Ashfields Care Home

About the service

Ashfields Care Home is a residential care home providing accommodation and personal care to 36 people at the time of the inspection. The service provides support to older people and those living with dementia or physical disabilities. The service can support up to 39 people. Ashfields Care Home is a detached, adapted building with 2 floors accessible by lift. There are 5 self-contained flats adjacent to the home and a large garden area.

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

The management of medicines was not always effective or robust. Records relating to medicines were incomplete or inaccurate. Recruitment checks for new staff were being completed, but these did not always include checks of employment history. We made a recommendation about this. Risks relating to people and the environment were assessed and monitored, and people told us there were enough staff to meet their needs.

Quality systems were not always effective in identifying issues relating to the management of medicines, recruitment practices or health and safety. Staff and people told us there was a positive culture in the home, and people spoke positively of the registered manager. People and staff were engaged in the running of the home, and people benefited from the home’s partnership working with external agencies.

People’s needs were assessed and used to develop person centred care plans. 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 received support personalised to them, from a staff team who felt supported by the registered manager.

Staff treated people with respect and understood the needs of people well. Staff understood the importance of providing care which promoted dignity, privacy and independence, and people spoke positively of the staff approach to providing care. People and their relatives were engaged in reviewing their care plans in accordance with their changing needs.

People received care tailored to their needs and were engaged in a range of meaningful activities both in the home and the local community. People were supported to maintain relationships with their loved ones, and relatives spoke positively about the service their loved ones received. Complaints and concerns were managed effectively, and people’s communication needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 14 May 2019). At this inspection, we found the overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and good governance at this inspection. We have made a recommendation regarding staff recruitment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashfields Care Home is a ‘care home’ providing personal care accommodation for up to 39 people. Accommodation was provided in the main building and five self-contained apartments.

People’s experience of using this service:

People continued to be protected from abuse and avoidable harm. Safe recruitment procedures were followed and there were sufficient staff to meet people’s needs. People received their medicines safely and when required. Staff were provided with a ready supply of personal protective equipment (gloves and aprons) and with relevant guidance of how to control and prevent the spread of infection. We saw that some staff did not follow the correct guidance and brought this to the registered manager’s attention. They took action to remind staff of requirements.

The service continued to be effective. People’s needs were fully assessed, and individualised care plans developed to ensure that effective care was delivered. Staff were well trained and knowledgeable about the people they supported. When people were unable to make decisions about their care, the service followed the principles of the Mental Capacity Act 2005. People were supported to maintain their health and well-being with access to a wide range of health and social care services.

People were served good quality nutritious food although we received contrasting feedback about a lack of choice to meet people’s preferences. The registered manager confirmed that they would discuss this at the next service user meeting and a recently distributed questionnaire also invited people to express their views about food served.

People were cared for by a staff group who were kind and caring. If needed, people had access to advocacy services to ensure their rights were protected.

There was a consistent and established staff team who knew people’s needs, likes and dislikes well. Each person had a personalised care plan detailing the support they required which was regularly reviewed. Activities were organised by the care staff. Some people said that they would like more to do and we discussed this with the registered manager. They confirmed that, along with the feedback regarding meals, they would discuss this at the next service user meeting.

People and staff described the registered manager as approachable, supportive and willing to listen to any concerns. There was a process to assess and monitor the quality of the service. The registered manager was aware of their responsibilities for reporting and had notified the CQC about events that had occurred within the service. Due to an administrative oversight, there had been a delay in informing us about a recent event, this was addressed, and we have received all notifications as required.

Rating at last inspection:

At the last inspection the service was rated Good. (12 October 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ashfields is a 39 bedded three-storey care home for older people. It is located in Macclesfield and is close to local shops and the town centre. Included in the number of bedrooms are five single storey flats located within the grounds of the home. The flats are linked to the main building via a roofed walkway and equipped with a call system. The flats have en-suite facilities including a small kitchenette and are designed for people who are more independent.

The service was last inspected in March 2013 where the service was found to be compliant in all the areas we looked at.

The home has a registered manager. 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. At the time of our inspection there were 38 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of care assistants who were well supported.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We found that there were sufficient staff deployed to meet the needs of the people living in the home.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’.

People living in the home told us that the standard of care they received was good. Comments included, “The staff are excellent” and “They treat me well”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they were confident that their relatives were safe and well cared for. One person told us, “I’m happy that they are looking after my mum”.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured that plans were put in place in the person’s best interests. We saw that applications had been made appropriately.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good and they had a wide variety of food choices as well as where they could eat their meal.

Staff members we spoke with were positive about how the home was being managed and felt that the manager was supportive, organised and approachable.

There was an internal quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who lived at the home. This included audits on care plans, medication and accidents.

The home was well-maintained and clean and provided a calm, homely atmosphere. There were a number of maintenance checks being carried out weekly and monthly. These included water temperatures as well as safety checks on the fire alarm system and emergency lighting. These were audited regularly.

We looked at four care plans and found them to be well organised and maintained. We found evidence that people who lived in the home and their families were consulted in the planning and reviewing of their care.

We looked at the cleanliness of the home and found that it was clean and well maintained. We looked at the procedures and practices in place to protect the health and safety of the people who lived in the home and found that these were in place and were regularly reviewed and updated.

We spoke to three members of staff who told us that they felt well supported in their roles and that they received regular supervision and lots of training. One told us; 'We have a supportive and understanding management team and they are flexible in their approach.' We looked at the training and supervision records for the staff and saw that they were well supported and had access to regular training.

We looked at the complaints procedure in the home and found that there had been no complaints made in the last year and that people were encouraged to make comments about their care.