Archived: Ashfield Residential Care Home

Ashfield Residential Care Home is a residential care home providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. On the day of the inspection, 20 people were living at Ashfield.

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

People were safe living at Ashfield. Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. People were protected from the risks associated with the spread of infection. The service was clean and well maintained.

There were enough numbers of staff deployed to meet people's needs and ensure their safety. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home. Medicines were managed safely. People were protected from the risks associated with the spread of infection.

Staff received appropriate induction, training and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

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; the policies and systems in the service supported this practice.

Staff were caring and kind and relatives confirmed this. We observed staff responding to people's needs with kindness and respect.

People living at Ashfield had a care plan which detailed their needs and preferences. People’s care needs were assessed prior to admission and regularly thereafter.

Staff supported people to meet their health and nutritional needs. Staff worked with health care professionals to maintain people's wellbeing.

There were quality monitoring systems and processes in place to identify how the service was performing and where improvements were required. We have made a recommendation around effective communication with relatives during the COVID-19 pandemic.

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 27 September 2017).

Why we inspected

This was a planned inspection based on the previous rating. We had also received information of concern prior to the inspection around night care. We did not find any evidence on this inspection to substantiate the allegations. Prior to the inspection, we raised the concerns with the provider and registered manager who provided assurances of their oversight of care at night.

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 key questions of safe, effective, responsive and well-led in this inspection. 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 the same. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashfield Residential Care 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.

Ashfield Residential Care home is a care home for seventeen older people some of whom are living with dementia. The home is owned by Circa Care Limited and Ashfield Residential Care Home is their only care home. At the time of our inspection there were seventeen 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 previous inspection on 22 September 2016 we rated the service Required Improvement overall. This was because there were two breaches of the regulations. We found that people’s care plans lacked detail and were not personalised enough. During this inspection we found that this had been addressed and people now had detailed and person centred care plans.

Previously we found that the service was not always working in line with the Mental Capacity Act 2005 (MCA) as they were not undertaking mental capacity assessments and best interest decisions. In addition they had not always applied for authorisations under the Deprivation of Liberty Safeguards (DoLS) appropriately. During this inspection we found that this had been addressed and the service was applying for DoLS authorisations for people and had undertaken mental capacity assessments and best interests decisions in a timely and appropriate manner.

Previously people did not have choice about what meals they ate. We found now people had a choice of nutritious meals each day and were offered alternatives if they did not like the menu choices. People also had a choice of hot and cold drinks to support them to remain hydrated.

The registered manager had come into post after the last inspection when the previous registered manager had resigned. Relative and staff feedback during our visit about the registered manager and the supporting director was all positive. They told us changes to the service were an improvement.

We found that that the environment of the care home has been improved since our last inspection. There was a larger lounge and dining area. This new area was well used, as there was a now a comfortable area for all people to sit and for activities to take place.

People and relatives told us staff were friendly and respected them. We found that there were enough staff to meet people’s support needs. The provider had systems in place to recruit staff in a safe manner.

Staff had received medicines administration training and administered medicines in a safe and timely manner.

The registered manager and staff understood their responsibility to keep people safe from abuse and demonstrated they knew how to report safeguarding adult concerns. People had risk assessments that were tailored to their circumstances. Staff knew the measures to take to protect people from harm.

The premises were clean, well maintained and free from malodours.

Staff supported people to access health care and worked in partnership with the local health teams to ensure people had the appropriate heath care.

People and relatives told us they knew how to raise concerns and complain. They believed complaints would be responded to and addressed by the registered manager.

The manager and director undertook audits and checks to ensure the quality of the service.

The registered manager asked people and relatives their views of the quality of the service provided at care plan reviews and the residents meetings and where necessary acted on these.

The service is a small, owner run residential care home providing accommodation and personal care for up to fifteen older people, some of whom were living with dementia.

There was a registered manager 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.

Although there was some good areas of practice by the home, in particular the care of frailer people who remained in bed, there were some areas as described below that required improvement in terms of choice and personalisation.

The service was not always working in line with the Mental Capacity Act 2005 as they were not undertaking mental capacity assessments and best interest meetings when people lacked capacity. In addition they had not always applied for Deprivation of Liberty Safeguards appropriately. This was a breach of regulations.

People living at the service were supported to eat and drink healthily. People’s care plans gave a brief indication about what food people might like or dislike. However people told us they were not offered a choice of menu and would prefer different meals on some occasions. We saw that whilst the service offered dietary alternatives there was not a choice of meals offered to people on a daily basis. People had care plans that covered a range of support needs, however sometimes they lacked detail and were not personalised enough. In particular the service offered limited choices around showering and bathing. The lack of personalised choice in meals and bathing was a breach of the regulations.

There were enough staff to keep people safe and recruitment processes were robust to ensure people living in the service were safe. Staff received training to support them to undertake their role. Staff could tell us how they would report safeguarding adult concerns and the service was reporting possible concerns in an appropriate manner. People had risk assessments to protect them from harm.

People received their medicines on time and staff administering medicines understood what the medicines were prescribed to treat. People were asked if they were in pain and were offered pain relief in line with guidelines. Medicines were stored in an appropriate manner. People received good support from staff to access appropriate health services such as the GP and district nursing service. Staff had received training to enable them to respond well in emergency. The service offered a good standard of care for people who were looked after in bed, for example, people were turned on a regular basis to avoid pressure ulcers developing.

Overall, everyone thought the staff were good or very good in terms of being caring, but there were some negative comments made by one person that we shared with the registered manager. We saw care being provided in a sensitive manner during our visit.

People expressed a gender preference when being supported with personal care and this was adhered to; some people were supported with their religious diversity needs. Some people had keys to their rooms and staff respected people’s privacy and kept their information in a confidential manner.

The service was well led by the experienced registered manager who was supported by the owner and senior care staff. Staff told us they could raise any concerns and there were regular staff and resident meetings. The service was audited on a regular basis and surveys were undertaken to assure the quality of the service given.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 9 and Regulation 11.

You can see what action we told the provider to take at the back of the full version of the report.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. During our inspection, we observed a staff shift handover meeting. We saw that peoples' individual care and support issues were discussed.

We looked at the records of five care workers and saw that individual supervision and appraisal meetings had recently taken place. Provider records also showed that a staff team meeting had recently taken place.

We asked the provider how they involved people using the service in its development. The provider told us that they held quarterly "resident meetings" to gauge concerns.

People's diversity, values and human rights were respected. A comment made by Barnet Local Involvement Network (LINks) visit on 12 January 2013 read, "Visits from local religious ministers can be arranged. At the moment only one resident takes advantage of this and receives regular visits from a priest."

People told us that they liked the food and we observed adequate fluids and food made available during our inspection. We asked people if they felt safe at Ashfield Residential Care Home, one person told us "I feel safe here, they look out for us."

Appropriate medication procedures ensured that medicines were administered and stored safely and records ensured that this had been monitored appropriately.

The majority of people using the service and relatives told us they felt staff cared for them well. One person said "the staff are good, they look after us." People using the service and relatives told us that staff are 'brilliant', 'excellent', 'marvellous' and 'very caring'.

The provider had systems in place to check the quality of the service.