Ashwood is a purpose built care home and is registered to provide accommodation and personal care for up 64 older people some of whom are living with dementia. At the time of our inspection 64 people were living at Ashwood.
The inspection took place on 23 and 25 September 2015. On the 25 we arrived early in the morning to inspect the service. Both days of the inspection were unannounced. We previously inspected Ashwood – Ware in December 2013. During this inspection we found that the provider had taken action to improve staffing levels at the home and was at that time meeting the required standards.
The home had a registered manager in post who had been registered since October 2010. 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 2008 and associated Regulations about how the service is run. However at the time of our inspection the home was being managed by a temporary manager from another of the provider’s homes due to the registered manager being absent from work.
CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Ashwood and a number of these were pending an outcome.
At this inspection we found there were insufficient numbers of staff deployed to provide care safely to people living in Ashwood. We found examples where people’s health and wellbeing had suffered as a result of this.
Systems were not in place to monitor, review and investigate incidents and accidents to keep people safe from the risk of harm or abuse.
Risk assessments had not always been developed to positively manage risks to people, once staff had identified a change to a person’s support needs.
People’s medicines were managed and stored safely, and people received their medicines as they were prescribed.
People were supported by staff who had undergone a robust recruitment process to ensure they were of sufficiently good character to provide care to people.
We found that staff had not been supported by the manager or provider to enable them to carry out their role sufficiently.
People’s nutritional needs were not always met or monitored. People were not able to freely choose what they ate and people’s weights and dietary records had not been maintained.
People we spoke with told us they had access to a range of health professionals, and records demonstrated they were referred quickly when their needs changed.
Staff spoke to people in a kind, patient and friendly manner, however people’s appearance meant they were not always treated in a dignified way.
People’s wellbeing was not always supported by staff who provided care and support to them. They did not ensure that they were meeting their individual needs and preferences by ensuring people’s social needs were met.
People did not always receive care that was responsive to their needs.
We found that Ashwood did not promote a culture that promoted support, fairness, transparency and an open culture. Staff morale was low, and at the time of our inspection, little had been done to address this.
People did not receive care that was well led and regularly monitored and reviewed to ensure the care was of sufficient high quality.