Asher Nursing Home

Updated 18 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 2 inspectors.

Service and service type

Asher Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Asher Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection, there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people living at the service and contacted 4 relatives to understand their experiences. For those unable to speak with us, or who were anxious due to our presence, we observed interactions from a distance between them and staff. We spoke with 10 staff members, this included the operations manager, deputy manager, registered nurses, care assistants, administration staff, domestic staff and catering staff. The registered manager and provider were not present on the day of our site visit, but we spoke with both of them afterwards.

We looked at 5 care plans along with numerous daily notes and medicine records. We reviewed training records and information related to safety, audit and quality assurance processed at the service.

Updated 18 January 2024

About the service

Asher Nursing Home is a nursing home which provides personal care to those with long standing, complex mental health needs. The service can support up to 17 people. At the time of our inspection, there were 14 people using the service.

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

The service was not well-led. There was no robust or effective governance system in place to ensure the service was meeting regulations. The registered manager and provider had not maintained oversight of the service to ensure that people's safety was maintained.

There was not an effective system in place to ensure the environment was safe and clean. There was a significant risk of fire at the service due to people smoking in their rooms and this had not been robustly risk assessed.

Documentation had not been maintained to an appropriate standard. Care plans and risk assessments were out of date, inaccurate or missing. People's care was not always planned or delivered in a person-centred way as staff did not have access to up to date and relevant information about people's care and support needs.

Accident and incidents were not being accurately recorded and reported. It was not clear what investigations were being done following an allegation of abuse to prevent further risk. Not all safeguarding matters had been reported to CQC, this is a legal requirement.

People were not supported to have maximum choice and control of their lives and staff did not 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. There was a significant lack of meaningful activity planned or taking place. This meant a condition of one person’s Deprivation of Liberty Safeguards (DoLS) was not being met.

Infection prevention and control (IPC) concerns were identified. Areas of the home were not suitably clean and this needed improvement to ensure people were safe and their dignity upheld.

Staff were not receiving regular supervision and told us that they did not always feel supported. There was a lack of consistent team meetings to allow ideas to be shared and improvements to be made to the service. Nurses had monthly meetings to specifically discuss clinical matters, however individual clinical supervision was not occurring consistently.

People told us they liked staff; we saw staff engaging with people in a kind and caring manner. The service worked with outside agencies to support people's mental health needs.

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 17 September 2021).

Why we inspected

The inspection was prompted due to concerns received about lack of reporting or investigating potential safeguarding concerns, staffing levels, nutrition and hydration, and lack of activities. A decision was made for us to inspect and examine those risks. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment; person-centred care; safeguarding people; need for consent; and good governance at this inspection.

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

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 of 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.