Care service description

Ashley Park Care Home is a care home that provides care, support and accommodation for a maximum of 30 older people some of whom are living with dementia. 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. The inspection took place on the7 November 2018. At the time of the inspection 26 people were living at the service.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. We found the service had improved in the Well Led domain.

Why the service is rated good

The service had a strong, visible person-centred culture and was exceptional at helping people to live their lives to the fullest. People, their relatives and staff told us the registered manager and all of the senior staff were caring, friendly and approachable. The registered manager and senior management took a personal interest in people and knew them well. They went above and beyond to ensure that people were supported in a way that benefitted them.

The registered manager worked in partnership with people's families and outside organisations to improve the care and support people received. The registered manager had systems in place which monitored health and safety and the quality of people's support. The systems were responsive and had led to changes being made. The registered manager was proactive with regard to how people's support could be improved.

People told us that they felt safe at the service. Staff understood what they needed to do if they suspected abuse as appropriate systems were in place. There were sufficient levels of staff to provide support to people when it was needed. The recruitment of staff was robust to ensure that only suitable staff were employed.

Staff care for people ensured that all of the risks were managed well. Equipment at the service was regularly serviced and appropriate checks were carried out. The provider had procedures in place to ensure people remained safe in an emergency. The service was clean and well maintained.

People were supported with their health needs. People were provided with health and nutritious meals and people had choices of what they wanted to eat and drink. When people were at risk of dehydration and malnutrition this was managed well by staff. Staff received training and supervision specific to their role.

Staff treated people in a caring and dignified way. We saw that people were encouraged to be independent and staff respected people’s choices around care. Staff understood the principles of the Mental Capacity Act 2005 and what they needed to do if they suspected a person lacked capacity.

People's needs had been assessed both before and after admission to the service. Care plans reflected people's needs and preferences. Care plans were evaluated regularly so they contained information about people's current needs. There was end of life care planning with people. People chose how they spent their time and could take part in activities if they wanted to. Staff worked well together and communicated changes to people’s needs to each other.

People told us that they would speak to staff if they had any concerns. There was a complaints procedure should anyone wish to complain. We saw that complaints were investigated and responded to. Notification were sent to the CQC where appropriate.

Further information is in the detailed findings below.

This inspection was carried out on 20 April 2017. Ashley Park Nursing Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 30 people. The accommodation is a large house arranged over three floors. The service also provides end of life care to people with the support of the local palliative care service. On the day of our visit 27 people lived at the service.

At the last inspection in April 2016, the service was rated Good however there were breaches in regulations around the Mental Capacity Act 2005 (MCA) and lack of training and supervisions with staff. At this inspection we found the service remained Good and the breaches had been met.

People’s legal rights were protected as staff were acting in accordance with MCA. Staff gained people’s consent prior to delivering care and understood the need to offer choices and respect people’s decisions. People told us they were involved in decisions regarding their day to day care.

Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Training was provided in line with the learning needs of staff to ensure their understanding.

People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified.

People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

Further information is in the detailed findings below

This inspection was carried out on the 14 and 15 April 2016. Ashley Park Nursing Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 30 people. The accommodation is a large house arranged over three floors. The service also provides end of life care to people with the support of the local palliative care service. On the day of our visit 27 people lived at the service.

On the day of our visit the registered manager was assisting at another service. 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. Instead we were assisted by the interim manager and the deputy manager.

People’s rights were not always met under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm. Assessments had not always been completed specific to the decision that needed to be made around people’s capacity. DoLS applications had been submitted to the local authority but we were unable to establish whether people’s capacity had been assessed before this was done.

Not all staff received one to one supervisions or annual appraisals to discuss their performance or training and development needs. Training for all staff was not up to date particularly around clinical care. However staff told us that they felt supported.

People were supported by staff that were given appropriate information to enable them to respond to people effectively although care plans did require more detailed information around the needs of people. Where it had been identified that a person’s needs had changed staff were providing the most up to date care. People were able to take part in activities which they enjoyed.

People’s needs were met because there were enough staff at the service. We saw that people were supported in a timely way with their care needs.

Accidents and incidents with people were recorded and trends analysed. Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Staff had undergone recruitment checks before they started work.

People’s medicines were administered and stored safely. Risks had been assessed and managed appropriately to keep people safe which included the environment. The risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm.

In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

People at risk of dehydration or malnutrition had effective systems in place to support them. People were weighed regularly and were supported to eat healthy and nutritious food. People had access to a range of health care professionals, such as the GP, Dentist and Optician.

People and relatives told us that staff were caring. We saw that staff were caring and respectful of people and ensured that people and relatives were involved in care planning. Staff knew and understood what was important to the person and supported them to maintain their interests.

People and relatives said if they needed to make a complaint they would know how to. There was a complaints procedure in place for people to access if they needed to.

People, relatives and staff felt that the services was managed well. Staff said that they felt valued and appreciated.

Systems were in place to monitor the quality of the serv

During our inspection we spoke with four people who used the service. All the people we spoke with were very positive about the service. One person we spoke with said; “It’s really perfect here, I feel very happy. You feel like you can do what you like. I feel quite safe here, I’m not nervous or afraid of anything”. Another person we spoke with said; “It’s very pleasant and we’re well looked after. It’s all left up to you, they don’t tell you to do anything”. A third person we spoke with said; “It’s by far the best home in the area. All the staff are respectful and I personally feel safe here”.

We found people’s consent had been sought prior to them receiving any care or treatment. All staff had been trained in safeguarding procedures and had access to the safeguarding policy and reporting procedures. There were appropriate systems in place to manage the storage, administration and disposal of medicines and an appropriate recruitment and selection policy which had been followed. We also found the home had an up to date statement of purpose available to people which contained appropriate information.

During our inspection we spoke with seven people who were living at the home. One person told us that the staff were ‘friends as well as carers’. This person also told us that the care was very good, the food was very good and the manager was nice and approachable. This person did tell us that the home had a lot of good activities, however, sometimes they did not receive their care early enough in the mornings and therefore missed some activities.

A second person we spoke with told us they found the home very satisfactory. This person told us they believed the staff were very well trained and that the home had a very good activities programme.

The other people we spoke with all commented on the staff and said they were ‘lovely and very kind’. One of these people told us they thought people were ‘beautifully looked after’. One other person told us they had spoken to the staff about there being a lack of fresh fruit with the meals and told us that since saying this there has been ‘more fruit than anyone could eat’.

Three people we spoke with did tell us that there was a larger amount of staff in the mornings and therefore that was when they had a bath however they would prefer having a bath at night but this was not always possible.

This inspection took place on the 17 November and the 09 December 2014 and was unannounced.

Ashley Park Nursing Home provides personal and nursing care, and is registered to accommodate up to 30 people some of whom are living with dementia. The home is a large period building with accommodation arranged over three floors, set in extensive gardens overlooking woodlands.

At the time of our inspection there was no registered manager in post. We were informed by the area manager that the registered manager had left the service two days prior to 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.

The home was clean and welcoming; however we found poor standards of cleanliness in the sluice rooms on all three floors of the home. We looked at infection control audits that had been completed and found that the sluice rooms had not been included.

Staff told us they had received the training they needed to do their jobs well. We found that the home had no records of staff appraisals, one to one sessions or supervision sessions. Some staff told us they had informal supervision which was not documented, and other staff told us they had not received supervision for at least one year. This meant that the provider had not provided opportunities for staff to discuss their personal development needs.

Records we looked at showed that the provider had not provided opportunities and support for staff to discuss their personal development needs and to have these meetings recorded for audit purposes. People and their relatives had opportunities to give their views about the service they received. At the time of the inspection the provider did not have a registered manager in post, however the interim manager promoted an open and inclusive culture.

People told us they felt safe in the home because of the way staff cared for them. We observed that people were supported in a timely manner with their personal care needs. We saw that people were supported at lunch time to have their meal in a relaxed and calm manner.

We looked at the staff rota and saw there was sufficient staff with appropriate skills and experience to meet people’s care needs. Staff we spoke with said they were supported by the management team, and had received the required training to enable them to do their jobs and meet people`s care needs. People were supported to maintain good health and to access healthcare professionals when required. Relatives told us they felt there was generally enough staff to meet their relative’s needs.

People and their relatives told us they were included in reviews in relation to their care needs. People’s reviews and risk assessments were up to date and provided information for staff about how people wanted to receive their care. We saw that people were asked for their consent; before personal care took place. We saw that people received their care how they wanted to receive it and in positive ways that met their individual preferences.

Staff knew the people they were supporting, and provided opportunities for people to make choices about how they spent their day. People were supported and encouraged to maintain their independence, and people told us the staff were caring.

People were treated with kindness and respect. We saw that during meal times in communal areas staff took the time to speak with people they were supporting. We observed positive interactions and people appeared to enjoy speaking to staff. People had a choice of meals, snacks and drinks, and could request an alternative meal if they did not want the meal that had been offered on the menu. People had been included in planning the menu and had the freedom to change their minds if they so wished.

We saw that people`s medicines were managed safely and were administered and stored in a safe and appropriate manner. Staff had received the training that they needed to administer medicines in a safe manner.

We found safe systems in place for recruiting new members of staff, and found staff had relevant documents in place for safe recruitment. We found that staff were aware of the safeguarding procedures and of their responsibility of protecting people from harm, and were confident in reporting abuse to the home manager.

We have made a recommendation about infection control and how staffs are supported to report concerns to the manager about infection control.

We have made a recommendation about staff supervision, and staff are supported to be involved in supervision and appraisals.

We have made a recommendation about further guidance and support for the management team around staff development and maintenance audits.