Archived: Ashmead Care Centre

Updated 31 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out an unannounced inspection on 20 and 21 November 2014. The inspection team included an inspector and a specialist advisor with experience in social work and the care of older people. We were also assisted by two experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses services, in this case services for older people and people with dementia.

Before our visit we reviewed information we held about the home including the last inspection report from March 2014 when we judged that the provider was meeting the regulations we inspected. We reviewed notifications we had received from the provider and other agencies since our last inspection and spoke with a lead safeguarding officer from the local authority and other health care professionals involved in people’s care. We also reviewed complaints and concerns reported to us by the relatives and friends of people who use the service.

We spent time talking with 20 people living at the home and 10 visiting relatives/friends. We spoke with the home manager, a peripatetic manager and a regional manager. We also spoke with five nurses, three care staff members and the home’s housekeeper. We discussed people’s care with a visiting GP and a palliative care nurse.

After the inspection we were contacted by two health and social care professionals who voiced concerns around the home environment and the care and treatment received by people living at the home.

We looked at all the communal parts of the home and with people’s agreement, looked at their rooms and bathrooms.

We reviewed six care records, five staff files and records relating to the management of the home.

Updated 31 March 2015

This inspection took place on 20 and 21 November 2014 and was unannounced. At our last visit in March 2014 the service was meeting the regulations inspected.

Ashmead Care Centre provides accommodation for people requiring nursing and personal care. The service can accommodate up to 110 people. At the time of our inspection 93 people were using the service.

The home was divided into six units. Three units were allocated to people living with dementia and two units were for people requiring general nursing. One unit which was to become a private 20 bedded unit was closed and undergoing refurbishment at the time of our visit. There did not appear to be any distinguishing features to any of the units and we saw that people with very different needs were placed across all six units. These arrangements may have made it difficult to provide specialist care to people identified as having very high support needs.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A newly appointed home manager was responsible for the day to day management of the service and was being supported in her role by a peripatetic manager, a deputy manager and a clinical nurse lead. The home manager told us she would be applying to become the registered manager in the near future.

People’s needs were assessed and care plans were developed to identify what care and support people required. We saw that reviews of people’s health and safety had been completed and updated in line with the provider’s policies and procedures.

Staffing levels were based on the dependency levels of people using the service. People using the service, relatives and friends and members of staff expressed concern that staffing levels were not always adequate to consistently meet people’s needs.

The home was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. We found that staff had received training and understood when a DoLS application should be made and how to submit one. However, this had not happened when applications were needed in relation to people being able to independently access different parts of the building and/or leave the premises if and when they wished to.

Staff had qualifications in health and social care, previous experience of working in care settings and received regular training. Most of the staff had completed training in dementia awareness.

We saw evidence that the home worked collaboratively with other health and social care professionals to ensure people received specialist care and treatment. Palliative care nurses visited the home on a regular basis and the home had gained accreditation in the Gold Standards Framework (GSF) in September 2014. GSF is an evidence based approach to optimising care for people approaching the end of their lives.

Staff demonstrated that they understood how to recognise the signs of abuse. Staff told us they would report any concerns to senior members of staff who would then assess the situation and report to the local authority’s safeguarding team and the Care Quality Commission (CQC) as required.

Activities were limited as the service did not have an activities co-ordinator. People using the service told us they had little opportunity to access the local community and take part in everyday activities such as going to the local shops, going out for a coffee or going to church.

We observed staff supporting people to make choices about the food they wanted. However, we noted that staff did not always ensure people were able to reach their food when it was served to them in their rooms. Some people who required prompting and/or support to eat their meal did not always receive this assistance. People’s opinions as to the quantity, quality and choice of food on offer, were mostly negative.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.