Archived: Ashford Lodge Nursing Home

Ashford Lodge Nursing Home is a residential care home providing personal and nursing care to up to 20 people. The service provides support to older people, younger adults and people living with dementia. At the time of our inspection there were eleven people using the service.

People’s experience of using this service and what we found

The service was not well-led. The management arrangements were not clear. There was no effective governance system and improvements since the last inspection were not sufficient to meet the requirements of regulation.

There were widespread concerns about safety. When people had accidents, there was no review or follow up to see how to prevent the same thing happening again. Staff were not provided with effective guidance to know how to keep people safe from harm. Some people had lost weight and no action was taken. Some areas of the home were visibly unclean. Medicine procedures were not always in line with best practice guidance.

Staff were not supported to undergo effective training. There was no training to know how to communicate effectively with people. People were not supported to have drinks at mealtimes until they had finished their food. There was limited choice of food at mealtimes. Information in people’s care plans was not always in line with best practice guidance.

At times, people’s dignity was compromised. People did not have access to outside space. The main lounge and the quiet lounge were cluttered, and many areas were in a state of disrepair including frayed carpets that posed a trip hazard.

People’s care was not always planned or delivered in a person-centred way. There were practices in the home which were designed to be easier for staff rather than to meet the needs and preferences of the people who lived there. Care staff were kind and caring towards people, however, they were busy and had to carry out tasks throughout the day, so had limited time to offer companionship to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 5 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to leadership and governance, safety, person-centred care and staff training.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Ashford Lodge Nursing Home is a care home with nursing providing the regulated activity accommodation for persons who require personal and nursing care to up to 20 people. The service primarily provides support to older adults including those living with dementia. At the time of our inspection there were 17 people using the service. The home is a large, converted residential property which has been extended.

People’s experience of using this service and what we found

People were not supported safely at Ashford Lodge Nursing Home. People were at risk of harm due to widespread, poor infection control and prevention (IPC) practices. Risks associated with people’s care and support were not always planned for, or mitigated, bedrails were not used safely, and the environment was not safe.

People were not consistently protected from abuse and improper treatment and there was a risk they may be supported by unsuitable staff. Although most people received their medicines as prescribed, records relating to medicines management were not always adequate to ensure safety.

Although there were enough staff available to meet people’s needs, staff did not always have up to date training and their practice did not demonstrate they were competent to meet people’s needs and ensure their safety.

People’s needs were not always assessed when they moved into the home and national guidance was not always followed in the provision of care. People were not fully supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some areas of the home did not meet people’s needs or ensure their rights were respected. People had enough to eat and drink.

Ashford Lodge Nursing Home was not well led. The management team had not created a culture of high quality, person centred care. Systems to ensure the safety and quality of the service were not effective and the management team did not always take accountability for failings.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement, with one breach of regulation (report published 10 January 2020). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about risk assessment and care planning, the management of people’s nursing care needs, leadership and management. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashford Lodge Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safety, infection control, staff competency, consent and management and leadership.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Ashford Lodge is a residential care home providing personal and nursing care to up to 20 people. The service provides support to younger and older adults and people living with dementia. At the time of our inspection there were 7 people using the service. Accommodation is provided in one large, adapted building.

People’s experience of using this service and what we found

This inspection took place in response to concerns raised about the ineffective management of the location. At this inspection it was identified people were at risk of not receiving safe and consistent support at Ashford Lodge. Actions were taken during and immediately after the inspection to ensure people were no longer at risk of harm.

There was not a robust system in place to ensure adequate numbers of suitable staff were available to meet people's needs. Financial stability systems were not in place, this meant consistent care and support may not be available to meet people’s needs. People were at risk of not having sufficient nutrition available to them due to the lack of a robust system in place for buying groceries.

People received their medicines as prescribed. Although staff members knew people well, they were not offered the managerial support they needed to promote safe care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 31 January 2023).

Why we inspected

We undertook this targeted inspection to check on specific concerns regarding the management of the location. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashford Lodge Nursing Home is a residential care home providing accommodation, personal and nursing care to up to 20 people. The service provides support to younger adults, older people and people living with dementia. At the time of our inspection there were 8 people using the service.

This was a targeted inspection that looked at medicine management, risk management and governance only.

People’s experience of using this service and what we found

People received their medicines safely. There were still some areas where best practice guidance had not always been followed. The manager assured us they had implemented measures to improve this.

Risks to people’s safety were assessed, managed and reviewed. Where people’s needs changed the manager updated the guidance for staff to follow to ensure staff knew how to keep people safe.

The manager had implemented improvements in the governance systems. The system enabled the manager to review the care people received and identify where improvements may be required to ensure people received safe care that met their needs and preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement/inadequate (published 28 December 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to regulations 12 [Safe Care and Treatment] and 17 [Good Governance] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashford Lodge Nursing Hone residential care home providing nursing and personal care to up to 20 people. The service provides support to people living with dementia, older and younger adults. At the time of our inspection there were 8 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The provider had failed to ensure staff completed training to know how to interact with people who have a learning disability. This became a legal requirement in July 2022.

Since the last inspection a new management team had taken over, although some improvements were in place further improvements were required to ensure people always received safe care. Medicines were not always safely managed. Risks to people’s safety were not always effectively assessed or mitigated. Staff were not always safely recruited.

New policies and governance processes were in place but were not always effective at recognising risks to people’s safety.

People were protected from the risks of infection. There were enough staff on duty to meet people’s needs in a timely manner. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s outcomes of their care had improved since the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 24 August 2022). At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider review their deployment of staff to ensure people received care in a timely manner. At this inspection we found improvements had been made.

Why we inspected

We received concerns in relation to the safety of the care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, governance and staff recruitment at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashford Lodge Nursing Home is a residential care home providing personal and nursing care to 17 people at the time of inspection. The service can support up to 20 older people, some of whom are living with dementia. The home stands in its own grounds with an enclosed garden.

People’s experience of using this service and what we found

Improvements were needed to the management of people’s medicines to ensure they were safe. Risk assessments were in place, but people did not always have a personal emergency evacuation plan to keep them safe in the event of a fire. Staff simulation fire evacuations were not routinely carried out.

People felt safe. People and their relatives were positive about the service and the care provided. A relative told us, “I’d recommend it here. It’s warm and comfortable. People are looked after.”

There were enough staff to meet people’s needs. Staff were trained and had the required skills to meet people’s needs. Staff told us they felt well supported, however there was no evidence staff received supervision. Recruitment processes ensured staff were suitable to work in the care service. Staff understood safeguarding procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s nutritional and healthcare needs were met. People and relatives praised the staff for being kind and caring. People had access to healthcare professionals and support. We saw staff treated people with respect. Procedures were in place to manage complaints.

Feedback about the service from both people, relatives and staff was positive. The registered manager had continued to make improvements to the service, but we identified systems of governance were not sufficiently robust or effective to ensure the service was fully compliant with all the regulations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 10 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

The service provides accommodation and personal care for up to 20 older people who maybe living with dementia. There were 15 people living at the home on the day of our inspection. Where people lacked capacity to make certain decisions, these were now made in consultation with people who were important to them and made in their best interests. Restrictions had been identified and applications had been made to ensure these were lawful.

Quality assurance systems were in place to review how the care and support was delivered. These needed to be developed to ensure they identified how improvements could be made in the environment and to keep the temperature of the home under review.

Staff were kind and polite to people, recognised people’s individual needs and provided care which met their preferences. People were supported to maintain the relationships which were important to them.

People were involved in planning and agreeing how they were cared for when they moved into the home. People chose how to spend their day and they took part in activities in the home and the community. People felt well looked after and supported and had developed good relationships with staff.

People received their medicines at the right time and systems were in place to ensure medicines were managed safely. People had a choice of food and drinks which met their needs and preferences. When necessary, staff recorded the amount people ate and drank and monitored this to maintain people’s health.

Staff understood their responsibilities to protect people from harm and knew how to raise concerns. Risks to people’s health and welfare were assessed and staff knew how to minimise the identified risks.

There was suitable staffing to meet the support needs of people and the trained staff understood their role and how to support people safely. The staff received support to enable them to identify personal development opportunities and to raise any concerns they had.

People were cared for by kind and compassionate staff who knew their individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

If people or relatives were unhappy with the care or service, they felt able to raise their concerns directly with the registered manager. People were encouraged to share their views about the home.

The service was registered to provide accommodation for up to 20 people. People who used the service had physical health needs and some were living with dementia. At the time of our inspection 17 people were using the service.

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.

We saw that the provider and registered manager did not have a clear understanding of how to support people with decision making and gaining their consent. Where people lacked capacity to make certain decisions, appropriate assessments had not been completed and recorded to show how people had been supported to make those decisions. Where people were being restricted of their liberty in their best interests, the appropriate authorisations had been applied for.

Daily activities were provided to support people’s interests or hobbies. People were able to make choices about the food they received, however the experience could be improved to offer a more positive experience to some people. We saw that referrals had been made to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

The provider determined the staffing levels on the number of people living in the home and the level of support they required. We saw that there was a procedure to ensure staff were safe to work at the home and when they started with the service they received a structure induction. Staff had received a range of training which they told us had enhanced the support they were able to offer and increased their knowledge. People and relatives told us they felt safe and staff understood their role in ensuring people were protected from abuse or poor practice. Risk assessments were in place to ensure people’s safety was maintained.

We saw that people were responded to in a kind and friendly manner and people felt able to make choices and be respected for their decisions. Medicines were managed safely and in accordance with good practice and individual’s prescribed needs. People felt confident they could raise any concerns with the provider and manager.

We saw that improvement had been made to the environment of the service had been made and there was a planned programme to continue to make improvements. The provider and manager had systems in place to monitor and improve the quality of the service. Staff felt supported by the provider and registered manager and they received ongoing support to continue their role.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

People told us that they had never seen care given without the consent of the person using the service and, where the person was unable to give consent their relatives were involved. One person told us 'I've never seen anyone have care or have to do anything against their wishes.' We saw evidence that confirmed this.

People told us that they were happy with the care their relatives received at Ashford Lodge and that they were involved in planning or reviewing their relatives care. One person told us 'I couldn't fault the care at all, it's just wonderful.' However we found that care plans and risk assessments were not always updated to reflect people's needs. Staff we spoke with felt the care plans were helpful but felt they did not always have time to read them.

People told us they received medication when required and had never experienced any problems with medicines. However during our inspection we identified concerns with the administration and management of medicines.

People we spoke with told us they felt Ashford Lodge was well maintained, that they would be happy to raise a complaint with the provider or senior staff, and were confident it would be resolved. However we noted people did not routinely have the opportunity to give their feedback about the home and that regular audits of medication, care plans and risk assessments were not carried out.

At the last inspection people told us they received their medication when required and had not experienced problems with their medication. We did not see evidence to confirm this and identified concerns about how medicines were managed. During this inspection we saw evidence that the provider had made improvements to the management and administration of medicines.

At our last inspection people who use the service told us they were happy with the care they received and care workers looked after their health well. We found that people were not always referred to health professionals for additional help when required.

At the last inspection people told us they received their medication when required and had not experienced problems with their medication. We did not see evidence to confirm this and identified concerns about how medicines are managed.

During this inspection we saw that improvements had been made in referring people for additional help when required. However the provider has not addressed all areas of concern identified with management of medicines and was not compliant with this outcome.