About the service:

Ascot Lodge Nursing Home is a 50 bedded service providing nursing or personal care to older people and people living with dementia. At the time of our inspection there were 43 people using the service.

People’s experience of using this service:

Since we last inspected the design and layout of the service had changed from four units to two units. The provider had a clear basis for change, which was to make social and living spaces bigger for people and to improve staff deployment. Whilst making changes to the environment we saw the provider had considered the needs of people living with dementia.

Staff were very caring. Everyone we spoke with was very complimentary about the staff. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

Activities were available to keep people occupied both on a group and individual basis. Trips out were also organised in line with people’s preferences.

Medicines were being administered safely and people’s dietary and healthcare needs were met. Checks which promoted safer storage of medicines had improved since our last inspection in September 2016.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training which was good and relevant to their role. Staff said they felt supported by the manager. The provider had transitioned to a new supervision and appraisal system, which created new requirements for line managers to follow when they held formal discussions with their staff. We saw the new system had adversely impacted on the frequency staff received a formal supervision and appraisal. We were satisfied the provider had clear improvement plan in place to address this.

Care plans were up to date and detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The manager provided staff with leadership and was described as being very approachable. Audits and checks were carried out and used to drive continuous improvements to the service people received.

People’s feedback was used to make changes to the service, for example, to the menu’s and activities.

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

Rating at last inspection:

At the last inspection the service was rated as good (report published 4 October 2018).

Why we inspected:

This was a planned inspection to check the service remained good.

Follow up:

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

The inspection took place on 13 September 2016 and was unannounced. The home was previously inspected in November 2013 and the service was meeting the regulations we looked at.

Ascot Lodge Nursing Home is a 50 bed nursing home offering care and support to older people living with dementia. It is situated within easy reach from the public transport to town centre and other amenities. At the time of our inspection there were 47 people using the service.

The service had a registered manager in post 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 2008 and associated Regulations about how the service is run.

Staff we spoke were knowledgeable about the process they would follow if they suspected abuse. They told us they received training in this area and would be able to recognise abuse. Staff also told us they knew how to use the whistle blowing policy and would raise anything that was a concern to them.

We looked at the systems in place to manage people’s medicines and found this was done in a safe way. We looked at storage and records of medicine and found these were accurate. The temperatures were taken of the room and fridge which was used to store medicines requiring cool. However, we did see that on some days these had not been recorded.

We found the provider had a safe and effective system in place for employing new staff. We looked at six staff files and found them to contain pre-employment checks and other appropriate information.

Each person had a dependency tool in their care records which identified their level of need. For example, low, medium, high or very high dependency. Through our observations and speaking with people who used the service, their relatives and staff, we found there were enough staff available to meet people’s needs.

Risks associated with people’s care were identified and appropriate measures put in place to reduce the risk occurring.

We spoke with staff about the training they received and they told us this was worthwhile and covered subjects appropriate to their role. Training provided was mainly completed by eLearning; however certain subjects such as manual handling were completed face to face.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff offered people choices and respected their decisions.

We observed meal times and found that people were involved in deciding what they preferred to eat and drink. Snacks and drinks were available throughout the day. We saw smoothies and snack plates were available to boost people’s nutritional intake where required.

People had access to healthcare professionals when required. We looked at care records and saw professionals such as speech and language therapists, and physiotherapists had been involved in their care.

Throughout our inspection we found staff to be caring and considerate when interacting with people. They showed respect by knocking on doors before entering and speaking quietly and confidentially with people.

Relatives we spoke with told us that the home had several social events where entertainers came in. They told us that birthdays were celebrated. On the day of our inspection it was a warm day and people enjoyed sitting outside. However, there was no other social stimulation taking place.

The provider had a complaints procedure which was displayed in the main entrance of the home. People we spoke with and their relatives had no concerns about the service and were very complimentary.

There was evidence of good leadership at all levels. Staff knew their roles and responsibilities well and looked to senior staff for advice and guidance when required.

We saw audits were completed to ensure the quality

People who lived at the home had varying degrees of dementia which meant some people were unable to make informed decisions on their own about their care and treatment. Therefore staff at the home ensured people’s families and advocates were involved in the planning of care.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People’s care needs were followed up by risk assessments to ensure the planned care minimised the risk to people.

There were effective systems in place to reduce the risk and spread of infection. Dedicated members of staff were seen carrying out cleaning duties throughout the home.

Appropriate checks were undertaken before staff began work. The manager ensured necessary checks were carried out with satisfactory results before staff were allowed to work.

We found that there were enough staff to meet people’s needs in some areas of the home. The manager explained that they had identified the need to increase the staffing numbers in other areas.

People’s complaints were fully investigated and resolved, where possible, to their satisfaction.

On the day of our inspection people looked contented. We observed the staff interaction with people. People reacted positively.

People with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing people who use services for a period of time and recording their experiences at regular intervals. This included people’s mood, and how they interacted with staff members, other people who use services, visitors and the environment.

Those who were able to communicate with us told us that they were comfortable and the care staff took care of them. They said they enjoyed the food and they could ask the staff members for a drink or snacks when they wanted.