We carried out an unannounced comprehensive inspection of Ashlands Manor Care Centre (Ashlands Manor) on 09 and 11 May 2018. Since this inspection we received concerns in relation to staffing levels, and management of end of life care. As a result, we undertook a focused, unannounced inspection to look into those concerns. This report only covers our findings in relation to the key questions of whether the service was safe, responsive and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashlands Manor Care Centre on our website at www.cqc.org.ukThis inspection was carried out on 18 and 19 December 2018. At our last inspection in May 2018, we found the service was meeting the fundamental standards, and we rated it good overall. At this inspection, the service continued to meet the fundamental standards, and the rating remained good overall, and the rating for safe improved from requires improvement to good.
Ashlands Manor is a '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. The service is a purpose-built home which can accommodate up to 57 people over three floors. All rooms are en-suite and each floor had its own separate facilities. The ground floor supports people requiring support with personal care, the first floor supports people living with dementia and the second floor supports people who need nursing care. There were 55 people living at the home at the time of our 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. There had been no change in registered manager since our last inspection.
No-one was receiving end of life care at the time of our inspection. However, we found there were systems and procedures in place to help ensure the service was prepared to provide effective end of life care when needed that followed good practice guidance.
Nurses employed by the home had received training in how to use specialist equipment that might be needed when providing end of life care. At the time of our inspection, staff had not received any general end of life training. However, we found they were aware of good practice and procedures and were aware of where they could seek additional support and advice from, if needed.
The service regularly used agency nurses, and occasional agency care staff. The registered manager had information about their training and qualifications that allowed them to check they had the appropriate skills and experience to meet the needs of people living at the home.
Where possible, the service used the same agency staff to improve consistency. However, at the time of our inspection, the regular agency nurses were on leave, and the nurse on duty on both days of the inspection had not worked at the service before. We spoke with the agency nurses who told us they felt they had received adequate handovers and inductions to the service to allow them to understand their responsibilities and the needs of people living at the home.
We found there were sufficient staff on duty to meet people’s needs. Some staff said they could be ‘pressured’ at certain busy times of the day, which was also our observation on the first-floor household that supported people living with dementia. However, we saw there were no significant delays to people receiving the care and support they needed.
The service used an electronic system to help manage medicines and record the administration of medicines. Staff told us they found the system worked well, and we saw it had a number of safety measures built into it to help ensure medicines were given safely. For example, the system alerted staff if someone required their medicine at a specific time, or if there had not been a sufficient time gap since the last dose of medicines.
The service was of a modern design and was clean. The service had recently received 100% in an infection control audit completed by the local authority area infection control lead.
Required servicing and maintenance of utilities and equipment at the home had been undertaken. However, we found the passenger lift had not had a required safety inspection. The provider sent us evidence that this was completed shortly after out inspection, and the lift was found to be safe to use.
Care plans were person-centred and contained the information staff would need to provide people with care that met their needs in a safe way, and in-line with their preferences. Although few people told us they had been involved in reviews of their care, people were happy with the information they received about their care and the level of their involvement.
Some people had DNACPR’s (do not attempt cardiopulmonary resuscitation) directions in their care files. We found this information was not always accurately reflected on people’s profile sheets or on the electronic medicines system. Whilst staff we spoke with were aware which people had a DNACPR in place, this would increase the risk that staff or other health professionals would not be aware of this information.
People were happy with the activities on offer. They were able to access the community and go on trips out as often as they wished. Since our last inspection, the service had started to hold scheduled activities on different floors of the home to help increase opportunities for engagement. The provider spoke about wanting to have conversations with people about their aims and aspirations when they moved into the home. One person had been supported to attend a surprise visit to the football stadium on the team they were a keen supporter of.
Staff told us they felt they received sufficient support. They said they were confident that they could raise any concerns with the management team and that they would be listened to. Several staff we spoke with demonstrated a clear commitment to the role and providing good quality care.
There were systems in place to help the provider and registered manager monitor the quality and safety of the service. This included audits of medicines, care plans and health and safety. The accident reporting system had recently moved to an electronic system, which provided opportunities for increased monitoring of themes and trends.
We noted the registered manager’s check of service and maintenance records had not been completed in November 2018, and had not picked up the lack of a required safety inspection of the passenger lift.