The inspection took place on 13 March 2018 and was unannounced. The last inspection of the service took place on 11 October 2017 when we rated the service Requires Improvement in all key questions and overall. We issued warning notices in respect of breaches of Regulations in relation to person-centred care and good governance, and made requirements in respect of dignity and respect, safe care and treatment, nutrition and hydration and staffing. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least ‘good’.
At this inspection we found that improvements had been made in all areas however not enough to improve the rating to Good. We found that whilst improvements had been made in relation to the safe care and treatment of people and good governance, further improvements were required in order to meet these Regulations. We found the provider had met breaches of Regulation regarding person-centred care, dignity and respect, nutrition and hydration and staffing. We have rated the service Requires Improvement overall and in the key questions of Safe, Responsive and Well-led. We have rated the key questions of Effective and Caring as Good.
Ashwood Care Centre is a 'care home'. People in care homes receive accommodation with nursing and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to accommodate up to 70 older people. At the time of the inspection there were 46 people living at the service. Accommodation is provided on three floors. People living on the first and second floor were living with the experience of dementia.
Bondcare (London) Limited manage nine care homes within London and are part of Bondcare, a national provider of care homes in the United Kingdom.
There was a manager in post. They had applied to be registered with the Care Quality Commission and this application was being processed at the time of our inspection. 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 and associated Regulations about how the service is run.
People did not always receive their medicines in a safe way and as prescribed.
The provider's systems and processes had not always identified risks such as the way in which medicines were being managed, risks of unsafe support being provided by a visitor and risks associated with infection prevention and control. This meant that they were not able to respond and take action to mitigate these risks.
We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance.
We are taking action against the provider for failing to meet Regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Following our feedback regarding areas of concern, the provider took action to mitigate the risks we had identified.
People's needs were being met, although there was a risk that these would not always be met in a way which reflected their preferences. Information about individual care needs was not always clearly recorded. The staff had recorded when people refused care, but they had not always investigated if there were other ways they could offer care to ensure people had the support they needed in a way they preferred.
The provider had improved the service. They had listened to feedback from the local authority, people using the service, staff and other stakeholders to help identify improvements they wanted. They had also addressed the majority of concerns identified at the last CQC inspection and we could see that there were systems and processes to continue making improvements.
People were happy living at the service. They felt well supported by kind and caring staff. They told us their needs were being met and they were able to make decisions about how they were being cared for. People were treated with dignity and respect and were able to maintain their independence if they wanted this. There were a range of organised social events and activities, and people also received individual support to meet their social and leisure needs.
The staff were happy working at the service. They felt supported by their manager and had the training and information they needed to care for people. There were enough staff to keep people safe and meet their needs. There were effective systems for sharing information amongst the staff team to make sure people received effective care.
People lived in a safe environment. The provider undertook checks on the safety of the environment and equipment. People had the equipment they needed. The home was clean. There had been improvements to design of the environment but further improvements were needed. For example, some bathrooms could not be used and best practice guidance for promoting dementia friendly environments had not always been followed.
People had enough to eat and drink. The staff monitored this and took action when people were identified as at risk. The staff worked with other professionals to ensure people's healthcare needs were being met. The provider had assessed people's needs and preferences and had recorded these in care plans. The staff kept records of the care that they had provided. They had responded to changes in people's needs and had taken action when people fell, became ill or their condition deteriorated. Some people were receiving care and support at the end of their lives. The staff had the skills and support to make sure these people were comfortable, pain free and their preferences were respected.
The provider had acted in accordance the principles of the Mental Capacity Act 2005 and restrictions on people's freedom had been lawfully agreed in their best interests.
There was a clear and visible management team, with the manager supported by the provider's representatives. People felt they could speak with the manager and that complaints were appropriately responded to. There were systems for identifying and improving the quality of the service and these included asking people living there and others for their views.