Ashleigh Rest Home

We found the following examples of good practice:

Staff had a designated changing room to put on and take off personal protective equipment (PPE) and uniforms safely with access to a shower and hand washing. Staff wore appropriate PPE to ensure people were protected as much as possible from the risk of cross infection. PPE points were located throughout the home and there was an ample supply of PPE in stock. Hand sanitisation points were on entry to the home and staff had access to pocket hand sanitiser to use when required. Staff had received training on how to put on and take off PPE safely including agency that attended the home. Enhanced cleaning was being completed throughout the day, to ensure the home remained clean and the risk of cross infection was reduced.

There were clear processes in place for visitors to the service. They were screened for Covid 19 symptoms on arrival, had to show a negative lateral flow test and vaccination status. They were also supported and required to wear appropriate PPE and maintain social distancing during their visit. A small lounge next to the entrance had been designated for visits which spread out by being booked in advance. During a recent outbreak at the home and in agreement with family and friends visiting had been restricted as advised by the local infection and prevention control team but the service had supported people to stay in contact with family and friends through regular video calls, window visits and telephone calls. The outbreak was effectively managed by the home with no other residents or staff tested positive for COVID-19.

The service participated in whole home testing and meeting COVID-19 requirements for people visiting the service(who are not exempt).

Ashleigh Rest Home is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. The service can support up to 11 people. The care home has eleven private rooms and there is a communal lounge and dining area with comfortable seating, for people to enjoy.

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

People were protected from avoidable harm. Staff carried out risk assessments and care records explained the actions required to minimise risks. Staff had completed safeguarding training and told us they would report any concerns to the registered manager, provider or external authorities to ensure people were protected from avoidable harm. Safe recruitment practices were followed, and staff were deployed effectively, so they could meet people's needs. Medicines were managed safely, and staff received training and practical assessment to check their competency in this area.

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 cared for in a safe, clean and homely environment by staff who were caring, competent and knowledgeable about people's needs. Training and supervision was arranged to ensure staff had the skills to carry out their role. People said the food was good, enjoyable activities were arranged, and they were supported to access medical advice if they needed this.

Staff treated people with dignity and respect and staff told us they respected people and ensured their privacy and dignity was maintained. Care was person centred, met people's needs and achieved good outcomes.

People were consulted and asked their views on the service provided. The registered manager provided people with surveys. Any comments were actioned whenever possible. A complaints procedure was displayed at the home and documentation showed complaints were responded and resolved.

The registered manager and provider had promoted an open, caring culture within the home. Staff and the registered manager worked closely together, and with external health professionals, to help enable people to have the best outcomes possible. The registered manager carried out regular checks on areas such as medicines, infection control, accidents and incidents and the environment to ensure shortfalls were identified and actioned and successes celebrated.

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 this service was good (published 05 August 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

Ashleigh Rest Home accommodates older people who are living with dementia. The home had 11 single bedrooms, four of which had en-suite facilities.

The service is registered to provide accommodation for persons who require nursing or personal care. There is 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.

People who lived at Ashleigh Rest Home told us they felt safe and supported by staff and the management team.

During our last inspection, we found issues with the reporting of safeguarding incidents. We found not all safeguarding incidents had been appropriately reported to the relevant authorities. We looked at how reporting of safeguarding incidents were being managed during this inspection. We found people were protected from the risk of abuse because staff understood how to identify and report it.

During our last inspection, we found evidence risk assessments were not always updated following a change in needs. We looked at how risks to people were being managed during this inspection. We found people were protected from risks associated with their care because the registered manager had completed risk assessments, which provided updated guidance for staff in order to keep people safe.

During our last inspection we found no additional checks were documented following an accident. This put people at risk of harm. In addition there was no evidence available to show that accident and incident records had been reviewed, in order to identify and analyse any trends or patterns. We looked at how accidents and incidents were being managed during this inspection. There was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.

During our last inspection, we made a recommendation that the provider follows best practice guidelines around infection prevention and control in care homes. We looked at infection control processes at this inspection and found improvements had been made.

During our last inspection, we made a recommendation around keeping Personal Emergency Evacuation Plan [PEEPs] up to date. We looked at PEEPs during this inspection and found people had up to date PEEPs in their files to aid safe evacuation.

During the last inspection, we found in some care files, consent forms had not been completed. We also found some examples where consent had been provided by people's family members, but there was no confirmation that people who had provided consent had legal authority to do so.

We found mental capacity had been considered and written consent to various aspects of care and treatment was observed on people's files.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We viewed records for two people documenting evidence conditions for DoLs authorisations were being followed.

During our last inspection visit, we made a recommendation around reviewing care files and the systems in place to ensure these were kept up to date. At this inspection we saw care records were written in a person centred way. Staff took note of the records and provided person centred care.

During our last inspection at the service, we found concerns around good governance. There were systems in place designed to monitor quality and safety across the service but we found these had not been used effectively at times; we made a recommendation around this. We looked at the improvements that had been made during this inspection. We found there were quality monitoring systems in place to help drive up improvements in the service. This helped to ensure people were living in a safe environment.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had undertaken checks. This was done to ensure staff had the required knowledge and skills, and were of good character before they were employed at the service.

We found the service was pro-active in supporting people to have sufficient nutrition and hydration. People said the quality of the food was good. One person said, “I enjoy the meals, I do like my food.” Care plans showed where appropriate, the staff had made referrals to health care professionals such as the community nursing team and GP's.

People received care which was relevant to their needs and effective because they were supported by an established staff team. The staff had received appropriate training such as moving and handling and had a good understanding of people’s needs.

We received consistent positive feedback about the care provided at Ashleigh Rest Home from people who lived at the home and their relatives. We observed staff as they went about their duties and provided care and support during this inspection visit. Staff appeared to understand the needs of people they supported and it was apparent trusting relationships had been created. One relative told us, “The staff understand that they cannot bring the residents into their world so they try to get into the residents world, and they do it very well.”

The registered manager and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

People told us, “I like to do crosswords and the staff will provide the things I want.”. And, “The staff would support me if I wanted to do something.”.

We saw people engaging in activities positively with staff. People were supported and encouraged to take part in activities, these were provided by the care staff and included one to one time and singing. People were encouraged to raise any concerns or complaints. The service had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

The registered manager kept up to date with current good practice guidelines by attending meetings at which they shared learning and discussed new developments in care. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

Ashleigh Residential Home accommodates older people who are living with dementia. The home has 11 single bedrooms, four of which had en-suite facilities. The home is situated in a quiet residential area and has a pleasant garden. Local amenities including bus stops, a church and shops are situated nearby.

The service is registered to provide accommodation for persons who require nursing or personal care. There is 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.

We found that the principles of the Mental Capacity Act (MCA) 2005 were not embedded in practice. Records showed that consent had been obtained in some areas. However, the service had not implemented a system to adequately assess people’s mental capacity in relation to the decision making process. Therefore, some people may have signed consent forms without fully understanding what they were signing.

We looked at how the service protected people from avoidable harm and known risk to individuals. Risk assessments were included in people’s care files and actions were documented clearly for staff to follow. However risk assessments were not always updated following a change in people’s needs.

We found that the service did not always follow safeguarding reporting systems, as outlined in the home’s policies and procedures. Accidents were recorded in the accident book. However, there was no evidence available to show that this information had been reviewed, in order to identify and analyse any trends or patterns.

There was effective communication between all staff members, including the managers. There was an established staff team, who knew about people’s individual care needs and who were passionate about their jobs and caring for others.

We found that written policies in relation to the recruitment of new staff were in place at the home. Records we saw demonstrated that safe practices had been adopted to ensure that staff employed were suitable to work with this vulnerable client group.

We found that the home was clean and tidy throughout. The provider had a policy with regards to infection control and records demonstrated that staff had been provided with training in this area. However, we found that best practices for infection control were not always being followed. We have made a recommendation regarding this.

We found that Personal Emergency Evacuation Plan [PEEPs] were generic and did not contain personal information to show how each individual could be best assisted to evacuate the premises, should the need arise. We have made a recommendation with regards to this.

There were some effective quality assurance systems in place that monitored care. However these systems did not always pick up on failings around valid consent and incident failings highlighted in this report. We have made a recommendation with regards to this.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to consent, safe care and treatment and safeguarding people from abuse.

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