management was asking what we wanted for our relatives in terms of activities, trips etc. Hopefully our ideas will be implemented.”

The management team shared lessons learned with staff through supervisions and team meetings. Ongoing monitoring was needed to ensure all lessons learned were implemented and sustained. Staff understood their roles and responsibilities to record and report incidents. One staff member said, “We will record information and pass onto nursing assistants or nurses.”

We visited the service partly in response to information we received about incidents that had occurred at the service and to assess if there was any ongoing risk. We found that investigations were underway or completed and lessons learned implemented. However, we found that some actions identified needed further embedding to mitigate future risk. The audit and monitoring systems in place also needed further scrutiny as some concerns we identified during our visit had not been picked up by the provider audits in place. However, concerns identified during our assessment were all actioned immediately.

Assessments were completed before admission and staff gathered information about people's needs prior to them receiving support. The new electronic recording system being implemented provides opportunity for greater detail to be recorded both at assessment and in care planning which will guide staff more clearly in how to support people. Some relatives told us they were involved in planning the care of their relative, however this appeared inconsistent across the service as some relatives told us they were not involved. People and relatives told us they were happy with their support. One relative said, “Following a fall and some rehabilitation, [Name] was sent to Ascot Lodge. [Person] was hardly mobile on admission. The staff at the home got [person] on their feet and [person] is now mobilising themselves. The staff are marvellous.”

Staff were aware of their role in supporting a person to transition from one service to another and in the continuity of care. One staff commented, “We have a handover in a morning when we start our shift so if anyone is ill, we know from that. I also ask and also look at files to see what people have been like. If anything is wrong or needs more attention, they always tell you.”

We received mixed feedback from partners about Ascot Lodge. Overall, partners felt that the team at Ascot Lodge were responsive but there were some areas where they could improve including having a more proactive approach. One professional also commented that it was sometimes difficult to get through on the telephone. Some information in care files also needed review to ensure that when information needs to be shared with other parties it is accurate and up to date.

The provider had processes in place to ensure safe systems, pathways and transitions were maintained. However, the quality of some people's care records and/or medication records required improvement to enable effective information sharing between partners.

Relatives we spoke to told us their family members were safe, and they felt confident in the support they received from Ascot Lodge and were confident any concerns would be appropriately responded to. One relative told us, “I know [person] is safe because the staff are on hand 24/7 and they are brilliant.”

There was a commitment from the senior team to provide staff with the skills and knowledge to keep people safe from abuse and neglect. Staff were able to recognise possible signs of abuse and knew how to report such concerns. Staff told us they received safeguarding awareness training and demonstrated knowledge of whistleblowing procedures. All staff we spoke with felt comfortable raising issues and were satisfied prompt action would be taken to safeguard people. A staff member told us, “I would go straight to [Name of registered manager] and then there’s the whistleblowing number in the foyer.”

During our site visit we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. The atmosphere in the home felt warm and friendly.

Safeguarding concerns had not always been reported as required. However, revised systems were now in place and safeguarding concerns were being reported to appropriate agencies within required timescales. The provider was not always working within the principles of the Mental Capacity Act (MCA). While consent was sought from people for day-to-day decisions, appropriate best interest decisions were not always in place for people who lacked capacity and had restrictive practices in place. When this was brought to the attention of the registered manager it was actioned immediately. There was a commitment from the management team to provide staff with the skills and knowledge to keep people safe from abuse and neglect. Policies and systems were in place to safeguard people from the risk of abuse. However, we identified some areas of care planning and recording and management of medication that needed further attention to ensure people were not inadvertently placed at risk.

People and their relatives told us they felt safe and were supported to understand and manage risks. One relative told us, “Staff are always aware of what is going on and are highly trained in dementia care. My [Name] can get quite aggressive and they always calm [person] down and quite quickly.” We received mixed feedback from relatives about their involvement in the assessment and care planning process. One relative said, “I was involved in the initial care plan, and it’s been updated since admission.” However, other relatives we spoke to told us they were not involved. While relatives we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard.

Staff spoken to were aware of the risks associated with people’s care needs and could describe the support people needed to manage those risks. One staff said, “If someone is not eating very well, not themselves or not drinking, I write it down, tell the nurse and keep an eye on them all the time.”

Overall staff were knowledgeable about people’s needs and preferences and how to manage people's risks. We observed that staff were vigilant when people were moving around or undertaking activities and made sure people remained safe. However, we noted one staff not following the correct process for the thickening of drinks for a person at risk of choking. This placed this person at increased risk of harm. Immediate action was taken by the registered manager.

While staff had a good awareness of people’s needs and how best to support them, our assessment found some care records did not meet the expected standard. The provider had not always ensured each person’s risks had been effectively assessed and measures in place to manage those risks did not always provide sufficient detail for staff to follow. The senior team was responsive to the concerns raised and immediate action was taken for the records identified. A review of all care records was also being completed as part of the transition to the new electronic recording system. Some risks identified during this assessment had also not been identified by the provider's own monitoring systems. However, prompt action was taken by the senior team when issues or concerns were highlighted.

We did not receive any concerns from people or relatives about the environment. Relatives told us that the home was generally clean and there were always cleaning staff about. One relative said, “The home is clean and tidy.”

We did not receive any concerns from staff about the environment or equipment within the service. One staff told us, “We can ask for additional resources if we need them for residents.”

During our site visit we observed some practices which did not always promote people's safety. We noted some carpets which were heavily stained and required a deeper clean or replacement and some areas needing general refurbishment. We observed items stored in one stairwell which posed a risk to people in the event of a fire. This was addressed immediately by the registered manager. We saw evidence that environmental and equipment checks had been completed. Equipment and PPE (Personal Protective Equipment) was available in different areas of the service for staff to access easily.

The systems in place to monitor the safety and upkeep of the premises required improvement. Although regular health and safety checks were completed by the provider some risks identified by Local Authority and ICB (Integrated Care Board) visits had not been picked up by the systems in place. The Infection Prevention and Control Nurse from the ICB had also visited in July 2024 and an action plan was in place from this visit. A review of the action plan showed that several actions had been completed and those still in progress had timescales for completion. The provider informed us that a full refurbishment was planned, and this would commence in October 2024.

People and relatives were positive about the staff and managers at Ascot Lodge. One relative told us, “My [Name’s] needs are always met, and [person] is always clean and tidy. They care with a warmth, not just because it is a job which is lovely.” Another told us, “[Name of registered manager] is always available if you wish to speak to [person].” However, some relatives felt that additional staff were needed. One commented, “There are enough staff about, but they are run off their feet.”

Staff told us they felt well supported in their role and received relevant training. One commented, “Managers are approachable and helpful.” Staff told us there were safe staffing levels at the service. One staff told us, “We seem to be really well staffed. If someone does phone in sick the nurse will have already phoned up a staff or agency before we come in. Very rare that we are short.”

During the site visit, we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. There were appropriate staffing levels in place and people did not have to wait when they needed support from staff.

Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that some areas of the process needed closer scrutiny. For example, to ensure there were no gaps in a staff member's work history. We shared this information with the registered manager who agreed to review for both new and existing staff. Staff underwent an induction and shadowing period prior to commencing work. They had regular updates to their training to ensure they had the skills and knowledge to carry out their roles. Competency assessments in Moving and Handling had only recently been introduced so had not been completed for all staff. A plan was in place to address this. Staff had undertaken specialist training to meet the individual needs of people using the service. During our visit one staff told us about training sessions they were running for new staff with a focus on care records to promote consistency in recording. Staff told us they received the support they needed to deliver safe care. This included supervision, appraisal and support to develop. The frequency of supervision stated in the provider’s policy however appeared low and most of the supervisions completed were group rather than individual supervisions. We asked the provider to monitor the effectiveness of this to ensure staff were receiving appropriate levels of support.

Feedback from people and relatives did not highlight any concerns about cleanliness and hygiene at the service or how staff minimised the risk of infection. Relatives told us that staff always wore gloves and aprons when administering personal care.

Staff were trained and understood their roles and responsibilities regarding safe infection control practices. No concerns were raised about the availability of personal protective equipment (PPE).

We noted some carpets were heavily stained and required replacement/deep cleaning and some areas of the building needed refurbishment. This was impacting on overall cleanliness of the building. We saw staff follow current practice when supporting people and that they used personal protective equipment (PPE) appropriately. PPE was available throughout the building and easily accessible for staff.

The provider had policies and procedures in place regarding IPC (Infection, Prevention and Control) and had systems in place to monitor practices. However, a number of IPC concerns had been picked up at visit in July 2024 by the IPC nurse from the ICB (Integrated Care Board) and an action plan issued. The registered manager showed us the progress made on the action plan from this visit with most actions completed and others in process with timescales for completion. The completion of all identified actions should make IPC measures at the service more effective. Monitoring systems will need reviewing to ensure revised IPC measures implemented are sustained.

No concerns were expressed by people or relatives regarding the administration of medication. People at the home that were living with Parkinson’s Disease were given their medicines on time, which is essential for their wellbeing and safety. Anti-epileptic medicines were also seen to be given in a timely manner, which could lower the risk of someone having a seizure. We also saw other drugs that require a minimum interval between doses were given safely.

The registered manager showed us evidence that audits were completed weekly to show any missed doses of medicines. There was also a dashboard which showed any missed doses for that day that could be followed up on. Staff also told us they didn’t have issues with medicines being unavailable. Whilst we were at the home, we noted that some medicines were overstocked. We reminded the home that they didn’t need to automatically reorder everything if they already had stocks from a previous supply. Staff told us that the relationship with the pharmacy could be better, as they often have issues with communication and obtaining medicines in a timely manner.

People that were prescribed as and when required ‘PRN’ medicines did not always have robust guidance in place, so that carers knew when to give these medicines. This could put people at risk of having too many PRN doses unnecessarily or not having them when needed. The home agreed that guidance could be more in-depth to ensure people received their medicines in the correct way. Although thickeners were stored safely and securely, staff didn’t have robust measures in place to ensure they were always given as prescribed to each resident who needed them. This could lead to people being administered the wrong amount of thickener, which could put the resident at risk of choking. Concerns were raised by the pharmacy that residents may be at risk of not receiving their medicines on time due to delays with the ordering process for some medications. However, we did not witness this on our visit. People that needed their medicines to be given ‘covertly’, hidden in food or drink, had minimal guidance in place on how to do this. The service acknowledged this could be more in-depth using guidance from a pharmacist and a GP. The site of application of topical creams and ointments was not always clear, due to the electronic system only allowing the current location to be recorded. However, accompanying paper body charts were completed to show where on the body they could be applied to prevent reapplication on the same site. During the inspection we saw evidence of daily stock checks of controlled drugs being completed and witnessed with two staff signatures. Medicines were locked away and separated appropriately for each resident. When medicinal patches were administered to people, we saw the home were rotating the administration site to minimise skin irritation and maximise effectiveness. This was documented on the electronic system and previous administration sites could be seen to avoid applying in the same area.