All inspections: Ashleigh Care Home - Care Quality Commission

The inspection took place 9,10,11 and 14 September 2015 and was unannounced.

The service was last inspected in March 2015, at this inspection the service was in breach of Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was in relation to poor standards of cleanliness throughout the service which mean that there was a risk of infection control not being effective.

We found that the service had not made the necessary improvements in relation to this breach since our last inspection and we found that there were a high number of breaches of other regulations.

Ashleigh Care Home is a residential care service, who offer personal care to up to 37 people. At the time of our inspection there were 29 people living within the service.

At the time of our inspection there was no permanent manager. The service was being managed by an acting manager who had been in the service for two weeks and an area manager who had been with the provider for two years.

We found that the standards of care in the service had deteriorated significantly since out last inspection. This was in relation to multiple breaches of the regulations.

Regulation 9, person centred care. We found that people’s care needs had not been assessed and there were no care plans for some of the people who lived at the service.For those people who did have care plans these were out of date and the information did not reflect their current needs or the care which was being given to them.

We found that people in the service were not treated with dignity and respect. Some of the people living in the service were unable to access the toilet without assistance and were being left for long periods without being given this assistance. Staff did not recognise how people’s dignity could be promoted and did not assist people when they needed help. This was a breach of Regulation 10 dignity and respect

The people living in the service were not asked for their consent for care to be carried out. The provider and the staff failed to recognise restrictive practices which were being carried out. There were no mental capacity assessments being carried out for the people living in the service to measure whether they were able to make their own decisions and which decisions they were able to make. This was a breach of Regulation 11, need for consent

The provider did not have safe processes in place to ensure that people were given the medications that were prescribed to them in the way in which they had been prescribed. We found that people who were in pain were not receiving their pain killers. There were very few risk assessments in place for people in the service and those that were in place were out of date and had not been reviewed. The equipment which was being used to assist people with poor mobility was limited. There were no assessments carried out to make sure that the equipment which was being used was safe or suitable for the needs of the person. We found widespread evidence that infection control measures were not in place and there was a poor standard of cleanliness throughout the service. This was a breach of Regulation 12 safe care and treatment

Staff did not recognise safeguarding incidents that were occurring. There were no safeguarding referrals made to protect vulnerable people living in the service until incidents were highlighted by CQC during the inspection. This was a breach of Regulation 13, safeguarding service users from abuse and improper treatment.

We found that some people were not being adequately hydrated as they were left for long periods without access to drinks. We saw that food records were inaccurate and were not filled in for long periods, which meant that staff could not monitor people’s fluid intake. This was a breach of Regulation 14, meeting nutritional and hydration needs.

We found that the equipment in the service did not meet the needs of the people living there. This was a breach of Regulation 15, premises and equipment.

We found that the provider was not dealing with complaints appropriately or in a timely manner. This was a breach of Regulation 16, receiving and acting on complaints

There were no processes in place to monitor the performance of the service or to maintain accurate records of the care which was being delivered. We found that there was no effective leadership within the service. This was a breach of Regulation 17, good governance.

There were not enough staff to care for people safely and to meet their needs. We found that the staff were not well trained and were not competent in all areas of their roles. This was a breach of Regulation 18, staffing.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 19 March 2015 and was unannounced.

When we last inspected Ashleigh Care Home in March 2014 we found the home was failing to meet the standards required in relation to meeting people’s nutritional needs. We told the provider that improvements must be made. On this visit we checked to see if improvements had been made.

Ashleigh Care Home is registered to provide residential care for up to 35 older people. Bedrooms are situated on both the ground and first floor with three communal lounges and a dining room on the ground floor. There were 27 people living at the home at the time of our inspection.

A new manager had recently been appointed and had started work at the home two weeks before our inspection. Because of this short time in post the manager had not completed their application to the Care Quality Commission for registered manager status. 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 that sufficient action had been taken to meet with the compliance action set as a result of our inspection in March 2014.

People told us they felt safe and staff knew how to maintain people’s safety although some had not had the required training.

We found the lounge and dining areas of the home generally clean although some bedrooms and ensuite rooms did not meet the standards of hygiene we would expect and adequate hand washing facilities were not always in place.

Staff training was in need of updating although this was being arranged. Systems for supporting staff were in place and although some slippage had occurred, the new manager had already recognised and addressed this issue.

Staff treated people with kindness and respect. People who lived at the home and their relatives told us the staff were very caring and understood their needs.

People received a nutritious diet and found the food enjoyable. People reported improvements in this area.

Care plans were in place but were in need of further development to make sure they fully reflected people’s needs.

Activities were provided but only when care staff had time to do this. The new manager was addressing this and hoped to engage a person into the role of activities organiser.

Processes were in place for auditing the quality of service provision. The new manager was in the process of bringing these up to date and had produced a development plan.

We found one breach of the 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 the report.

When we visited this service in November 2013 we found complaints were not being handled appropriately and accurate and appropriate records were not maintained. We said improvements were needed. The provider sent us an action plan detailing how they would address these issues. We made this visit to see what improvements had been made.

A new manager had been appointed since our last inspection.

We found the complaints identified during our last inspection as not having been managed had been addressed appropriately. We found an overall improvement in record keeping but identified some areas still in need of improvement.

Whilst looking at care records we identified an issue with maintaining healthy nutritional status for some people who lived at the home.

As this was a focussed inspection we did not specifically ask people for their experiences of the home. However, we did speak with two people who told us they were very happy with the care and level of service they received from a kindly staff team.

When we inspected this service in August 2013 we found that improvements were needed in several areas. This visit was made to see what improvements had been made.

A new manager was in post and told us that they were addressing the issues we had identified at our last inspection. People told us that the manager was affecting changes for the better.

We saw that care plans had been updated although we found that one person did not have one at all. Most of the people we spoke with told us that they received good care.

We saw that people's nutritional needs were being met. People told us that the meals had improved although could still be "a bit hit and miss."

Staff had received safeguarding training and understood their responsibilities in keeping people safe.

Auditing of the quality of service was taking place but some minor improvements were still needed.

We looked at two additional areas because we identified problems. These were that the service was not dealing with complaints properly and were not maintaining appropriate records.

People we spoke with said the following:

'It's alright here, the staff are lovely.'

"It's improving here."

"They (the staff) are dedicated to the job."

"I am worried because there are only two staff at night now."

"One night there were two agency staff here, neither of them knew what to do."

"I like it here"

Staff told us that things at the home were improving and that they enjoyed their jobs.

This scheduled inspection was brought forward due to concerns raised by Local Authority Contracts following their visit to the home the previous week. These concerns centred on people losing weight and the home not having enough food available to provide them with an adequate and nutritious diet.

We found that little action had been taken to address these concerns and therefore the needs of the people living at the home had not been met. We saw food charts for two of the people identified as 'at risk' had not been put in place immediately and the ones in place detailed minimal intake.

We found that large amounts of food planned for use was out of date.

We found that staff had failed to follow their own policies in safeguarding people. We also found that processes for risk assessment and care planning were inadequate. None of these issues had been picked up through the homes internal auditing.

We spoke with six people who lived at the home. Some of these people were unable, due to complex care needs to tell us about their experiences. We were not able, on this visit, to speak with relatives of people who lived at the home.

These are some of the things people who lived at the home told us:

"The staff are nice, they help me."

"The food fills you, I won't say any more than that."

When we asked if they had enjoyed their lunch one person said "No, I don't go for that type of food"

"I am very bored here"

Staff told us they enjoyed working at the home.

During our inspection visit we spoke with seven people who live at the home and some visiting relatives. These are some of the things they told us:

"The staff are lovely, the food is good"

"The girls come when I need them, they are really good"

"I would like to have more to do"

Relatives told us that they were happy with the care provided. They told us that if there were any issues at all they would bring them to the attention of staff who dealt with things immediately.

Staff told us that they enjoyed working at the home. They said they felt as though they were given the training they needed and had the support of the senior staff and manager.

Many of the people living at the home had some form of memory loss and had difficulty expressing themselves, because of this not everyone we met were able to tell us what they thought about the service however, staff observed had good relationships with these people and they were seen to have their privacy and dignity respected.

We observed people being spoken to in a kind and friendly manner and care being delivered by a staff group who understood their needs and preferences.

People who were able to comment told us that they were happy living at the home, and the staff were good. One person said, 'I have no complaints, all the staff are good'.

People told us that there were activities in the home however; people also told us that sometimes they got bored as there was not always something happening on a daily basis that they could take part in.

People told us that they enjoyed the food, and they were offered a choice of what to eat. One person said, 'I always have a cooked breakfast'. Another person told us, 'There's plenty pots of tea and biscuits. I have a cooked breakfast everyday, nice food, but sometimes would like bigger portions.

Lunchtime was seen to be a relaxed event and staff supported people sensitively and discreetly.

Many of the people who use this service could not tell us directly about their experiences due to a variety of complex needs however, staff observed had good relationships with these people and they were seen to have their privacy and dignity respected.

One person said they thought the staff were good and they liked living at the home. Another person said the food was good and they enjoyed having a cup of tea.

A visitor said that although they had not been to the home often, the staff were approachable and people looked well cared for.

During the visit we observed staff providing support to people in a sensitive and dignified way, and treating people with respect.

Achievements by the home include:

'The Healthy Choice Award' 'Silver' Award, has been awarded by Kirklees Council in partnership with the NHS Trust.

'Scores on door' Attained a 4 out of 5 star rating, which is a food hygiene national award, awarded by the council.

Archived: Ashleigh Care Home

All Inspections

9,10,11 & 14 September 2015

During a routine inspection

19 March 2015

During a routine inspection

12 March 2014

During an inspection looking at part of the service

5 November 2013

During an inspection looking at part of the service

13 August 2013

During a routine inspection

18 April 2013

During a routine inspection

28 May 2012

During a routine inspection

10 November 2011

During a routine inspection