Ash Lodge Care Home with Nursing

Ash Lodge Care Home with Nursing is a care home providing personal care and accommodation to up to seventy people. The service provides support to older people and people with dementia. At the time of our inspection there were sixty four people using the service.

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

The provider was not consistently working in line with the principles of the Mental Capacity Act which put people at risk of being deprived of their liberty without lawful authority. Care records showed some people who had been identified as lacking capacity had missing information on capacity assessments and best interest decisions.

The provider had safeguarding systems and processes to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure risk of harm was minimised.

Staff sought people's consent before providing care and support. People's individual communication needs were considered to support them to be involved in their care.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

Staff had been recruited appropriately and had received relevant training, so they were able to support people with their individual care and support needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm.

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 the service was good (published on 21 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. A decision was made for us to inspect and examine the information we had reviewed. As a result, we undertook a comprehensive inspection.

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.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ash Lodge Care Home with Nursing on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how changes will be implemented. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

Ash Lodge Care Home ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home.

Staff were adhering to Personal Protective Equipment (PPE) guidelines and extra PPE locations had been set up near to the resident's room.

Ash Lodge Care Home provides nursing and personal care to a maximum of 54 adults. The service consists of two separate units over two floors; the nursing unit on the ground floor and the dementia care unit on the first floor. On the day of our inspection there were 53 people at the home.

At the last inspection in November 2014 the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager; however she was not present on the day of the inspection. 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.

People who lived at the home were kept safe because staff were trained to identify signs of abuse and understood reporting procedures. Potential risks of harm to people had been identified and guidance for staff was in place to support people safely. There were enough staff to support people and staff had been recruited safely. People received their medicines as they were prescribed.

People were supported by staff who had the training and skills to consistently meet people's changing needs. Staff had regular supervision and support to reflect on and develop their care practices so that people benefitted from quality care. Staff understood the importance of seeking people’s consent before care was delivered. 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. People told us they were happy with the choice and quality of the meals provided and staff understood the need to support people who were poorly or living with dementia to eat and drink sufficient amounts to maintain their health. People were supported to access health care professionals without delay to maintain their health.

People described the staff as very caring, attentive, polite and patient. People enjoyed the fact that staff spent time with them. People's privacy and dignity was protected by staff and people were encouraged to maintain their independence. The development of care practices to support people approaching the end of their life showed a compassionate response to people’s needs.

People were supported by a dedicated activities team who provided a variety of regular events for people to enjoy. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and that the registered manager would strive to resolve these.

Staff spoke positively about the management of the home and felt supported by the management team. There were several different platforms used in which people could voice their opinions on the service and we saw the management team used feedback and comments to continually improve the service. Everyone including external professionals told us the home was welcoming, had a nice atmosphere and was well organised. The registered manager and provider had continued to monitor the quality of the service and had further developed aspects of the service to provide better outcomes for people.

People were involved in decisions about their care and were asked for their consent before care and treatment was given. One person said, 'People talk to me about what I want but I don't always know what they mean. They are patient and explain it another way.' Another person said, 'I know about my treatment and the tablets I have to take. Staff give me my medication at the same time every day they are good like that. They always explain what they are doing and ask if that's ok.'

Care plans were personalised and risk assessments were in place. Staff had the information they needed to meet people's identified needs. People's needs had been assessed by a range of external health professionals so that their health care needs were monitored and met.

People received their medicines as prescribed by their doctor to ensure their health needs were met.

Staff were trained and supported in their roles. Staff knew how to protect the people living there so that they were safeguarded from harm.

Robust audit systems were in place for monitoring and improving the quality of the service, when needed, for people who lived in the home.

During our inspection we spoke with six people who lived at the home, six relatives, five staff and two additional people who had come to look at the home to find out about the service provided. One person told us, 'I have lived here for a long time and it is quite okay'. Another person said, 'Very nice home. The staff are kind and look after me'.

As some people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there.

We saw that people were treated with respect and dignity. People's needs had been assessed by a range of health professionals including dieticians and speech and language staff. This meant that people's health care needs had been monitored and met.

Staff had received training to help them recognise abuse and inform them of who they should report to if they had a concern.

Recruitment processes ensured that staff employed were suitable and safe to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.