The inspection took place on the 22 and 23 November 2016 and was unannounced.Ashbourne Court Care Home, to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 64 older people. The home is situated over three floors. People who receive residential care live on the ground floor, people who have nursing needs live on the first floor and those who require nursing needs who are also living with dementia live on the third floor. Some people living at the service also had additional health conditions such as epilepsy, diabetes and Parkinson’s Disease. Each floor of the home comprises of single accommodation with en-suite wet rooms with washing and toileting facilities. Separate bathrooms are available for those who prefer to use a bath to meet their bathing needs. Each floor has their own communal lounge with a separate quite lounge for people to entertain guests on the Charlton Unit. A kitchenette area with a sink, fridge, toaster and hot and cold drink making facilities is available on each floor as part of the communal dining rooms. The home has its’ own secure rear garden and is situated in a residential area approximately a mile from the town of Andover. At the time of the inspection 58 persons were living at the home.
The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Relatives of those using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.
People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. Appropriate risk assessments were in place to keep people safe.
People were kept safe as the provider ensured sufficient numbers of staff were deployed in order to meet people’s needs in a timely fashion. In the event of unplanned staff shortages the provider sought to use existing staff including the registered manager to deliver care. Agency staff were not used in the home to ensure familiarity and continuity of care for people living at Ashbourne.
Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.
People were protected from the unsafe administration of medicines. Nurses and senior staff responsible for administering medicines had received additional training to ensure people’s medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by managerial staff to ensure they remained competent to administer people’s medicines safely.
The provider used robust recruitment processes to ensure people were protected from the employment of unsuitable staff.
New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely.
People were supported by staff who had up the most relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.
People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people during their daily interactions. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. Appropriate authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.
People were supported to eat and drink enough to maintain their nutrition and hydration needs. We saw that people enjoyed what was provided. People’s food and drink preferences and eating support required were understood and appropriately provided by staff.
People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.
Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff.
People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home.
Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager.
People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were available to people to enrich their daily lives. Staff were motivated to ensure that people were able to participate in a wide range of activities and encouraged them to participate where possible.
The registered manager fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.
Relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager. The registered manager provided strong positive leadership and promoted the providers values. These were promoted on a daily basis with each floor of the home selecting a value they wished to evidence that particular working day. These values were known by staff and evidenced in their working practice.
Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. People were assisted by staff that encouraged them to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided in order to drive continuous improvement.