Ashton Grange Nursing & Residential Home

Ashton Grange is registered to provide nursing, care and accommodation for up to 31 people. There were 29 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Most people were also living with dementia, some of these people could show behaviours which may challenge others. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors which had been extended to the rear.

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

The registered manager and provider had made significant improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including with their medicines. The improvements made, needed more time to be sustained, maintained and fully embedded into the culture of the service.

People received care and support that was safe. One person said, “I feel safe and comfortable, the staff are so kind and polite.” One relative explained this was the third experience of residential care and said, “This one has won hands down-really wished this had been the first home.”

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.

There was a stable staff team who were knowledgeable about the people they supported and had built

trusting and meaningful relationships with them.

Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s really lovely here, the people are so special and the staff team supportive.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One health professional described the service as, “The atmosphere is positive, there have been improvements, especially in the leadership, the presence of the manager on the floor has improved communication.” A visitor said, “It’s a busy home, the activity lady is tremendous fun, a live wire, gets people motivated.” People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as specific sign language, pictures and objects of reference, to gain their views.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Visitors told us that they had discussed their loved one’s wishes and one visitor said, “I personally felt they had prepared me, not only my wife.” End of life care was delivered professionally and with compassion.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve and plans to develop the service and maintain their care delivery to a good standard.

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 (published 14 February 2019) and there were five breaches of regulation. 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:

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Accommodation was provided over two floors of a turn of the century house, which had been extended to the rear. The service was situated in a quiet residential street in Horsham.

The service had 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 provider is Ashtonleigh Homes Limited who own another home in the area. The owner also provided a service in two other homes; these are registered as different legal entities.

The service was last inspected on 26 January 2016. It was rated as good at that inspection.

At this inspection, we identified a wide range of areas which needed to be addressed and the service is now rated as requires improvement.

The provider’s own quality audit systems had not identified some areas or ensured appropriate action was taken before our inspection to reduce people’s risk. Similar issues were identified at the other three services owned by the provider. Matters identified at this service included making sure appropriate standards of hygiene and infection control were maintained and certain aspects of medicines care and treatment were in place. The provider had also not ensured all people who had difficulties with consenting to care and treatment had relevant best interest decisions and Deprivation of Liberties safeguards (DoLS) considered. People had care plans but the provider had not identified in their quality audits that they did not consistently reflect their needs, were not always reviewed when necessary and were not always being followed by staff. National guidelines in relation to relevant areas such as diabetic care and prevention of pressure ulceration were being followed and reflected in people’s care plans.

We recommend the service follows NICE guidelines on care planning to support people who are living with diabetes.

People received a mixed approach from staff, some of whom did not show a kindly, caring approach. This lack of care was also shown at mealtimes where some people were not always attended to in the way they required, while other people received the assistance they needed. Some people who remained in their rooms were supported in a functional way by brief, infrequent visits. Other staff supported such people in a kindly understanding way. People who went to the lounge were supported by staff who engaged with them in an effective way.

There were enough staff on duty. Staff had been recruited in a safe way. Staff told us they were supported by the provider, including through the training they received. All staff were aware of their responsibilities in relation to ensuring people were safeguarded from risk of abuse.

Staff ensured the safety of people in some areas, including supporting people who needed assistance to move about in a safe way and when supporting them with certain aspects of their medicines care and treatment. People told us relevant external healthcare assistance was requested when necessary.

People and staff told us they felt supported by management. People and their relatives said they were confident if they raised any complaints that they would be listened to and action would be taken.

The provider had acted to ensure people’s safety in some areas, for example by developments in fire safety precautions by the installation of a sprinkler system. They also had plans for up-grading and making improvements to the home environment.

We identified five breaches in the Regulations 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.

Ashton Grange Nursing Home provides accommodation and nursing care for thirty-one older people, living with dementia, who need support with their nursing and personal care needs. On the day of our inspection there were thirty-one people living in the home. The home is a large detached property situated in Horsham, it has two large communal lounges, a dining room and well maintained gardens.

The service had a registered manager. 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.

There were sufficient numbers of staff to ensure people’s needs were met and their safety maintained. Staff had received induction training and had access to ongoing training to ensure their knowledge was current and that they had the relevant skills to meet people’s needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe, one person told us “I feel very safe, there are always staff about, I like living here.”

Risk assessments had been undertaken and were regularly reviewed. They considered people’s physical and clinical needs as well as hazards in the environment and provided guidance to staff in relation to the equipment that they needed to use and the amount of staff required when assisting people. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments, instead risks were assessed and managed to enable people to be independent. Observations of people assessed as being at risk of falls showed them to be independently walking around the home. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice. For example, accidents and incidents were monitored and reviewed to identify trends and minimise reoccurrence and changes were made as a result.

People received their medicines on time and told us that if they were unwell and needed medicines that staff provided these. One person told us “Staff are very pleasant, I had a splitting headache and I asked for something for the pain. The nurse came along and gave me some medicine to help.” People were asked for their consent before being offered medicines and were supported appropriately, being offered a drink to take their medicine safely and comfortably. Medicines were administered by registered nurses whose competence was regularly assessed. There were safe systems in place for the storage, administration and disposal of medicines.

People were asked their consent before being supported with anything. Mental capacity assessments had been undertaken to ensure that for people who lacked capacity appropriate measures had been taken to ensure best interest decisions were made on their behalf.

People had access to relevant health professionals to maintain good health. One person told us “The doctor comes to visit me here, it is usually a woman, which I am in favour of. If I ask for the optician to visit, they visit and carry out an eye test. The chiropodist comes to check my toes nails.” Records confirmed that external health professionals had been consulted to ensure that people were being provided with safe and effective care. People’s clinical needs were assessed and met and they received good health care to maintain their health and well-being.

People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements and foods were fortified with cream, milk and cheese to increase their calorie intake.

People were involved in their care and decisions that related to this. People were asked their preferences when they first moved into the home. Regular reviews and meetings provided an opportunity for people to share their concerns and make comments about the care they received. Relatives confirmed that they were involved in their loved ones care and felt welcomed when they visited the home and knew who to go to if they had any concerns. The provider had dealt promptly with a complaint that had been made and changed practice as a result. There were various processes that people and their relatives could use to make their comments and concerns known. The provider welcomed feedback and was continually acting on feedback to drive improvements within the home.

People were treated with dignity, their rights and choices respected. Observations showed people being treated in a respectful and kind manner. People’s privacy was maintained, when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy maintained.

Staff knew people’s preferences and support was provided to meet people’s needs, preferences and interests. There was a variety of activities that people appeared to enjoy. People were able to make suggestions as to how they wanted to spend their time and these were listened to and acted upon.

There was a homely, friendly and relaxed atmosphere within the home. People were complementary about the leadership and management and observations confirmed that the aims and values of the provider were embedded in staff’s practice. Staff felt supported by the registered manager and were able to develop in their roles. There were rigorous quality assurance processes in place that were carried out by the registered manager and the providers to ensure that the quality of care provided, as well as the environment itself, was meeting the needs of people.

We also spoke with two relatives who were visiting. They also confirmed they were satisfied with the delivery of care. One relative told us, 'I think it is very good. I have seen a lot of changes recently. There had been a high turn over of staff and a lot of uncertainty. But now, under this manager, I would consider it is levelling out. The manager is good at recruiting competent staff. Overall the level of care is very good. I don't think my relative will get better care anywhere else.' Another relative said, 'The care provided is of a very high standard. I have never had any issues or concerns. The manager is very efficient and approachable. I feel confident my relative is getting the care they need.'

We spoke with one member care staff who was on duty and had recently been employed. They told us about how they had been recruited. They told us they felt well supported by the manager whilst they learned about what was expected of them.

We also gathered evidence of the provider's recruitment and selection process by looking at the new member of staff's record. It demonstrated that the recruitment process was sufficiently robust to ensure care staff employed by the provider were fit to work with the vulnerable and elderly.

'It's great here. I just like it.'

'They're very kind.'

Some people using the service were unable to communicate with us verbally because of their dementia care needs, so we observed their experience and how staff engaged with them. People were treated respectfully. We saw staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.

We also spoke with two of the home's owners, the manager, a nurse and two care staff.

We were concerned that thorough checks were not always made on staff before they started working in the home. For example, we found incomplete references and unexplained gaps in employment history.