Ashbury Lodge Residential Home

Ashbury Lodge Residential Home accommodates up to 44 people in one adapted building. At the time of our inspection 34 people were residing at the home. Accommodation is arranged over two floors which are accessed via a lift or stairs. There is a small garden to the front of the building and a car park available to visitors.

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

People received a high level of care which met their needs. However, systems in place to monitor the quality and safety of people's care were inconsistent. Further improvement was needed to ensure governance was organised and evidenced decisions were made to follow other professionals’ advice. It also proved that changes in the care planning records system were necessary.

People felt safe and secure living in the home. People and their relatives were happy with the service and had good relationships with staff members. Risk associated with people's care had been identified and assessed. People received their medicines safely. There were enough staff deployed to meet people's needs. The environment was safe and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

Where incidents or accidents occurred, there was evidence of analysis being completed to determine what measures could be put in place to improve people's safety. Relevant action was taken to reduce the risk of incidents while systems were put in place to keep people safe.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID-19 testing for people, staff and visitors was being followed.

People's needs were assessed prior to them using the service. There was ongoing training for all staff. Staff were supported with regular supervisions and were given the opportunity to attend regular meetings to ensure they could deliver care effectively. People were supported to eat a nutritionally balanced diet and to maintain their health.

People were supported to have maximum choice and control of their lives and staff provided them with care in the least restrictive way possible; the policies and systems in the service promoted this practice.

Staff treated people with kindness and respect, and spent time getting to know them and their specific needs and wishes. We observed positive interactions between staff and people who lived in the home. Staff were responsive to people's needs. People and their relatives knew how to raise concerns. There was a range of activities for people to enjoy.

The registered manager and staff had worked hard to address the shortfalls identified at the last inspection. The registered manager carried out a series of audits to check and monitor the quality of the service and ensure records were completed accurately. The registered manager provided clear leadership and considered the views of people, their relatives and staff in respect to the quality of care provided. The registered manager and staff used the feedback to make ongoing improvements to the service.

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 requires improvement (published 10 June 2021).

Why we inspected

The inspection was prompted in part due to concerns received from other healthcare professionals about people's safety and lack of communication with the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of Safe, Effective, Responsive and Well-led only. For those key questions that were not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

The overall rating for the service has changed from requires improvement to good based on the findings of 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashbury Lodge Residential Home accommodates up to 44 people in one adapted building. At the time of our inspection 37 people were residing at the home. Accommodation is arranged over two floors which are accessed via a lift or stairs. There is a small garden to the front of the building and a car park available to visitors.

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

Care records did not always contain sufficient detail about people's current needs. Documentation relating to people’s capacity and decision making lacked some information. It was not clear how people lacking capacity were involved in the process of best interest decision making. Quality assurance systems had not always been effective in identifying the concerns we found at this inspection.

People were not supported to have maximum choice and control of their lives and staff did not provide them with care in the least restrictive way possible and in their best interests; the policies and systems in the service did not promote this practice.

We have made a recommendation on keeping accurate records with regard to people’s consent.

People were positive about their experiences of using the service. They told us they felt safe with staff and that if they had concerns, they could raise them one of the registered managers.

Medicines were managed safely, and staff were knowledgeable about recognising and reporting abuse. There were sufficient numbers of staff on duty to meet people's needs. There were systems in place to learn from safety related events.

People's dietary needs were met, and staff had the knowledge and understanding to support those who needed additional support at meal times.

Staff told us the registered managers were approachable, they felt supported and communication amongst the team was good.

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 (published 12 September 2018).

Why we inspected

We received concerns about acting on complaints and concerns that people’s consent was not always sought appropriately. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashbury Lodge Residential Home on our website at www.cqc.org.uk.

Follow up

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.

Ashbury Lodge 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 care home accommodates up to 44 people in one adapted building. At the time of our inspection 42 people were residing at the home. Accommodation is arranged over two floors which are accessed via a lift or stairs. There is a small garden to the front of the building and parking available.

At our last comprehensive inspection in May 2017 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service had not always obtained the appropriate consent from people and the care plans required improvement. We issued one requirement notice and a warning notice. We returned in November 2017 to do a focused inspection to check if the required improvement had been made. At that inspection we found enough improvement had been made to address the immediate concerns but further improvement was needed.

At this inspection we found the required improvements had been completed and therefore we have rated the service as 'Good' overall.

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.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff had received Mental Capacity Act (2005) training and told us how it applied to their work.

People had their support and care needs assessed before moving to Ashbury Lodge. This information was then used to start an individual care plan. Care plans contained a good level of information that was clearly detailed, personalised and reviewed regularly. The service used an electronic care planning system which required an individual log in and password. This made sure information was held securely.

Risks had been identified, assessed and the most appropriate measures put in place to keep people free from avoidable harm. Risk assessments were reviewed monthly or sooner if needed.

Staff were trained in different topics and could ask for further training if they felt it was needed. Staff told us they felt supported and could approach the senior management at any time.

The service followed safe recruitment practice and all required pre-employment checks had been completed. There were sufficient staff deployed to meet people’s needs.

People were protected from potential abuse from staff who were aware of the different types of abuse and when to report any concerns. Staff were confident appropriate action would be taken. People told us they felt safe at the service and knew where to go to report or raise any concern.

Medicines were managed safely as safe systems were in place to order, store, administer and dispose of medicines. Staff were trained to administer medicines and followed safe practice. Where appropriate people were referred to healthcare professionals. The service worked in partnership with a range of professionals such as GP’s, district nurses and dieticians.

People had a choice of meals and where needed staff provided people with support to eat and drink. Mealtimes were relaxed and unhurried. Snacks and drinks were provided throughout the day.

There were activity workers in place who took the lead on providing activities at the service. People were able to participate in events based around their interests and abilities.

People and their relatives told us the staff team at Ashbury Lodge were kind and caring. We observed many positive social interactions between people and staff. Staff knew the people they were supporting and there was evidence of a mutual respect.

Complaints were well managed and documented. Where any lessons needed to be learned this was shared with staff and discussed. Team meetings were held regularly and there was a daily heads of department meeting.

End of life care was provided and people could record their wishes in their care plans. Where needed the service worked with other healthcare professionals to make sure people were comfortable and pain free.

The team worked closely with dementia specialists to improve the care and support provided. A dementia consultant was retained who provided guidance, advise and training on dementia care.

Quality monitoring systems were in place. Audits were completed across a range of areas to monitor the quality and safety. Action plans were produced and reviewed by senior management to make sure the required improvement was completed.

This inspection was carried out to assess whether the provider had taken action to meet the warning notice we issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notice have been sustained, to assess whether action has been taken in relation to the requirement notice and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notice we issued and we have not changed the ratings since the inspection on 31 May, 01 June and 05 June 2017. We looked at the responsive domain and the well led domain. We have not changed the rating for the well led key question from ‘Requires Improvement’ because to do so requires a full assessment of all the key lines of enquiry related to this question. We will complete this assessment during our next planned comprehensive inspection. We have not changed the rating for the responsive domain as there remains areas of improvement to be made. The overall rating for this service is 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting the 'All reports' link for Ashbury Lodge on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken the immediate action necessary to address the issues in the warning notice, but further improvements were needed.

A registered manager was in post at the service. 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.

Ashbury Lodge is a care home without nursing that can accommodate up to 44 people. At the time of our visit, 40 people were using the service. One person was receiving respite care with a view to moving to the service on a permanent basis. The inspection took place on 9 November 2017. This was an unannounced inspection.

The recording on people’s positive behaviour monitoring charts had not been completed appropriately and demonstrated a lack of understanding around supporting people positively during times of distress.

People and their relatives continued to raise concerns around the provision of activities. The service was in the process of reviewing the activities provided and recruiting a lifestyle and wellbeing co coordinator to support in this area.

Complaints continued to be managed appropriately within the service, however CQC had continued to receive a further five concerns regarding this service.

The service had started to use a system known as ‘Resident of the day’ to ensure that all aspects of a person’s care and support needs had been met and reviewed. Each person would be the ‘Resident of the day’ during the month and all staff roles would be involved in ensuring this person felt well supported.

There had been improvements to the monitoring charts that were in place. We saw that new food and fluid charts had been implemented which clearly identified why each person needed this chart in place.

A home manager had been recruited and people spoke positively about the management arrangements with one person commenting “We have two managers and can go to either of them, one is new but lovely, they always help me, they don’t say we haven’t got time.”

Systems were in place to monitor the service, however we noticed the review of some records did not always document when areas of improvement had been picked up. This was found in accident records and the review of positive behavioural charts.

There was a registered manager in post when we inspected the service. 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 our previous inspection in April 2016, the home received a rating of requires improvement and were in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection improvements had been made but we found that the service had one repeated breach of Regulation 17 Good governance and one new breach of Regulation 11 Need for consent was identified. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks, however we found that people did not have moving and handling risk assessments in place and information in their mobility care plans did not provide staff with clear guidance. One person was on a behaviour monitoring chart as there had been several incidents of aggression towards other people and staff. We saw that this person had no risk plan in place to manage these behaviours and there was no clear guidance on what staff were to do to support this person.

Staff had received training in how to recognise and report abuse and were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

The service had not always obtained the appropriate consent before taking decisions on behalf of people to ensure care was given in line with their preferences. Staff did not always demonstrate sufficient knowledge around the principles of supporting people who lacked capacity.

The service had remained in breach of the Regulation for ineffective recording in care plans. There was often inconsistent or conflicting information which made it hard to ascertain a person's most current needs.

There continued to be mixed responses from people, their relatives and staff about the activities provided by the service. We observed activities including board games and crafts during our visit and people being asked to participate.

We found that one notification of abuse had not been raised to CQC or The Local Authority Adults Safeguarding team. We raised this with the senior management team who submitted the necessary notification and conducted an investigation into this. The outcome of this event was that the recording did not accurately reflect the events and the person concerned was found to not have been placed at risk when this incident occurred.

Improvements had been made to the décor of the home including redecorating the bathrooms and installing new flooring.

There was a registered manager in post when we inspected the service. 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. The registered manager was present and approachable throughout our inspection. Staff, relatives and people who used the service told us the registered manager was always available if they needed to speak with her and had confidence in her abilities to manage the service.

Infection control was not always managed safely or appropriately in the home. This included shared hoist slings with no recording they were being cleaned in-between different people using them. Communal bathrooms and toilets needed attention to make them fit for purpose. We observed a cracked mirror, cracked toilet cistern, a missing ceiling panel and marked floors and general disrepair.

Medicines were not always managed appropriately in the home. This included the recording of medicines, guidance for medicines taken as required and the management of people who needed their medicines covertly.

The home had sufficient levels of staff and they were seen to be visible for people to call on should they need support. The registered manager had a comprehensive recruitment process in place so people were supported by staff that had completed the necessary checks to be able to work with vulnerable adults.

People were given choices at mealtimes and fluids were encouraged throughout the day. However for people needing assistance with their meals this was not always completed in a dignified manner.

Staff had not received all the necessary training to be effective in their role. Only two people in the home had completed training to support people whose behaviour may challenge, yet we saw staff dealing with these situations throughout our inspection. The provider’s policy stated staff should have received this training.

Where people had been deprived of their liberty the registered manager had made the appropriate referrals to the governing body. This was implemented after a capacity assessment had been completed and a best interest meeting had taken place. Families were involved in the process.

People and their relatives spoke positively about the care and support they received. They said that if they had any concerns they could speak to either staff or the management team. They said they felt their concerns would be listened to and where required appropriate action taken.

Care plans were seen to lack detail and guidance for staff to follow. Risk assessments had not always been put in place and monitoring forms were not consistently completed.

Communication and participation in the development of the home was encouraged and feedback was considered and where appropriate acted upon. Relatives were welcomed in the home and involved in their loved one’s care.

The registered manager was approachable and available for people to see and worked alongside staff on the floor. People, their relatives and staff felt confident that the home was well managed.

The registered manager had quality monitoring systems in place to assess the service. Things that we identified on inspection had been identified by the registered manager as needing improvement and plans were in place.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We observed that people were provided with the appropriate support to eat their meals. Peoples dignity was promoted. We saw that the service recorded information about peoples individual likes and dislikes with regards to food. Recording was completed that ensured that nutritional health was being monitored.

The provider was undertaking building work to provide a new larger kitchen and a new lounge-dining room.

We spoke with relatives who were visiting the home and they told us they were always made to feel welcome. We were told that the manager and staff were approachable and listened to concerns.

We found that people were provided with a choice of food and that the home had systems in place to monitor nutritional needs. However we found that improvements were required to some of the arrangements for the provision of the lunchtime meal. We saw there was a lack of choice over the timing of this meal for some people and that the required staff support was not always available.

The home was clean and hygienic and regular checks on cleanliness were undertaken by the senior staff.

Staff we spoke with told us they were receiving regular supervision and were well supported by the senior staff and managers. We found that improvements had been made to the planning and organising of staff training and that the majority of people were up to date with the required mandatory training.

The home had systems in place for monitoring and auditing the quality of care.

We saw that various improvements had been made to the environment and that more building work was being planned. A new summer lounge had been completed and was due to be put into use shortly.