Ashington House

We found the following examples of good practice.

There were suitably robust measures in place to help prevent or minimise the risk of relatives and friends, professionals and others who visited the care home from catching or spreading infections.

Access to the care home was being restricted for non-essential visitors. As a result, alternative arrangements had been put in place to help people maintain social contact with their relatives and friends. This included video calls and socially distanced visits in the back garden. All visits had to be pre-arranged and any essential visitors to the care home on arrival were required to have their temperature taken, wash their hands and wear a face covering. Clear instructions explaining what visitors and staff must do to minimise the spread of infection were displayed throughout the care home, including in the entrance porch.

There were suitable arrangements in place to ensure people admitted to the care home were tested for COVID-19 and had to self-isolate in their single occupancy bedroom for at least 10 days thereafter. People living in the care home who had tested positive for COVID-19 or showed signs of being symptomatic were required to isolate in their bedroom for 10 days. People were routinely checked by staff for symptoms of COVID-19, which included having their temperature checked daily.

Staff used personal protective equipment (PPE) in accordance with current infection prevention and control (IPC) guidance. We saw staff who were supporting people in communal areas always wore their PPE correctly. This included ensuring their face mask covered their nose and mouth. Staff had received up to date training in COVID-19 related IPC guidance, correct use of PPE and safely swap testing people with learning disability. Staff demonstrated a good understanding of recognised best IPC practices and the correct use of PPE, including donning and doffing procedures (putting on and taking off PPE). Managers and staff confirmed the service had always had adequate supplies of PPE.

The care home was kept clean. Staff kept detailed records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles. Several staff told us they were required to clean these high touch areas at least two-hourly. We also saw communal areas were kept uncluttered so cleaning could take place effectively. There were appropriate laundry processes in place, so clothes were not mixed and washed together, and the laundry room was subject to regular enhanced cleaning.

The provider had thoroughly assessed and mitigated infection risks to everyone living and working in the care home who were all in high risk groups, such as people with learning disabilities and black, Asian and minority ethnic (BAME) members of staff. The registered manager told us she would take these identified risks into consideration and made reasonable adjustments if staff needed to be assigned to support people who were symptomatic and/or had tested positive for COVID-19.

Managers confirmed the service did not currently use any temporary agency or bank staff. They were also aware of good practice in relation to care staff only working in one care setting to reduce the risk of spreading infection. Staff who did work in multiple care settings were told they were no longer permitted to do this and were asked to choose which care setting they wanted to permanently work in. To help staff maintain social distancing during staff handovers at the end of each shift these meetings were now held in kitchen which was a large enough space to allow people to stand a safe two-metres apart.

A regular ‘whole home testing’ regime was in place at the care home. This ensured people living in the care home were tested at least monthly and staff were tested weekly. People were also tested without delay if they became symptomatic or if anyone in the household 'bubble' of a member of staff displayed symptoms. Managers knew how to apply for coronavirus testing kits for people living in the care home and for staff. They had no issues with the supply of COVID-19 home testing kits. People living in the care home had received the flu vaccination and staff were being encouraged to follow suit. Managers were liaising closely with their local GP surgery to arrange COVID-19 vaccination’s for everyone living and working at the care home as soon as possible.

There were a range of IPC policies and procedures which had been reviewed and updated since the start of the COVID-19 pandemic. These included contingency plans for managing adverse events, such as COVID-19 outbreaks and related staff shortages. Managers routinely monitored and audited compliance with IPC practices. This included daily walkabout tours of the building to check the premises were clean and that staff wore their PPE correctly. Managers also supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely.

Further information is in the detailed findings below.

Ashington House is a residential care home that provides personal care and accommodation for up to six people some of whom have learning and physical disabilities and autism. At the time of this inspection five people were receiving support from this service.

People's experience of using this service:

Staff were aware of people’s communication needs and knew what people were saying when they used their body language. However, people’s communication aids required updating which the registered manager agreed to implement immediately.

Risks to people's health and safety were sufficiently identified and assessed which guided staff on how to mitigate the potential risks to people. Staffs’ employment history was appropriately checked before they were employed by the service. People had support to manage their medicines safely. Staff were aware of the actions they had to take should they notice people being at risk of harm or when incidents and accidents took place.

Staff were provided with opportunities to update their knowledge and skills in all areas required for their role, including the Mental Capacity Act 2005 (MCA) which they applied in practice as necessary.

People’s health needs were assessed and they had the necessary support to attend their health appointments when needed. Staff assisted people with their meal preparations and ensured that people had their meals not rushed.

Personal information about people was kept safely. Staff were kind to people and respectful of their privacy. Strategies were in place to support people in the decision-making process.

People’s care records were person-centred and individualised. People were encouraged to raise concerns when they had any so that the staff team could address them accordingly. Staff supported people to have conversations about their wishes at the end of their lives.

Everyone involved in people’s care told us that the registered manager was caring and led by example. Quality assurance processes were in place to monitor the service delivery. There were shared responsibilities between the staff team to ensure good care for people.

Rating at last inspection:

At the last inspection on 9 December 2016, the service was given a rating of Good in all key questions.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspection will be planned in line with our re-inspection programme. If any concerning information is received, we may inspect the service sooner.

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

Why the service is rated Good

Since our last comprehensive inspection the provider had made some improvements, most notably to the ways in which they managed the risk of people developing pressure ulcers. At the time of our inspection the service was meeting all relevant fundamental standards.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs and promoted their independence. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. Medicines were managed safely.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was designed and adapted to meet people’s individual needs.

People received a variety of nutritious food that met their individual needs. They received the support they needed to stay healthy and to access healthcare services.

Staff knew people well and had developed positive caring relationships with them. They knew how to communicate information in ways that people understood, which helped enable people to make choices about their care. Staff supported people to take pride in their personal appearance and provided care in a way that promoted people’s dignity and independence.

People received personalised support that was responsive to their individual needs. Staff were aware of people's needs, goals, abilities, likes and dislikes. People received support to maintain contact with their families and to meet their religious and cultural needs. People took part in a range of individual and group activities to suit their abilities and interests.

The service had a complaints procedure and this was available in an accessible format. The provider also routinely gathered feedback from people and their representatives through surveys. They used feedback alongside their own audits and quality checks to continually assess, monitor and improve the quality of the service. The service had a clear vision and values and demonstrated an inclusive and empowering culture where people were involved in the day to day running of the service.

Further information is in the detailed findings in the main body of the report.

Staff demonstrated good knowledge of individual's needs and how best to meet them. We saw that there were varied activities for people, both in the local community and at various clubs or day centres. People's needs were assessed and care and support was planned and delivered in line with their individual care plan. We looked at every person's care records and saw that care plans were developed from assessments and using information from relatives and placing social workers. These care plans were then recorded in such a way that they expressed people's support needs from the perspective of the individual.

The manager was able to demonstrate that the care team had undergone training in safeguarding people from abuse and that this training was updated at regular intervals. There were also clear policies and procedures in place and the manager was aware of the contact details of all the local authorities who had placing contracts with the service.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. We saw that questionnaires and surveys were sent to relatives and local authorities and that the service had received positive feedback from those questionnaires. One local authority commented "No complaints whatsoever". A relative commented that the staff team were very caring and did a good job.

One person told us that they were happy living at the home, saying "I have all I need in my bedroom", they told us that staff provided the care and support they needed and "helped and listened". Two people told us that they were settled and were seen to be happy and relaxed with staff in the lounge during our visit.

Care plans were seen to be person centred. The care and support was in line with placing social workers expectations. There were no current safeguarding concerns and placing social workers we spoke with said the manager and staff were approachable and they felt confident any issues they raised would be dealt with quickly.