Archived: Ashbourne Lodge

Updated 30 October 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 was 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.

This inspection took place on 11 and 20 August 2015 and the first day was unannounced. This meant the staff and registered provider did not know we would be visiting.

The inspection team consisted of two adult social care inspectors, one specialist professional advisor and an expert by experience. A specialist professional advisor is someone who has a specialism in the service being inspected such as a nurse. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had experience in caring for older people living with dementia.

Before we visited the home we checked the information we held about this location and the service provider. For example, inspection history, safeguarding notifications and complaints. No concerns had been raised. We also contacted professionals involved in caring for people who used the service, including commissioners, safeguarding staff and district nurses. No concerns were raised by any of these professionals.

The registered provider was not asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we spoke with 15 people who used the service and two family members. We also spoke with the area manager, the manager, deputy manager, nine care workers, a housekeeper and the cook. We also spoke with one external healthcare professional prior to the visit.

We undertook general observations and reviewed relevant records. These included five people’s care records, four staff files, audits and other relevant information such as policies and procedures. We looked around the home and saw some people’s bedrooms, bathrooms, the kitchen and communal areas.

Updated 30 October 2015

This inspection took place on 11 and 20 August 2015. The first inspection day was unannounced, which meant the staff and registered provider did not know we would be visiting. The registered provider knew we would be returning for the second day of inspection.

Ashbourne Lodge is a purpose built care home built across two floors. The lower floor Ash unit accommodates up to 25 people with residential care needs. The upper floor is split into two units, the Cedar and the Oak. The Cedar unit offers accommodation for up to 15 people with residential care needs. The Oak unit is a dedicated dementia care unit designed for older people living with a dementia and can accommodate up to 17 people. Each unit has its own kitchenette area, where people who used the service, their visitors and relatives can make use of the tea and coffee making facilities. Each bedroom offers en-suite facilities and each unit also provides additional bathing and showering facilities. The home itself is positioned in a residential area and offers designated parking to visitors and people who use the service.

The home had a manager in place who had been working there as the manager since November 2014. At the time of inspection the manager was in the process of becoming registered with the Care Quality Commission (CQC) since May 2015. A registered manager is a person who has registered with the 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.

On the first day of inspection the manager was on annual leave and the deputy manager was in charge of the day to day management of the service. We found the deputy manager did not have full managerial oversight and was unable to answer questions such as how many people lived upstairs.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. 14 members of staff out of 51 had not received training in safeguarding. Staff we spoke with said they would be confident to whistle blow [raise concerns about the home, staff practices or provider] if the need ever arose.

Assessments were not always undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were not put in place to reduce the risks identified. Care plans provided some evidence of access to healthcare professionals and services. Although we saw no evidence of this when people lost weight or had a fall.

There were sufficient numbers of staff on duty to meet the needs of people using the service although duty rotas showed some staff worked excessively long hours with one staff member working up to a 100 hours in seven days. Care was provided in a task focussed way. Staff were very busy on the morning and although the afternoon was a lot quieter we did not see staff engaging with people who used the service. We recommend the manager monitors staff working hours and checks staff effectiveness and wellbeing after such long working hours to ensure the safety of both staff and people using the service.

All of the care records we looked at contained some written consent, for example consent to photographs and to the care provided. Although not all of these forms were completed and consent was not sought for people using bed rails.

Medicines were not always managed safely. We recommend the manager completes medicine administration competency checks, as per NICE guidelines 1.17.

Accidents and incidents were monitored monthly but nothing was done to address patterns or themes.

We found that supervisions and appraisals had taken place and were up to date. There were gaps in training records.

We saw that people were not involved in activities. The activity coordinator had left the service the weekend before the first inspection day. The service had advertised for a new activity coordinator. Staff were not supporting with activities until this role was filled. Staff were receiving a full day of training on our first day. This was taking place in the lounge located on the Ash unit. Therefore people had no where to sit other than the corridor or their own rooms, which isolated them.

People’s nutritional needs were met and their individual preferences and wishes adhered to. We recommend the manager updates what information the cook has available.

The service was spacious and suitable for the people who used the service. On the first inspection day some areas of the service needed a clean, for example the bathrooms had overflowing bins and air vents were covered in dust. Bedding and towels looked really worn. On the second day areas were all clean and new towels had been ordered.

We saw water temperature checks were taken regularly and the hot water did not exceed 44 degrees. However bath temperatures were not regularly recorded and when they were they were showing temperatures as low as 34 degrees. We recommend the registered provider follows recommended guidance on safe water temperatures.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks. We could not see any evidence of fire drills taking place or legionella testing.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found one person was living of the dementia unit but it was not clear whether they had a dementia type illness. The deputy manager did not have a full understanding of DoLS.

People who used the service, and family members, were complimentary about the standard of care. Staff told us that the home had an open, inclusive and positive culture.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible..

Care records were confusing, had limited information and were not person centred.

The registered provider had a complaints policy and procedure in place and complaints were fully investigated, although not all complaints were recorded. We recommend the manager documents each complaint and outcome.

The area manager carried out monthly monitoring visits. Each month they highlighted issues for example care plans need to be more person centred, care plans need more detail, no evidence of peoples capacity and no activities taking place. No action plans were put in place to rectify problems found, therefore every month the same issues were documented. We could see no learning or action plan from the monitoring visits.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.