We carried out this inspection on the 28 January and 10 February 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
Ascot Nursing Home is located in Linthorpe on the outskirts of Middlesbrough, in close proximity to public amenities. The home has a number of communal areas including three lounges, a large dining area and a conservatory leading out to the garden. There are bedrooms and bathrooms on all three floors for which there is lift access. In September 2014 the number of registered places increased from 33 to 34.
A registered manager has been post since the service opened. The provider has always ensured a registered manager was in post. Thus, when the registered manager retired a new manager was appointed and they became registered in November 2014. 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 used the service and relatives we spoke with told us they felt the staff did a wonderful job and felt the home provided an outstanding service. People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.
People we spoke with were positive about the care they received and said that they felt safe. Staff were trained and understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose. Staff ensured people were kept safe from abuse and avoidable harm.
We found that the activity coordinator and provider proactively ensured a wide range of opportunities were available for people to engage in meaningful occupation. This was in the form of an internal activities programme, which included social activity, pet therapy and sensory stimulation as well as external activities, such as going out for trips and meals.
Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training. The provider had organised additional training on this subject for all of the staff to complete. The majority of people were able to make decisions but the home were following guidance from the supervisory body which suggested all the people needed to be subject to DoLS authorisations. The guidance we looked at had not clearly outlined that only people who had been assessed as lacking capacity would need to be subject to DoLS. We discussed how people with capacity to make decisions can agree to restrictions being in place. We found that people do go out when they want to and the staff have used assistive technology, for example trackers, to help individuals who become a little confused to go out independently and find their way back to the home.
Where people had difficulty making decisions we saw that staff helped them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate. This meant staff worked within the law to support people who may lack capacity to make their own decisions. The provider was completing more work with staff to ensure they understood all aspects of the MCA. The registered manager had requested information to demonstrate that relatives had enacted lasting powers for care and welfare before they became decision makers for the person.
People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.
Accidents and incidents were monitored each month to identify trends. We found that when trends were found action was taken. For example certain times of the day were highlighted as being high risk, so the provider ensured extra staff were on duty to cover these times.
We reviewed the systems for the management of medicines and found that people received their medicines safely.
People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. Throughout the week a nurse, five care staff, a cook, kitchen assistant and domestic staff were on duty during the day and a nurse and four staff were on duty overnight. During the week days the registered manager, head of care, administrator and maintenance staff were on duty. One of the providers visits most days and we heard from relatives that they often assist staff with care tasks.
Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.
Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia, strokes and diabetes. We found that the provider and registered manager ensured staff received regular refresher training. They also routinely checked that staff understood how to put this training into practice at supervision sessions and staff meetings.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.
The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the provider and registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.
We saw that the provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.
Regular surveys and resident and relative meetings were held. We found that the analysis of the surveys showed the majority of people believed the home delivered an excellent service and this view was echoed in our discussions with people during the visit.