Archived: Ashwood Lodge Care Home

Ashwood Lodge Care Home is a residential care home that provides accommodation and personal care for up to 25 people. Some of the people were living with dementia. At the time of our inspection there were 18 people using the service.

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

The provider had taken the decision to close the home. The communication of the intended closure of the home was badly managed. People and staff told us they did not know what was happening and had been given very little information.

The home was not well maintained, which meant it was difficult to sustain infection prevention and control (IPC) measures. Adequate plans to keep people safe in the event of a fire were not in place. The Fire Service had recently inspected the home and found a number of safety issues which resulted in an enforcement notice being issued. The provider had implemented an agreed action plan to reduce the risks.

The management of people’s weight loss was not effective. Food required to support people with a fortified diet was not readily available. Malnutritional universal screening tool (MUST) were not used to assess people's needs in relation to diet and maintaining a healthy weight.

Medicine management was unsafe. Contingency plans had not been put in place for the re-ordering of medicines. Protocols for PRN ‘when required’ medicines were not always in place or lacked detail.

Permanent staff were recruited safely. The home did not have safe procedures for the use of agency staff. Protocols for checking the identity of agency staff and the completion of an induction was not in place.

The provider did not have robust quality assurance processes. Systems were in place to investigate safeguarding matters. Staff had completed safeguarding training.

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.

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

Rating at last inspection and update

The last rating for this service was good (published 16 September 2019).

Why we inspected

We received concerns in relation to people’s care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of this full report.

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

Due to the shortfalls found during the inspection the provider was requested to produce an action plan detailing what action and by when that they would address the issues identified.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, the assessment and mitigation of risk and the management of the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

Measures had been implemented to ensure people entering the home did so following current guidance regarding personal protective equipment (PPE) and social distancing. This included temperatures being taken on arrival and PPE being used.

The provider had robust systems to ensure safe admissions, including only allowing new admissions after a confirmed negative result of the COVID-19 test. New admissions isolated for the required number of days.

An additional cleaning schedule had been introduced to ensure robust measures to reduce infection risks, including additional tasks such as cleaning of any regular touched surfaces. The provider participated in the COVID-19 regular testing programme for both people and staff.

People were encouraged to stay in regular contact with friends and relatives. Staff supported people to make regular telephone and video calls and the registered manager had created a private Facebook page for people living in the service with photos and updates from their loved ones.

Staff ensured activities still took place. During the recent snow fall, staff made a large snowball to bring into the home which evoked lots of memories and conversations.

Staff participated in various training sessions around infection control and using PPE. Staff's competency around infection control and PPE was checked regularly to prevent staff complacency. There were designated areas for donning/doffing PPE.

Ashwood Lodge is a residential care home that provides accommodation and personal care for up to 23 people with mental health problems. On the day of our visit there were 19 people using the service.

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

Medicines were administered safely. Medicine records were not always correct; however, this was addressed immediately. People were protected from abuse by staff who understood how to identify and report any concerns. The risks to people’s health, safety and welfare had been assessed, recorded and plans put in place to reduce these. Staffing levels enabled people’s needs to be met safely, and ensured people received consistent and reliable support. The management team sought to learn from any accidents or incidents involving people. Some concerns with infection control were addressed immediately.

Staff were recruited safely and received appropriate training and support to enable them to carry out their role effectively. 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. People were happy with the food provided

Staff were caring and treated people with kindness and respect.

People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them. People were confident to raise any concerns. People enjoyed the activities provided.

There was a clear management structure and staff were supported by the registered manager. Quality assurance systems were completed. The registered manager would benefit from some administrative support.

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

Rating at last inspection and update

The last rating for this service was good (published 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service was previously inspected in November 2015 and was not meeting one of the regulations we inspected. This related to people not being supported to maintain relationships or involvement in their community due to a lack of activities provision. We took action by requiring the registered provider to send us action plans telling us how they would improve this. When we returned for this inspection we found the issues identified had been addressed, though some improvement in activity provision was still required.

Ashwood Lodge is a 27 bedded care home providing residential care. The service does not provide nursing care. The home is a converted building, with all of the communal areas and bedrooms situated on the ground floor. At the time of the inspection 23 people were using the service, 14 of whom were living with dementia.

There was a registered manager in place. 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.

Risks to people were assessed and plans put in place to reduce the chances of them occurring. Regular checks of the service’s premises and equipment were carried out to ensure they were safe to use. Plans were in place to support people in emergency situations. The registered manager monitored accidents and incidents to see if lessons could be learned to help keep people safe.

People’s medicines were managed safely. Safeguarding procedures were in place to protect people from possible abuse. The registered manager monitored staffing levels to ensure enough staff were deployed to keep people safe. The registered provider’s recruitment process reduced the risk of unsuitable staff being employed.

Staff received the training they needed to support people effectively and were supported through regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. People were supported to maintain a healthy diet and to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the support they received from staff at the service, describing it as kind and caring. People were treated with dignity and respect. Staff encouraged people to be as independent as possible, while always ensuring they were available to provide support and keep people safe. Throughout the inspection we saw numerous examples of kind and caring support being delivered. People were supported to access advocacy services where these were needed.

We have made a recommendation about the planning and delivery of activities.

People’s care was based on their assessed needs and preferences. Care plans were regularly reviewed to ensure they reflected people’s current support needs. The service had a complaints policy, which was publicly advertised and accessible in the reception area. People and their relatives told us they knew how to complain and would be confident to do some.

Staff spoke positively about the culture and values of the service and said they felt supported by the registered manager and registered provider.

The registered manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people using the service and their families in an annual questionnaire. We received required notifications from the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Some part of the home needed maintenance work to ensure that they were safe and pleasant places for people to live. Some parts of the home were not clean and hygienic. For example, some carpets were badly marked, bathroom flooring was cracked and slippery when wet, some pieces of equipment and parts of the home were dirty and in need of cleaning. Compliance actions have been set and the provider must tell us how they plan to improve.

Medication systems were in place to help people get the medication they had been prescribed. Suitable arrangements were in place for the safe storage and administration of medication, with the manager able to demonstrate improvements that had recently been made. For example, increased stock checks and better recording.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One authorisation was in place at the time of our visit. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Assessment and care planning systems were in place, to identify people's needs and help staff provide the care people needed.

Quality assurance systems and checks were in place, but these had not always been effective at identifying and addressing problems at the service without external interventions. For example, the food hygiene issues recently raised by the Environmental Health Officer or the maintenance and cleanliness issues raised by our inspection.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were caring and supported people in kind and pleasant ways. People who used the service were complimentary about the attitude of the manager and staff, and care that they provided. One relative commented, 'It may be a bit tired (the premises), but in what matters it's amazing, in care, the way staff treat people'. Another relative told us, 'They (the staff) are very good actually.'

Is the service responsive?

People's needs had been assessed and care plans put in place describing their care needs. These records included information about people's individual needs and preferences. There was evidence that people's records had been reviewed and that other professionals were involved in people's care appropriately. Where we have raised concerns the manager has listened and kept us informed of the actions they are taking.

Is the service well-led?

There was a registered manager in place, but they were often working as the senior carer on shift, rather than as a supernumerary manager. This had impacted on the time they had available to oversee the management and leadership of the service. Staff we spoke with indicated that the nominated individual (official company representative) did not visit the home very often and the records of the directors 'monthly' monitoring visits indicated that they had only completed three official monitoring visits in the last year. Concerns have recently been raised about the home's performance in some areas by the local authority, environmental health and ourselves. This indicated that the provider was not proactive in identifying and resolving issued independently.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We spoke to staff and found that they were very knowledgeable about people's likes and dislikes and how they wished to be supported. We were able to see how people's skills and independence were promoted.

Where people were highlighted as being at risk, for example, with pressure sores care plans had been developed. We found that care records contained up to date care plans and risk assessments.

We found that the care records contained evidence to confirm that people had been involved with health professionals. People's health, safety and welfare were protected when more than one provider was involved in their care and treatment.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We found that people were protected from the risks of unsafe or inappropriate care and treatment because records were accurate and up to date.

The care records we looked at, and our observations during this visit, showed that people's needs were assessed and their care was planned and delivered appropriately. Staff were able to describe the care and support people needed and explain how they maintained people's privacy and dignity.

Although the home is located in an old building, we found that it provided a safe and comfortable place for people to live. There had recently been some redecoration and new carpets installed. Staff told us that essential maintenance was carried out and people were not put at risk.

Feedback from people who used the service, and their relatives, indicated that staff were usually available when people needed them. Staff rotas, discussions with staff and our observations, showed that sufficient staff were on duty to meet the needs of the people living at the home.

People who use the service and their relatives told us that the manager was approachable and that they could speak to her if they wanted. There was a complaints procedure in place and records showed that complaints had been responded to appropriately.