Ashglade, Bromley.Ashglade in Bromley is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care and caring for adults over 65 yrs. The last inspection date here was 12th April 2018 Contact Details:
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19th March 2018 - During a routine inspection
Ashglade is a ‘care home’. People in care homes receive accommodation and nursing or 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. Ashglade is situated in the London borough of Bromley that provides care for up to 12 people. At the time of the inspection the home was providing care and support to 10 people. The home had a registered manager in post. 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. This inspection was carried out on 19 March 2018. At our last inspection at the service on 25 May 2017 we found there were not always enough staff to meet people’s needs. At this inspection we found that improvements had been made and there were enough staff on duty to meet people care needs. People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. Staff had the knowledge and skills required to meet people’s needs. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People said they enjoyed the meals provided and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them. People needs were assessed before they moved into the home. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People’s privacy and dignity was respected. There was a range of activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on. The provider recognised the importance of monitoring the quality of the service. They sought the views of people, their relatives and staff through satisfaction surveys. The registered manager worked with other care providers and professional bodies to make improvements at the home. Staff said they enjoyed working at the home and they received good support from the registered manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to them when they needed it.
25th May 2017 - During an inspection to make sure that the improvements required had been made
We had carried out a comprehensive inspection on 10 and 11 January 2017 and found a serious breach of legal requirements in respect of the record keeping and management at the home. We took enforcement action in respect of this breach and had served a warning notice telling the provider to meet the regulations by 20 March 2017. We undertook an unannounced focused inspection of Ashglade on 25 May 2017 to check that improvements needed to meet legal requirements had been made. Ashglade provides accommodation and residential care for up to 12 people. In this report, the name of a registered manager appears who was not managing the regulated activities, at this location, at the time of the inspection. Their name appears because they were still registered as manager on our register at the time. CQC is in the process of establishing the most appropriate means for their removal as the registered manager for this location. At this inspection on 25 May 2017 there was a new manager in post who had started after our last inspection in January 2017. They were applying to register as the registered manager for the location at the time of this 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.’ At this inspection we looked at aspects of two key questions; Is the service safe? And is the service well led? This is because regulations were not being met fully in these areas at our last comprehensive inspection in January 2017. We found improvements had been made in these areas since our last inspection. However we also found a further breach in respect of staffing levels as there was not always enough staff deployed to meet people’s needs at all times. We found there was an absence of staff in the communal areas to support people when needed. Staffing levels in the day and at night had not been reviewed to consider increased dependency levels at the home. You can see the action we have asked the provider to take at the back of the full version of this report. We found considerable improvements had been made by the new manager at the home. Records of people's care had improved. Care plans and risk assessments were up to date and reflected people’s current needs. There was detailed guidance for staff which we observed was followed in relation to possible risks. Some improvement was still needed as we found two risk assessments for skin integrity had not been totalled correctly to identify the correct level of risk but this had not impacted on people’s care, as we saw there was guidance to reduce risk and suitable equipment in place. Improvements had been made to the systems to monitor the quality and safety of the home. The manager had ensured audits were regularly carried out across aspects of the running of the home and we saw where they identified areas for improvement this work had been completed. Work was being carried out to improve the conservatory and garden areas that had previously been identified as needing improvement. Improvements had been made to the way risk was monitored. However, some improvements were still needed to ensure that this was effective over all aspects of the home. For example the issues about staffing had not been identified by the provider and systems to identify possible new risks had not worked effectively at all times. Although improvements have been made, the overall rating for the home therefore remains Requires Improvement in line with our characteristics for ratings.
10th January 2017 - During a routine inspection
This inspection took place on the 10 and 11 January 2017 and was unannounced. At our previous inspection on 17 November 2015, we found a breach of regulations in respect of the safe management of medicines. We carried out this inspection to check that the home now met legal requirements and provide a fresh rating for the home. Ashglade provides accommodation and residential care for up to 12 people. The registered manager was not managing the regulated activities at this location at the time of the 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. A new manager had been appointed and started work at the service after the inspection. We found breaches of regulations at this inspection. We had concerns about the management and oversight of the service, and quality monitoring processes were not robust. Audits were not always completed and where they had been, they did not always identify problems or ensure action was taken to address issues. Recent audits had not identified inaccuracies in people’s risk assessments. People’s care plans and risk assessments were not always up to date or did not reflect their current needs. Accurate records of people’s care and treatment were therefore not always maintained. Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. Improvements were required to ensure staff received adequate training, supervision and appraisal. Medicines were safely managed but regular assessments of staff to ensure they were competent to administer medicines were not always in place. Some people and their relatives did not feel consistently involved in reviews about their care, and records reflected this. The arrangements to meet people’s needs for stimulation and social engagement were not always personalised to meet their individual needs. However, a new activities coordinator had recently started and had plans to improve the activities provided. We will check on these aspects at our next inspection. People told us they felt safe and staff treated them in a caring manner. People’s individualised needs with regards to their disability, race, religion and gender were identified and plans put in place to meet their needs. Staff were aware of the potential signs of abuse to look for and what action to take if they were concerned. People were supported to maintain a balanced diet and told us they enjoyed the range of meals on offer. People also told us that there were enough staff available to safely meet their needs, and we saw that staff were available to support people where required. Recruitment checks were completed before staff started to work at the home. Staff had received training around the Mental Capacity Act 2005 (MCA); applications for authorisations under Deprivation of Liberty Safeguards (DoLS) were appropriately made. People had access to a range of healthcare professionals when required. A complaints procedure was in place and people told us they knew how to raise concerns if they needed to.
17th November 2015 - During a routine inspection
This inspection took place on 17 and 18 November 2015. The inspection was undertaken by two inspectors and was unannounced.
At our inspection of 28 May 2015 we found that issues in relation to the safety of the premises had been resolved. At this inspection we found that improvements in these areas had been maintained and that the premises and surrounding areas were safe. Fire risk assessments were continuing together with other safety processes connected with fire and infection control. A ramp had been constructed for people to safely leave and enter the property.
Ashglade is a care home located in the London Borough of Bromley. The home is registered to provide accommodation and support for up to 12 older people some of whom are living with dementia. At the time of our inspection 11 people were using the service. The home is a large detached house over three levels. There is an outdoor area with a patio and a large and accessible garden.
There was a registered manager in place. 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 this inspection we found a breach of regulations because some medicines were not always securely stored and the administration of medicines were not always recorded. You can see the action we have asked the provider to take in respect of this breach at the back of the full version of the report.
People received care, food and fluids in line with their care plans and as advised by health care professionals. Action had been taken to support people where risks had been identified and there were arrangements in place to deal with foreseeable emergencies. Peoples care plans were up to date and included detail about their needs and preferences. People using the service said they felt safe and that staff and the manager treated them well. Staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available for staff and they told us they would use it if they needed to.
Recruitment of employees was robust with good record keeping and checks including DBS and ID procedures.
Staff had received training in order to meet the needs of people using the service. They had also received regular supervision and an appraisal of their work performance. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
There were enough staff on duty to meet people’s needs safely. We saw that staff respected people’s privacy, dignity and independence and engaged with them in a caring manner. They understood and responded to people’s individual needs and were familiar with people’s histories and preferences.
People and their relatives had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.
28th May 2015 - During an inspection to make sure that the improvements required had been made
We carried out an unannounced comprehensive inspection of this service on 9 and 10 December 2014. A breach of legal requirements was found. This was because aspects of the service were not safe. While some premises issues previously identified had been addressed, the provider had not fully implemented the necessary recommendations from a fire safety risk assessment.
After the comprehensive inspection, the provider wrote sent us an action plan to say what they would do to meet legal requirements in relation to this breach. They told us they would complete the action required by 01 April 2015. We undertook a focused inspection on the 28 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements.
This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ashglade’ on our website at www.cqc.org.uk.
Ashglade provides accommodation and personal care for up to 12 people. There was a registered manager in place. 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. The registered manager understood their responsibilities as a registered manager.
At this inspection of 28 May 2015 we looked around the premises and saw that the provider had acted on the recommendations of the fire risk assessment and now met legal requirements. We did not ask people for their views about this legal requirement.
While improvements have been made we have not revised the rating for this key question; to improve the rating to ‘Good.’ This was because at the previous inspection we found, although the provider met legal requirements, some improvements were needed in the management of medicines. We did not inspect the management of medicines at this inspection. We will review our rating for safe at the next comprehensive inspection.
12th December 2013 - During an inspection to make sure that the improvements required had been made
We inspected the service on the 12 December 2013 to follow up on the warning notice issued on 19 September 2013 and found that the provider had met the required actions to safeguard people from abuse. However, we found not all the care plans reflected up to date actions from the risk assessments that had been completed. Also, there were not always effective recruitment and selection processes in place as gaps in employment history had not always been explored; and references were not always received from those specified. There were nine people living at the home on the day of our inspection and we spoke with everyone. People we spoke with told us they were very happy with the care and that the staff were very good. One person said "it's lovely here and staff are very friendly and kind". We observed people being spoken to respectfully and in a pleasant manner. We were told that staff come quickly when call bell was pressed, except sometimes in the night because there is only one staff on shift.
19th September 2013 - During an inspection to make sure that the improvements required had been made
We inspected the service on 02 July 2013 and found the provider had not responded appropriately to allegations of abuse and they did not have an up to date safeguarding vulnerable adults policy in use. At our inspection of 19 September 2013 we found that the provider had not taken appropriate steps to safeguard people from the risk of abuse.
2nd July 2013 - During a routine inspection
People told us they were very happy at the home and there was plenty to do. One person said “I can go out shopping when I want to; the staff arrange it with me" and another person told us they enjoyed the activities on offer at the home. One person also told us "there is nothing I don't like about this home" and a further person told us "the manager is a good leader and the home is run pretty well". We found that people were asked to consent to their care and that their relatives were involved where appropriate. Care was planned and delivered in line with people's individual needs and medication was administered safely. Staff were supported through training and supervision and people knew how to make a complaint and described the home's manager as approachable. However the provider had not taken steps to protect people from the risk of abuse because they had not always acted appropriately in response to allegations of abuse.
22nd January 2013 - During an inspection to make sure that the improvements required had been made
We previously inspected the service on 20 April 2012 and found the home needed to make changes in several areas to ensure they were meeting the essential standards. The provider wrote to us and told us they would address the issues identified at our April inspection. We returned to inspect the service on 23 January 2013 and found the provider had taken account of the views of people using the service and consulted with them about their care. The care plans and risk assessments reflected people's individual preferences and changes in their diet. The provider had reported a safeguarding issue to the police, social services and the Care Quality Commission. Staff were trained in safeguarding vulnerable adults and the provider had carried out appropriate recruitment checks. The provider had also implemented audits to check on the quality of the service provided.
20th April 2012 - During a routine inspection
People we spoke with told us that “staff are very pleasant here”. Two people told us they feel staff listened to them. One person said that “staff like to please you”. People told us they liked the friendliness of the home. A relative we spoke with described the home as “generally pretty good”. Two people said that there is only limited menu choice available but that the cook “will make an alternative meal if asked”.
7th June 2011 - During a routine inspection
People told us that they were happy with the care at the home. They said that they were well cared for and that the staff were friendly and supportive. However, on our visit to the care home on 7th June 2011 we found some concerns with cleanliness and infection control, medicines management and assessment and monitoring of the quality of service provision. For these areas we have asked for immediate improvement.
1st January 1970 - During a routine inspection
This inspection took place on 9 and 10 December 2014 and was unannounced. At the last inspection on 12 and 13 May 2014 we had found breaches of the Health and Social Care Act 2008 in respect of safety of premises, procedures to reduce the risk of infection and systems to monitor the quality of the service. We referred the service to the London Fire and Emergency Planning Authority (LEFPA) because of concerns about adequate fire safety. They served the provider with a notice of deficiency on 18 June 2014. Following this inspection the provider sent us an action plan to tell us how they would meet the regulations.
At this inspection of 9 and 10 December 2014 we checked to see the action plan had been completed and that the provider was meeting the regulations.
Ashglade is registered to provide care for 15 people. There were only 12 rooms at the service when we inspected. The manager told us that following the initial registration, some alterations had been made to the property to put in ensuite facilities in some rooms. This had reduced the number of places available. The manager told us she would ensure an application was made to correct the numbers of people they were registered to provide care for.
There was a registered manager in place. 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.
We found the breaches we had identified at the last inspection had mainly been resolved. There were improvements to the system to monitor quality at the service and processes to reduce the risk of infection were in place and being used. There had been improvements made to aspects of the premises we identified at the previous inspection. Although a ramp for people to safely enter and leave the property had not been installed when we inspected but we were sent evidence of its completion the following day.
We found new breaches of regulations in regard to premises. A new fire risk assessment carried out on 22 September 2014 had identified a number of immediate actions; we saw evidence that only two of these had been completed. The notice from the LEFPA had not been fully complied with. This was a breach or Regulation 15 of 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.
People and their relatives said they felt safe from abuse and discrimination. Staff were trained and knew how to recognise and respond to concerns about abuse. Processes were in place to identify any risk to people and these risks were monitored and plans in place to reduce risk. However we did identify some improvements that were needed in the management of medicines.
There were enough staff to meet people’s needs safely. Staff received adequate training and support to deliver care to meet people’s needs. The premises were clean throughout and equipment was regularly maintained and serviced when needed.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). One application had been made and authorised since the last inspection. We found that the required processes had been followed. Staff had received training on the Mental Capacity Act 2005 and procedures were in place to act in accordance with the associated code of practice. However we identified that some staff needed further assistance to fully understand their responsibilities under the act.
People were supported to have sufficient amounts to eat and drink. Their health needs were monitored and referrals were made to a range of health professionals to meet their needs. People told us staff were caring and treated them with care and respect. Care plans were regularly reviewed to ensure they met people’s needs and people felt involved in planning their care and support. A range of suitable activities were organised that catered for people’s varied needs.
People told us the manager was approachable and staff said they felt their views were listened to. We identified some improvements needed with the monitoring of quality of the service. The manager regularly monitored the care and facilities for people using the service. Where some concerns with the premises were identified, either by people using the service or through audits, there was not always evidence of a prompt response from the provider and this required improvement.
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