Ashlodge

We found the following examples of good practice.

People were supported by staff to have visits from their friends and family in various ways throughout the pandemic. When face to face visits had not been possible, people had, had window/door visits and visits in the garden. Visitors were asked to confirm they had completed a test for COVID-19, had their hands sanitized and were provided with full PPE to wear whilst visiting.

The home was clean and there was regular domestic staff who completed a cleaning programme. The cleaning products had been reviewed and updated to ensure suitability for cleaning during a pandemic. The cleaning programme now included regular cleaning of high touch areas.

There was an allocated infection control lead who monitored staff practice and carried out regular infection control audits. There was a good supply of personal protective equipment (PPE) and staff had received specific COVID-19 training. Staff received regular updates on IPC.

Regular testing for people and staff was taking place, in accordance with government guidelines. Staff entered the service through a back room, where they changed into clean work clothes. Staff were seen to be wearing masks when in the service. Hand sanitisers were available and placed in strategic areas in the service. Suitable bins were placed around the home to dispose of PPE safely.

Ashlodge is a detached property close to the seafront in Bexhill -on-Sea. It provides care and support for up to 16 older people with care needs associated with older age. This includes people with low physical and health needs and people with mild dementia and memory loss. Ashlodge provides respite care that includes supporting people while family members are on a break, or to provide additional support to cover an illness.

At the time of this inspection 13 people were living in the service. This inspection took place on 14 June 2018 and was unannounced.

There is a registered manager at the home who is also one of the partners and a registered provider that owns the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

We inspected Ashlodge in February 2016 and found the provider was in breach of three regulations. At the last inspection improvements had been made but the provider remained in breach of two regulations. This was because the provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to. The management systems that included quality monitoring had not always ensured safe and best practice was followed or required improvements were responded to. Following this inspection, the provider wrote to the CQC with an action plan on how these regulations were to be met.

At this inspection we found these regulations had been met and the service was rated ‘Good’ overall.

However, we found the management arrangements did not ensure effective leadership in all areas. Some records had not been completed in a consistent way and although there was no evidence that this impacted on care, evidence of appropriate care and support was not always clearly recorded. This included records relating to DoLS and best interest decisions. This was identified to the registered manager as an area for improvement.

Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They understood the principles of gaining consent and the registered manager had a good working knowledge of the MCA and involved health care professionals to support them when people did not have capacity to make decisions. They recognised when people may be deprived of their liberty and followed correct procedures to protect people's rights.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness, they were polite and considerate in their contact with people. They demonstrated genuine care for each person. People's dignity was protected and staff were respectful. We received positive feedback about the care and the atmosphere in the service. People liked the ‘homely’ feel of the service and told us they felt ‘safe’. They liked living in a small home where everyone knew each other. Visiting professionals told us staff were kind and responded to people’s health and welfare needs fully and appropriately.

Medicines were stored and handled safely. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what they should do if they believed people were at risk of abuse. Staff received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They understood the principles of gaining consent and the registered manager had a good working knowledge of the MCA and involved health care professionals to support them when people did not have capacity to make decisions. They recognised when people may be deprived of their liberty and followed correct procedures to protect people's rights.

Staff completed a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people's needs could be met in a timely and safe way. Staff felt well supported and could raise any issue with the registered manager. There was an open culture at the home and this was promoted by the pleasant staff and visible registered manager. Staff enjoyed working at the home and felt supported.

People had the opportunity to take part in a variety of activities in the service. This took account of people's preferences and choice. Visitors told us they were warmly welcomed and people were supported to maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use.

People were very complementary about the food and the choices available. People needed minimal support with eating and staff were positive in their approach to promoting people's independence. People's nutritional needs were monitored and responded to ensuring people’s needs and preferences were taken in to account.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views daily and satisfaction surveys had been completed. The registered manager was readily available led by example and responded to any feedback that she received in a positive way.

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. The registered manager is also one of the registered owners of Ashlodge.

Ashlodge was inspected in February 2016. We found the provider was in breach of three regulations. Improvements were required to quality monitoring systems to ensure the environment was safe and well maintained. Risk assessments to ensure emergency evacuation procedures needed to be reviewed and updated to ensure they were appropriate. Systems to ensure people did not have unnecessary restriction to their liberty needed to be reviewed and updated. The provider gave us an action plan on the day of this inspection. This confirmed they had addressed all these issues.

This comprehensive unannounced inspection took place on 17 and 18 May 2017. At the time of this inspection 14 people were living in the service. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found some improvements but the provider remained in breach of two regulations.

The provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to. The passenger lift had not been thoroughly checked in accordance with health and safety legislation. The risk of legionnaire’s disease had not been fully addressed and hot water checks were not consistently completed. Medicines that were being stored under refrigeration had not been stored securely. Emergency evacuation procedures did not clearly clarify how people would be evacuated quickly and a contingency plan for guidance was not available. The provider had not ensured staff were clear on action to be taken following a foreseeable emergency. Therefore the provider remained in in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The leadership of the service was not effective in all areas. Management systems that included quality monitoring did not always ensure safe and best practice was followed or required improvements were responded to. The PIR was poorly completed and an action plan was not supplied following the last inspection report. A system to ensure required notifications were sent to the CQC was not established. The service did not have up to date policies and procedures to underpin the care and practice within the service. For example, there was no staff supervision or appraisal policy or procedure that clarified how staff were to be supported. Therefore the provider remained in in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to live a life that they enjoyed. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service, and the approach of the staff. A visiting health professional was positive about the care and support provided. They told us staff worked with them to improve people’s health.

People said they were ‘lucky to be here’ and told us they felt they were safe and well cared for at Ashlodge. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff had been trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had an understanding of both and followed correct procedures to protect people’s rights. People’s Medicines were administered and disposed of safely by staff who were suitably trained. People had the opportunity to take part in a variety of activities in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported to maintain their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager. There was an open culture at the home and this was promoted by the pleasant staff and visible registered manager. Staff enjoyed working at the home and felt supported. People were encouraged to share their views though contact with the staff and registered manager.

People were very complementary about the food and the choices available. People needed minimal support with eating and staff were positive in their approach to promoting people’s independence. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

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. The registered manager is also one of the registered owners of Ashlodge.

This comprehensive unannounced inspection took place on 10 and 11 February 2016.

Some of the systems to monitor the quality of the environment were not thorough. For example, cleanliness of the kitchen. In addition, the electric wiring certificate was out of date and problems with fire safety checks were not resolved in a timely manner. The registered manager was not fully aware of their responsibilities in relation to ‘duty of candour.’

There were no records of maintenance issues that had been identified. Although there was a fire risk assessment in place this was not detailed and did not cover all aspects of fire safety. There were individual fire risk assessments for people but it was evident that to follow the procedure as stated, would mean that people could not be evacuated quickly.

The registered manager and staff had training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard. They had assessed that some restrictions were required to keep people safe and had made referrals to the local authority for authorisations. However, there was no documentation to demonstrate that the least restrictive option had been used before someone’s freedom was restricted.

Staff had a good understanding of people as individuals, their needs, interests and hobbies. They were committed to ensuring people lived happy and enjoyable lives. There was emphasis on supporting people to maintain their independence.

Staff monitored people’s nutritional needs and people had access to food and drink that met their needs and preferences. One person told us, "The food is very good here, there is nothing to grumble about with it, it’s fresh and there is plenty of it."

People brought photographs and memorabilia with them when they moved to the home so bedrooms were homely. People could opt in or out of activities and their decisions were respected. They valued the advantages of living in a care home. For example, one person told us, "The best thing about being here is you are not on your own." Another said, "I enjoy talking to the carers and the others, there are always people around."

Staff received the training and supervision they needed to meet the needs of people who lived at Ashlodge. There was a training and supervision programme in place to ensure staff maintained current knowledge and skills. As the home is hoping to change their registration to care for people with dementia, staff had received training on dementia and on caring for people who challenged others.

People were supported to have access to healthcare services and maintain good health on a day to day basis or when there was a change in their health. This included GP’s, dentists and opticians.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with her at any time and knew they would be addressed appropriately. Staff and people spoke positively about the way the service was managed.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

One person told us that 'they can't be beaten in my opinion. Anything I need, they help me with and they push me to carry on doing as much as I can, including my exercises'. People told us that they knew all the staff by name and felt they had a good relationship with them. We observed that people were very comfortable with the staff and there appeared to be good rapport and a friendly atmosphere.

We looked at the staff files and found evidence of supervision and appraisals for staff which included observation of work and self-assessments. These included providing personal care. We found that the staff had undergone mandatory and additional training to support them in their roles.

We looked at records relating to the care and welfare of people living and working in the home. On the whole these were found to be well completed. Records pertaining to the maintenance and safety of the premises and equipment were available in the home.These demonstrated that the home and its equipment were suitably maintained.

We looked at the storage facilities and staff practice followed to safeguard confidential records. We found that records were kept securely.

People using the service and staff told us that staffing levels were appropriate. This meant that staff were able to provide the care required. We saw that staff responded promptly and sensitively to requests for help. People told us they felt safe living in the home and were well looked after by staff who had the skills to do their job. One person said. 'There are enough staff and they are very caring.'

We looked at the systems and processes that the home had in place to ensure the environment was safe and that complaints were dealt with appropriately. Records seen and processes followed ensured a safe well maintained environment and ensured complaints could be raised.

We looked at records held in the home and how these were stored. Not all care records were up to date or reflected all the current needs of people using the service. Certificates to demonstrate the safety of some equipment and services were not available.