Archived: Ashbourne Court Care Home

Ashbourne Court is a care home providing personal and nursing care to up to 64 people. There were 57 people using the service when we inspected. The accommodation is arranged over three floors. The Charlton Unit cares for people living with dementia and is on the top floor. The Watermills unit is on the first floor and provides nursing care. The Anton Unit, on the ground floor, provides residential care and so the people on this unit are generally more independent. There are no registered nurses based on this unit and any nursing needs are met by the community nursing team.

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

The registered manager was well respected, and staff described him as a “Good leader”, “Passionate” and “Dedicated”. People and their relatives continued to have faith in his ability to ensure positive outcomes for people and the social activities met people’s individual needs and helped them to lead as full a life as possible. There were effective quality assurance systems in place. There continued to be a culture within the service of promoting education and learning. People, their relatives and health and social care professionals were confident staff had the right competence, knowledge and experience to provide effective care. The leadership team and nursing staff collaborated with partner organisations effectively and this helped to ensure positive outcomes for people.

There were sufficient staff deployed to meet people’s needs. People and their relatives told us the service provided safe care and risks were well managed. Medicines were managed safely and people, their relatives and professionals felt the service had responded well to the infection control challenges the virus presented. The provider had appropriate policies and procedures which ensured staff had clear guidance about what they must do if they suspected abuse was taking place. Staff were confident that any concerns raised would be acted upon by the registered manager to ensure people’s safety.

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 ‘Outstanding’ (published August 2019).

Why we inspected

The inspection was prompted in part due to a concern about a safety related incident which had occurred within the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at continued risk of harm from this concern. The provider has undertaken a thorough investigation. This had identified a number of learning outcomes and there is an action plan in place to address these.

Please see the safe and well led sections of this full report.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from outstanding to good. This is based on the findings at this inspection.

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.

We found the following examples of good practice.

People were well supported by staff to have telephone and internet contact with their family and friends. The service facilitated in person visits in a manner which minimised the risk of infection spread, including one nominated visitor in line with guidance, screened visits in the foyer of the home and window and garden visits.

Plans were in place to isolate people with COVID-19 to minimise transmission. There was an isolation plan that involved zoning the home and cohorting staff to different floors in the event of an outbreak. The service had good supplies of personal protective equipment that were readily available at stations throughout the service.

Visitors were asked health screening questions and to sanitise their hands on arrival. Temperature checks and lateral flow tests were carried out and once a negative result was received staff facilitated the visit. Visits were staggered and visiting spaces cleaned between use.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter and there were enhanced cleaning practices with high touch areas such as door handles and surfaces cleaned several times a day.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as quizzes, crafts and exercise sessions. The provider had increased the supported activities sessions by more than 50% during the pandemic to prevent people from feeling socially isolated.

Ashbourne Court Care Home is a care home providing personal and nursing care to up to 64 people. There were 59 people using the service when we inspected. The accommodation was arranged over three floors. The Charlton Unit provides residential and nursing care for people living with dementia. The Watermills Unit provides general nursing care and the Anton Unit provides residential care. There are no registered nurses based on this unit and people’s nursing care needs are met by community healthcare services.

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

Relatives and professionals described the end of life care as outstanding and expressed complete confidence in the skills of knowledge of staff in end of life care. People received person-centred care that truly recognised their individuality, exceeded expectations and achieved positive outcomes. There was a focus on providing activities which were meaningful to people and which provided enjoyment and occupation. People's communication needs were identified and planned for. People expressed confidence that they could raise any issues or concerns with any member of staff or the management team and that these would be addressed.

People consistently told us that staff were exceptionally kind, caring and compassionate and that they were respected by staff who valued them as a unique individual. Equality and diversity were embedded in the principles of the service. Staff demonstrated an inclusive culture and respected people’s individuality and that of their colleagues.

People needs were assessed and planned for. Staff were well trained and well supported and had the necessary skills and knowledge to perform their roles and meet their responsibilities. People’s nutritional needs were met. The design and layout of the building met people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Action was being taken to ensure that best practice frameworks regarding consent were fully embedded.

Care staff were well informed about risks to people’s health or wellbeing and knew how to deliver their care safely. Whilst there were sufficient numbers of staff available to meet people’s needs, some of the feedback we received indicted that these were not always deployed effectively. The registered manager has acted to review this. Overall medicines were managed safely. The service was visibly clean throughout and no malodours were noted. Staff received training in safeguarding adults from harm and had a positive attitude to reporting concerns. There were a range of robust systems in place to learn from safety events and lessons learnt were shared effectively with staff.

People benefited from a well led service and the registered manager and deputy manager had shaped a culture where people were at the heart of the service. There was a clear leadership and management structure in place which helped to ensure that staff at all levels were clear about their role and responsibilities. The service was well organised and had a range of systems in place to ensure its smooth operation and to support good communication. People and their relatives were treated as partners and were actively consulted and involved on an ongoing basis about their care and wider issues within the home. Staff felt valued and were well motivated to provide the very best care to people.

Rating at last inspection

The last rating for this service was Good (November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.