This unannounced inspection took place on 15 and 16 August 2018.Ashbury Lodge 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.
The care home accommodates up to 44 people in one adapted building. At the time of our inspection 42 people were residing at the home. Accommodation is arranged over two floors which are accessed via a lift or stairs. There is a small garden to the front of the building and parking available.
At our last comprehensive inspection in May 2017 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service had not always obtained the appropriate consent from people and the care plans required improvement. We issued one requirement notice and a warning notice. We returned in November 2017 to do a focused inspection to check if the required improvement had been made. At that inspection we found enough improvement had been made to address the immediate concerns but further improvement was needed.
At this inspection we found the required improvements had been completed and therefore we have rated the service as 'Good' overall.
There was 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.
People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Staff had received Mental Capacity Act (2005) training and told us how it applied to their work.
People had their support and care needs assessed before moving to Ashbury Lodge. This information was then used to start an individual care plan. Care plans contained a good level of information that was clearly detailed, personalised and reviewed regularly. The service used an electronic care planning system which required an individual log in and password. This made sure information was held securely.
Risks had been identified, assessed and the most appropriate measures put in place to keep people free from avoidable harm. Risk assessments were reviewed monthly or sooner if needed.
Staff were trained in different topics and could ask for further training if they felt it was needed. Staff told us they felt supported and could approach the senior management at any time.
The service followed safe recruitment practice and all required pre-employment checks had been completed. There were sufficient staff deployed to meet people’s needs.
People were protected from potential abuse from staff who were aware of the different types of abuse and when to report any concerns. Staff were confident appropriate action would be taken. People told us they felt safe at the service and knew where to go to report or raise any concern.
Medicines were managed safely as safe systems were in place to order, store, administer and dispose of medicines. Staff were trained to administer medicines and followed safe practice. Where appropriate people were referred to healthcare professionals. The service worked in partnership with a range of professionals such as GP’s, district nurses and dieticians.
People had a choice of meals and where needed staff provided people with support to eat and drink. Mealtimes were relaxed and unhurried. Snacks and drinks were provided throughout the day.
There were activity workers in place who took the lead on providing activities at the service. People were able to participate in events based around their interests and abilities.
People and their relatives told us the staff team at Ashbury Lodge were kind and caring. We observed many positive social interactions between people and staff. Staff knew the people they were supporting and there was evidence of a mutual respect.
Complaints were well managed and documented. Where any lessons needed to be learned this was shared with staff and discussed. Team meetings were held regularly and there was a daily heads of department meeting.
End of life care was provided and people could record their wishes in their care plans. Where needed the service worked with other healthcare professionals to make sure people were comfortable and pain free.
The team worked closely with dementia specialists to improve the care and support provided. A dementia consultant was retained who provided guidance, advise and training on dementia care.
Quality monitoring systems were in place. Audits were completed across a range of areas to monitor the quality and safety. Action plans were produced and reviewed by senior management to make sure the required improvement was completed.