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Care Services

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Ashminster House, Hythe Road, Ashford.

Ashminster House in Hythe Road, Ashford is a Nursing home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, dementia and treatment of disease, disorder or injury. The last inspection date here was 8th September 2018

Ashminster House is managed by Barchester Healthcare Homes Limited who are also responsible for 186 other locations

Contact Details:

    Address:
      Ashminster House
      Clive Dennis Court
      Hythe Road
      Ashford
      TN24 0LX
      United Kingdom
    Telephone:
      01233664085
    Website:

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2018-09-08
    Last Published 2018-09-08

Local Authority:

    Kent

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

15th August 2018 - During a routine inspection pdf icon

The inspection took place on 15 August 2018. The inspection was unannounced.

Ashminster House is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashminster House provides accommodation and support for up to 60 older people. There were 55 people living at the service at the time of our inspection, however one person was in hospital so 54 people were present during the inspection. People had varying care needs. Some people were living with dementia, some people had diabetes or had suffered a stroke, some people were receiving end of life care. Some people required support with their mobility around the home and others were able to walk independently.

The service was split into three units. Two units provided nursing care with registered nurses leading the staff team on each of those units. One of these units was called ’memory lane’, to care for people who were living with dementia in the more advanced stages. The third unit provided registered care for those people who required 24 hours care, however, did not need nursing care. This unit was led by a team leader who was not a registered nurse, but skilled and experienced in providing social care. Lounges and dining areas were available in each unit.

A registered manager was employed at the service by the provider. 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 our last inspection on 22 June 2017, the service was rated as ‘Requires improvement.’ We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to the health and safety of people receiving care had not been mitigated to prevent harm; checks and audits had not always been effective and action had not been taken to address shortfalls; the provider had not acted on people’s and stakeholder’s views to improve the service.

At this inspection improvements had been made and the provider was now compliant with Regulations 12 and 17. People were safer as risk assessments were comprehensive and up to date. Staff had the guidance they needed to support people to maintain and improve their independence while at the same time preventing harm. A range of audits were now undertaken to check the quality and safety of the service provided and action had been taken where necessary when areas for improvement had been identified.

We also made two recommendations to the provider, that they assessed the dependency levels of people in their care in order to calculate the numbers of staff needed; that care plans provide a more consistent approach within different sections of the care plan.

The provider had introduced a tool to assess the dependency levels of people and this was reviewed each week. This provided the information the registered manager needed to ensure staffing levels were in line with people’s needs. We found staffing levels were suitable to meet people’s needs.

People’s care plans now covered all the areas of care and support they had been assessed as requiring. A more holistic approach was taken when planning people’s care.

Two further areas were noted as requiring improvement at the inspection on 22 June 2017, a better understanding was needed amongst staff of people’s rights within the principles of the Mental Capacity Act 2005; staff one to one supervision meetings were focused on the negative areas of their work and did not address personal development.

Staff now showed a better understanding of the Mental Capacity Act 2005 and documents showed the basic princip

22nd June 2017 - During a routine inspection pdf icon

This inspection took place on 22 and 23 June 2017 and was unannounced.

Ashminster House provides accommodation, personal care and nursing care for up to sixty older people, some of whom are people living with dementia. The premises are split into three different units. The ground floor (Windmill Lodge) is for up to 24 older people with nursing needs. On the first floor ‘Rose Court’ is a 12 bed unit for people with dementia and ‘Memory Lane’ is for up to 21 older people with dementia and nursing needs.

At the time of the inspection there was no registered manager. A new manager had been recruited and was due to start in July. The deputy manager was acting manager and present 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.

The arrangements for managing risk were inconsistent. Risk assessments were in place but they did not contain enough detail to give staff guidance to mitigate risks. The information contained in the risk assessments and the records in people’s room were inconsistent. There was a risk that people would not be moved safely. There was an emergency evacuation procedure and practices had been conducted but there were no personal emergency evacuation plans in place with details about how to support each person in the event of an emergency.

Care plans contained insufficient detail, conflicting information, were out of date or were not completed. There was a risk that people would not receive safe care responsive to their needs.

Audits in the home had been completed but only the recent audits had been effective at picking up shortfalls and the acting manager was working through the resulting action plans. People, their relatives and other stakeholders were asked for their views about the service. Feedback had been responded to and some action had been taken but there was no clear development plan for the service to drive improvements overall.

Staff were not sufficiently deployed in all parts of the service, particularly during the morning and lunch time. Staff were polite and took their time with people when giving care but there were long periods of time when people were left unattended with just a quick check to make sure they were safe.

There were gaps in some essential training as some staff had not received training in epilepsy and diabetes. Staff supervision and meetings were task focused and looked at areas for improvement only, rather than enabling staff to discuss their development and balancing this with what they did well.

People were asked for their consent before staff gave care or treatment. The acting manager and staff were aware of their responsibilities under MCA. Assessments and best interest meetings had been held when people needed support to make decisions about their care.

People were supported to have choice and control of their lives within the limitations of the service and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People said they felt safe and staff knew how to recognise and report potential abuse. There were clear processes in place to safeguard people and for staff to blow the whistle. People were confident that the acting manager and staff would act if there were any concerns. People and their relatives knew how to complain and said they would feel comfortable raising any concerns to the acting manager and staff. There were safe recruitment processes in place.

People were supported to be as healthy as possible and to eat and drink well. There were choices and specialist diets were catered for. The service worked alongside other health professionals and people were supported to main

10th March 2014 - During an inspection to make sure that the improvements required had been made pdf icon

At our inspection on 24 October 2013 we identified concerns around people's health needs, in that they were not always being monitored or met. The provider wrote to us and told us that they would address these matters by 8 December 2013. At this inspection records showed that people who needed their blood pressure to be regularly monitored for health reasons received these checks to ensure their health needs were met. We saw there were systems in place to share information with staff about people’s needs to ensure people’s needs were met.

At our inspection on 24 October 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. The provider wrote to us and told us that they would address these matters by 8 December 2013. At this inspection we saw that written guidance was available to staff about people’s care, staff completed records at the time they provided care and there were systems in place for the registered provider to be able to monitor that these records were accurately maintained by staff.

24th October 2013 - During an inspection to make sure that the improvements required had been made pdf icon

We spoke with one person who lived at the service who told us that they liked living there. Their comments included “The staff are very nice” and they told us that the staff knew their needs well. A relative told us that the atmosphere on the unit for people with dementia, “memory lane”, was welcoming and calm and when people became distressed the staff obviously knew them well and knew how to respond to them.

At our inspection on 9 January 2013, 25 March 2013, 29 May 2013 and 12 August 2013 we identified concerns around people's health needs, in that they were not always being monitored or met. At this inspection we saw that staff responded to people’s health needs effectively. However, we saw one example of a person not always having their blood pressure monitored as directed in their care plan and a nurse in charge of the unit for people who were physically frail was not aware of one person being at high risk of developing pressure areas on this unit.

At our inspection on 25 March 2013 and 29 May 2013 and 12 August 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. At this inspection we saw that staff still did not always complete records to accurately reflect the delivery of care, written guidance was still not always available to staff about people’s needs and there were no records to show how the registered provider checked that records about care delivery were completed accurately by staff.

The provider had systems in place to obtain feedback from people who live at the service, staff and relatives to be able to monitor the quality of the service it provided.

12th August 2013 - During an inspection to make sure that the improvements required had been made pdf icon

People we spoke with told us they liked living at the service. Comments included “I have no complaints at all,” “They really look after me and spoil me” and “The staff are kind”.

At our inspection on 9 January 2013, the 25 March 2013 and the 29 May 2013 we identified concerns around people's health needs not always being monitored or met. At this inspection we saw that people's health needs were being met because staff monitored people’s health and ensured people received medical attention when they needed it. However, one senior staff member was unaware that they needed to check one person’s blood pressure that day. We saw an example of one person’s high pulse rate not being effectively monitored to promote their health. We saw that guidance from healthcare professionals was being followed to promote people’s health and wellbeing.

At our inspection on the 25 March 2013 and the 29 May 2013 we identified concerns around records not always providing guidance to staff about people's needs and staff not always maintaining records accurately. At this inspection we saw that there was written guidance available to staff about people’s needs. However, this guidance did not always provide clear instructions for staff to follow. We saw there were systems in place for staff to record the delivery of care. However, the system in place to monitor records identified that staff were not always accurately recording the delivery of care.

29th May 2013 - During an inspection to make sure that the improvements required had been made pdf icon

One person told us “I can’t really see how it can be improved”. A relative told us “The staff are always so cheerful and bright and pop their heads in. Nothing seems too much bother.” Another relative told us “Things are so much better than they were. [Their relative] is up every day, unless they are tired."

At our inspection on 9 January 2013 we identified concerns around care not always being delivered in a respectful manner, staff knowledge around potential adult protection concerns and the action to take, staff not always being supported in their roles and the systems in place to monitor service delivery effectively. At this inspection we saw that these areas had been addressed.

At our inspection on 9 January 2013 and 25 March 2013 we identified concerns around people’s health needs not always being monitored or met. At this inspection we saw that people’s blood pressure was not always being monitored effectively and instructions from health professionals were not always being implemented.

At our inspection on 25 March 2013 we identified concerns around records not always providing relevant information to staff. At this inspection we saw that guidance from health care professionals was now included in people's care plans, however not all records provided guidance to staff around people's needs and staff did not always maintain records accurately.

25th March 2013 - During an inspection to make sure that the improvements required had been made pdf icon

On the 9 January 2013 we inspected the service and found that people did not always receive safe care and treatment that met their individual needs on the physically frail unit and memory lane, which was a unit for people with dementia.

During this inspection we saw that some areas where we had identified a concern had improved. People had the opportunity to engage in social activities. A person now had their oral health needs met, their skin integrity monitored and their arm positioned in line with the guidance in place.

However, we saw that people did not always have their health needs met or followed up. Staff did not implement the guidance in place to address a person’s specific health needs. Two people had unexplained weight loss that had not been investigated further and relevant health professionals had not been informed. One person’s blood pressure had not been effectively monitored in accordance with their guidance in order to promote their health.

Guidance from health care professionals was not always implemented to help in the management of behaviours which were described as challenging. Incidents continued to be noted whereby their behaviour resulted in injuries to other people who lived at the service.

We saw that people’s care records did not always provide guidance for staff to be able to meet the needs of people effectively. The recording systems in place did not always support the effective management of service delivery.

9th January 2013 - During a routine inspection pdf icon

The service provided care to people who had dementia who lived in a part of the service called ‘memory lane’ , people who were ‘physically frail’ lived on the ground floor and people recuperating from hospital lived at the ‘step down’ unit.

We saw that people’s privacy was promoted. However, people were not always treated with consideration and respect. Some staff we spoke with referred to people that needed support to eat their food as “feeds”.

People were not always involved in decisions around their care and treatment. The delivery of care did not always reflect people’s care plans and there was limited guidance for staff on meeting the needs of people who had dementia.

We found that not all staff were able to demonstrate they knew how to recognise potential abuse and the action to take in response to it.

We saw that the building was designed to enable people and equipment to move around freely and it was an environment that was pleasant for people to live in.

Staff told us there were enough staff on duty to meet the needs of people. People told us there were not enough staff on duty. One person told us, “I could die waiting for them to answer my call.” Staff did not always receive adequate supervision to be able to deliver care safely and consistently.

We saw there were systems in place to regularly assess and monitor the quality of service delivery, however, these were not always effective in identifying areas of concern for service development.

29th March 2012 - During an inspection in response to concerns pdf icon

People told us that they thought “the home was ideal”. People also said that they liked the freedom at the home, and staff were always supportive.

7th December 2011 - During an inspection in response to concerns pdf icon

We did not speak with people during this site visit, but observed care being given, and spoke to staff and the registered manager.

16th June 2011 - During a routine inspection pdf icon

We spoke to two residents and two relatives. The residents told us that “the care could not be any better” and one relative said “although he wouldn’t want his wife to be anywhere else, he was sometimes concerned that staff did not always have time to spend with residents”. Another relative told us “the high turnover of staff was a concern, as it took time for new staff to get to know the residents”.

1st January 1970 - During a routine inspection pdf icon

The inspection visit was carried out on 19 and 20 May 2015 and was unannounced. The previous inspection was carried out in March 2014, and there were no concerns.

Ashminster House provides accommodation, personal care and nursing care for up to sixty older people, some of whom are people living with dementia. The premises provides care on two floors in three units. There is a passenger lift between floors. The ground floor (Windmill Lodge) is for up to 24 older people with nursing needs; and the first floor has two units for people living with dementia. ‘Memory Lane’ is for up to 21 older people with nursing needs and living with dementia; and ‘Rose Court’ is a 12 bed unit for people with residential needs and living with dementia.

The service is run by a registered manager, who was present on the day of the inspection visit. 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.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Applications had been made to the DoLS department for all of the people living with dementia for depriving people of their liberty for their own safety. This was because the doors to the units and the passenger lift were safeguarded by key pad locks.

Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager, or with outside agencies if they needed to do so.

The service had systems in place for on-going monitoring of the environment and facilities. This included maintenance checks, and health and safety checks. There were comprehensive risk assessments in place for each area of the premises. These showed how to minimise the assessed risks. The registered manager or deputy reviewed these with the regional director as part of monthly monitoring programmes. There were individual risk assessments for each person living at the service. These included risks such as the risk of falls, or the risk of choking; the use of bed rails and the risk of developing pressure sores. All of the risk assessments were written in relation to each person’s needs. Actions were identified and put in place to lessen the risks. Emergency procedures were suitably detailed and included a personal emergency evacuation plan for each person.

Staff were visible in all areas of the service during the inspection visit. There were sufficient numbers of staff to meet people’s individual needs without rushing them. People spoke highly of the staff and said they “Always have time for us”. The service had robust recruitment procedures in place to check that staff were suitable for their job roles.

Staff were given a detailed induction, and were supported through their probationary period. This included essential training such as fire safety, safeguarding adults, and food hygiene. Staff training records showed that staff kept up to date with training requirements, and were given additional training relevant to their job roles. This included dementia care, and customer care. Most care staff had completed formal qualifications in health and social care or were in the process of studying for these. Records of supervision and appraisals confirmed that staff were working to appropriate standards and were supported by the registered manager and the deputy manager. Staff were encouraged to attend meetings, and to take their part in the development of the service.

Nurses were able to keep up to date with their skills and competencies and complete training or refresher courses in subjects such as catheterisation or venepuncture (taking blood samples). Nursing and senior staff administered medicines and followed safe practices for this.

The premises were visibly well maintained and well presented. There were no offensive odours, and people told us “They always keep it very clean”. There was an on-going business plan to keep the service in a good state of repair, and to make changes to further enhance the environment. This included regular redecorating and refurbishment of bedrooms and communal areas.

People’s own views were listened to and taken into account, and their care plans showed that their independence was promoted and their dignity was respected. People were given choice in how they lived their lives, and made their own decisions about when they wished to get up and go to bed, their meal choices, their clothes, and social activities. They were given clear information about the service, and discussions were carried out with the person and/or their representative for any changes in their care planning. People who lacked mental capacity or had fluctuating capacity were supported with decision-making. This followed agreed protocols to involve their next of kin or representative, and health and social care professionals, to make decisions on their behalf and in their best interests. Staff were fully informed about the importance of applying the Mental Capacity Act 2005, and to enable people to make decisions within their capacity.

The nurses and care staff maintained good links with the local GP practices, and contacted people’s doctors as needed. Referrals were made to other health professionals such as dieticians and dentists when necessary.

People were able to choose their food at each meal time, and snacks were always available. Each unit had it’s own kitchenette area where staff could make drinks and snacks for people. People spoke highly of the food, using words such as “Excellent” and “First-class”. The food was home-cooked, including home-made biscuits and cakes each day. Dining areas were attractively presented with tables laid with tablecloths, napkins and fresh flowers, and several people said how much they appreciated this.

People said that staff had a very caring approach. This was evident from the welcome received in the reception area, through to care staff, nurses, and other staff on each unit. Relatives and visitors were made welcome and were encouraged to recognise it as people’s home. The different units maintained a homely feel with pictures, games and ornaments in evidence. Units for people living with dementia had many items available to support people throughout the day with familiar objects to trigger memories and enjoyment.

An activities co-ordinator oversaw the management of activities programmes and entertainment, but the staff had a holistic approach, and all of the staff saw it as their responsibility to spend time with people, talk with people, and carry out small acts of kindness (such as getting drinks or showing people where to go). Each person was provided with a key worker who spent a minimum of three occasions per week talking with people they supported, to see that they were happy and settled in the service, and to identify any areas where they could be further supported. There was a wide range of individual and group activities every day, and we observed people laughing together, playing cards, playing dominoes and skittles and enjoying music and singing.

People’s care plans were person-centred, were discussed with people and their relatives (as preferred), and contained comprehensive information. Separate care plans were written for each aspect of care, and monthly reviews were carried out. People’s family members were invited to take part in reviews if they wished for this. People were informed about the service’s complaints procedure and this was clearly displayed. There were systems in place to monitor and follow through minor concerns as well as complaints. These showed that people’s views were taken into account, were listened to, and changes were made in response where needed.

The service was led by a registered manager who worked closely with the deputy manager and the staff team. Staff were fully informed about the ethos of the service and its vision and values. They recognised their own roles as important in the whole staff team, and there was good team work throughout the inspection. Staff showed respect and value for one another as well as for people living at the service and their family members. Staff spoke highly of the registered manager and deputy manager, and said they were always available and very supportive. They led by example, and spent time wherever possible working alongside the rest of the staff team. Staff said they made them “Feel valued”. People and their relatives said they could “Not speak highly enough” of the registered manager and deputy. Relatives often nominated staff for care awards given by the company. This was due to how they “Spent time with people, had a cheerful attitude and gave consistently good care”.

The registered manager carried out monthly audits to monitor the progress of the service. Quality assurance surveys were carried out for people living in the home and relatives, and the results were displayed in the reception area. The results for 2014 had been very positive, with an overall score for all aspects of the service as 927 points out of a possible 1000.

 

 

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