Ashridge Court Care Centre

Ashridge Court Care Centre is a residential care home that provides accommodation and support for up to 69 older people. On the day of our inspection there were 52 people living at the home. Some people had illnesses or disabilities associated with old age such as limited mobility, physical frailty or lived with health problems such as diabetes. Some people lived with dementia and sensory impairment. Accommodation was arranged over two floors with stairs and a stair lift connecting each level.

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

People told us, “I love my views, it’s a good place to live,” and “They look after me well here.” Quality assurance systems were in place with good management oversight. There were areas that still needed to be developed and this was acknowledged by the management team. The nominated individual had identified that the care documentation needed a more person-centred approach to individual care, and risk. At present the approach was generic and not person specific. Staff knew people very well and described how they safely supported people in their daily lives. This however, needs to be reflected within the documentation to ensure new and agency staff provide consistent safe care.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. For example, the local authority and CQC. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. Staff understood the risks associated with the people they supported. People received their medicines safely, when they needed them. There were enough suitably trained staff to meet people's needs at the time of the visit. Staffing levels were regularly reviewed following admissions and changes in a person's health condition. The provider ensured that when things went wrong, accidents were recorded and lessons were learnt. The environment was comfortable, clean and well maintained.

We requested COVID-19 infection procedures and policies during the inspection. These reflected current guidance and we were told they were updated regularly. All staff were aware of the government guidance and confirmed that they received updates daily. Staff were all wearing protective personal equipment (PPE).

There was a calm and happy workplace culture and staff we spoke with provided positive feedback about the management style. Staff told us that they felt well supported by the management team and received regular supervision and wellbeing meetings.

Referrals were made appropriately to outside agencies when required. For example, GP visits, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred. They felt that improvements to the service had been made and were still being implemented.

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 07 December 2018)

Why we inspected:

We received information that indicated that people may be at risk. As a result, we undertook a focused inspection to review the key questions of safe 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 coronavirus 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 remained Good. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Ashridge Court 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.

Ashridge Court Care Centre is a care home with nursing located in Bexhill On Sea. It is registered to support a maximum of 69 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home has four separate wings offering residential care based on people’s particular needs and requirements, including one which is a specifically designed dementia unit that can accommodate up to 14 people. On the day of our inspection, there were 63 people living at the service.

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.

We previously carried out an unannounced comprehensive inspection of this service in September 2017. Ashridge Court was awarded an overall rating of ‘Requires improvement’ as improvements were needed in the safe and well led questions. At that inspection improvements were needed to ensure that care delivery was supported by risk assessments that ensured that people’s health needs were monitored and acted on when needed. This inspection found that the necessary improvements had been made and the overall rating had improved to ‘Good’ with all questions being awarded ‘Good’.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and Dementia. There was a good level of information and guidance for staff to follow for those people who lived with complex needs. For example, oxygen therapy, moving and handling and percutaneous endoscopic gastrostomy (PEG) which is a way of introducing food, fluids and medicines directly into the stomach by passing a thin tube through the skin and into the stomach, for those unable to eat were clear and accompanied by photographs of how equipment for each should be used. There were safe systems for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and people said staff were available to support them when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. For example, the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. There was a consistent use of agency staff and the registered manager ensured that the agency staff used had the necessary skills to work at Ashridge Court. People said they felt comfortable and at ease with staff and relatives felt people were safe.

People were supported with their nutrition and hydration needs. Clear guidance was available for staff to follow when people had specific dietary needs. People spoke positively about their mealtime experiences and told us they were always offered choice and enjoyed their food. Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with diabetes, dementia and Parkinson’s disease. Staff had formal personal development plans, including two monthly supervisions and annual appraisals that ensured staff were supported in their role.

People were supported to make decisions in their best interests. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with laughter and smiles.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day, seven days a week and were developed in line with people's preferences and interests. Staff had received training in end of life care supported by the local hospice team. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals. The provider had established an accessible effective system for identifying, receiving, recording, handling and responding to complaints.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns. The registered manager had made strong links with the local community and supported two local charities by fund raising. They also worked in partnership with a local service and provided apprenticeships within the home for employment opportunities for individuals who lived with autism.

Ashridge Court Care Centre is a care home with nursing located in Bexhill On Sea. It is registered to support a maximum of 69 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home has four separate wings offering residential care based on people’s particular needs and requirements, including one which is a specifically designed dementia unit that can accommodate up to 16 people. On the day of our inspection, there were 63 people living at the service.

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.

At our inspection on 16 December 2014 we found that the service was safe, effective, caring, responsive and well led. Our overall rating of the service was Good.

At this inspection improvements were needed to ensure that care delivery was supported by risk assessments that ensured that people’s health needs were monitored and acted on when needed. This was because actions had not been taken to address high blood sugars, low blood pressures and some wound documentation was not accurate and did not follow good practice guidelines.

We recommend that the service seeks advice and support from a reputable source to ensure that staff are confident in the management of wound care, diabetes and hypotension.

Equipment such as pressure relieving mattresses were not set correctly as per the manufacturer’s guidance. In addition, the quality monitoring systems had not identified these shortfalls. We found staff knowledge and understanding in areas such as the Mental Capacity Act 2015 (MCA) and behaviours that challenge required improvement. The provider had not ensured that staff completing MCA assessments had a clear understanding of how to capture and record people’s capacity in line with legislation. MCA assessments did not evidence how staff had arrived at decisions related to people’s capacity via best interest meetings and discussions. The documentation and guidance to manage behaviours that challenge for some people was about responses to behaviours shown, rather than proactive strategies to reduce the likelihood of negative behaviours that place staff and people at risk.

Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration. Some minor improvements were needed for ‘as required’ documentation in that they lacked monitoring of the effectiveness of the medicines.

People told us they felt safe in the home. Staff were knowledgeable about safeguarding policies and how to recognise different types of abuse. Routine health and safety checks were undertaken covering areas associated with fire safety, health and safety and servicing. The service had contingency plans in the event of an emergency evacuation. Staff and records indicated that fire training and testing was undertaking regularly. All staff were trained in first aid and resuscitation techniques.

People were satisfied with staffing levels. There were enough staff on duty to support people at busy times of the day such as meal times, and to support people with one to one time. The service had used regular agency nurses and care staff whilst recruiting to the vacancies at Ashridge Court. Staffing levels were regularly reviewed to ensure appropriate numbers of staff were available when people’s dependency changed. The provider had safe systems for the recruitment of staff.

Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration. Some minor improvements were needed for ‘as required’ documentation in that they lacked monitoring of the effectiveness of the medicines.

People reported staff were trained and able to meet their needs. Staff supported people in an effective and safe way, for example when they needed to be supported in moving. New staff reported positively on induction to their roles. Staff were provided with the training they needed. Supervision systems ensured individual staff training needs were identified.

Involvement of a range of healthcare professionals, for example the tissue viability nurses had been procured as necessary. People who were assessed as being at nutritional risk were identified and supported in the way they needed to maintain or increase their weight. People were positive about the meals. There were systems to ensure people who were living with dementia could choose what they wanted to eat. Where people could not support themselves independently to eat their meals, they were fully supported by staff.

People said the staff were caring and supported them in the way they wanted. We saw staff supporting people who were frail and/or living with dementia in a way which encouraged them in making choices and being independent. Staff were consistently respectful to people and ensured their privacy and dignity.

Staff were responsive to people. Staff were aware of people’s individual needs, developing care plans which identified these needs, for example in relation to changes in their mobility. A wide range of activities were provided to people. These included individual and large group activities. Activities were available seven days a week and there were regular trips out of the home.

People felt they could raise issues with the manager and if they did, the manager would take action. Records of complaints made by people showed the manager and provider took action where issues were reported to them.

People and staff were complimentary about the management of the home. Staff said the culture of the home was supportive to them. A member of staff reported, “I think it is amazing here I like the staff and the residents.”

We used a number of different methods to help us understand the experiences of people using the service. Not everyone who lived in the home was able to tell us about their experiences. Those who could told us 'I have a wonderful life here.' And 'staff are wonderful.' Visitors we spoke with told us they were very happy with the standard of care. One person told us 'I am kept informed of all that's going on, staff listen and things get done, they look after people so well.'

During our inspection we found that people had been involved in decisions about their care, and chose how they spent their time.

Care plans documented the needs of people living in the home. Risk assessments had been completed when required. Peoples care needs were reviewed regularly, this meant that staffing levels could be assessed to ensure that there were sufficient staff to meet the needs of people living in the home.

Staff received regular supervision, and were encouraged to attend further training. All staff we spoke with told us that training was offered regularly, we were told 'there is lots of training every month we can do something, the training is really good.'

During our inspection we found that care and treatment was being provided to meet people's needs. People using the service and/or their representatives were involved in decisions about their care and treatment.