Ashworth Grange

Ashworth Grange is a care home providing personal care for up to 64 people, some of whom are living with dementia. There are communal areas and accommodation on both the ground floor and first floor. The service has 4 units, referred to as neighbourhoods, Daisy, Poppy, Rose and Lilly. At the time of our inspection there were 64 people using the service.

People’s experience of the service and what we found:

The service provided a homely, friendly, and inviting environment for people. There was a positive and inclusive culture maintained by managers and staff, where people were actively engaged and placed at the heart of service delivery.

People were protected from avoidable harm and had their individual care needs and risks assessed, monitored and managed. Where accidents and incidents occurred, these were reported and investigated appropriately, and learning used to mitigate future risks and improve the service. Medicines were managed safely.

Staff were recruited safely and there were enough staff to meet people’s needs. Effective infection prevention and control (IPC) practices were in place. The service provided a homely, clean and tidy environment for people.

Effective quality assurance systems were in place to drive service improvement. The registered manager maintained good oversight of the service and information was shared with staff and external agencies when required.

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

The last rating for this service was good (published 13 November 2018).

Why we inspected

We inspected due to the length of time since the last inspection. We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

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

We found the following examples of good practice.

• The home was well ventilated and clean; regular cleaning procedures were in place to minimise the risk of infection.

• Infection control procedures were understood and implemented by staff.

• Staff confidently demonstrated how they used personal protective equipment (PPE) and hand sanitising points were readily accessible at strategic places throughout the home.

• The service engaged with a regular testing programme and staff were positive in their approach to supporting people with this process.

• There was effective teamwork in place to support people's well-being and help prevent them from feeling socially isolated.

Following the last inspection the registered provider sent us an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. At this inspection we checked to see whether improvements had been made and found the registered provider was meeting all the regulatory requirements.

Ashworth Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashworth Grange is registered to accommodate up to 64 people. The service provides care for people with residential needs as well as those living with dementia. The home is divided into four units over two floors connected by a lift. At the time of our inspection 54 people were using the service. One unit for people living with dementia had been re-opened following our last inspection.

A registered manager was in place. 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.

Emergency procedures were robust to protect people in the event of the need to evacuate the building. We found the systems for managing people’s medicines were safe and competency checks on the administration of medicines were comprehensive and up to date.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Safe recruitment and selection processes were in place.

The required number of staff was provided to meet people’s assessed needs and provide a good level of interaction.

Risks were assessed and well managed. Incidents and accidents were analysed to prevent future risks to people and learning from incidents was evident.

Staff told us they felt very well supported and they received regular supervision, training and appraisal to meet their development needs. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home.

People told us they enjoyed their meals and meals were planned around their tastes and preferences. People were supported to eat a balanced diet and action was taken where people’s nutritional intake had declined.

People were supported to maintain good health and had access to healthcare professionals and services. The service was adapted to meet people’s individual needs.

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

Positive relationships between staff and people who lived at Ashworth Grange were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.

People were involved in arranging their support and staff facilitated this on a daily basis. People were supported to be as independent as possible throughout their daily lives.

The management team promoted an open and inclusive culture whereby people were encouraged to express their diverse needs and preferences.

Care records contained detailed information about how to support people and people engaged in social and leisure activities which were person-centred.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were approachable.

Everyone told us the service was well-led. The registered manager was visible in the home and knew people’s needs. Staff at the home knew their roles and welcomed feedback on how to improve the service.

Improvements had been made to the system of governance and audits within the service and the management team had an effective overview of the quality and safety of the service.

The registered provider had increased resources and senior management input to the home. This had proved effective in driving improvements.

People who used the service and their representatives were asked for their views about the service and they were acted on.

Following the last inspection, we met with the registered provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At this inspection we checked to see whether improvements had been made and found improvements had been made in all areas, although the registered provider was still not meeting two of the regulatory requirements.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Ashworth Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashworth Grange is registered to accommodate up to 64 people. The service provides care for people with residential needs as well as those living with dementia. The home is divided into four units over two floors connected by a lift. At the time of our inspection 45 people were using the service including one person who was currently in hospital. One unit for people living with dementia remained closed following our last inspection.

A registered manager was in place. 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.

Emergency procedures were not robust to protect people in the event of the need to evacuate the building. Two night staff members did not know the correct procedure to follow in the event of a fire and had not received fire drills in line with the registered provider’s policy. These staff were uncertain how many people were living in the home on the day of our inspection. This was a continuing concern from our last inspection and was a breach of regulation 12, safe care and treatment.

Most risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence, although some lacked detail. Behavioural support plans did not always contain sufficient detail to investigate the causes of behaviour that may challenge others and to support staff to prevent and manage behaviour effectively. Consistent records of behavioural incidents were not always kept.

We found the systems for managing people’s medicines had improved and issues from our last inspection had been addressed. Competency checks on the administration of medicines were up to date. People received their medicines safely.

Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Safe recruitment and selection processes were in place.

The required number of staff was provided to meet people’s assessed needs and provide a good level of interaction.

Incidents and accidents were analysed to prevent future risks to people and learning from incidents was evident.

Staff told us they felt very well supported and they received regular supervision, training and appraisal to meet their development needs. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home. The registered manager was planning to improve the recording of initial induction to the home environment for new staff.

People told us they enjoyed their meals and meals were planned around their tastes and preferences. People were supported to eat a balanced diet and action was taken where people’s nutritional intake had declined.

People were supported to maintain good health and had access to healthcare professionals and services. Community professionals told us the service had improved and was working in partnership with them to improve outcomes for people. The service was adapted to meet people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. New electronic recording systems meant signatures had not been recorded on best interest decisions and the registered manager planned to address this straight away using paper signature records for important decisions and consent.

Positive relationships between staff and people who lived at Ashworth Grange were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.

People were involved in arranging their support and staff facilitated this on a daily basis. People were supported to be as independent as possible throughout their daily lives.

The management team promoted an open and inclusive culture whereby people were encouraged to express their diverse needs and preferences.

Most care records contained detailed information about how to support people, however some records were inconsistent. People engaged in social and leisure activities which were more person-centred.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were approachable.

Improvements had been made to the system of governance and audits within the service. There were some issues that had not been picked up by this system. This showed that whilst improvement had been made since the last inspection, some issues relating to governance remained.

People told us the service was well-led. The registered manager was visible in the home and knew people’s needs.

The registered provider had increased resources and senior management input to the home. This had proved effective in driving improvements to the quality and safety of the service provided.

Feedback from staff was positive about the registered manager. Everyone at the home knew their roles and welcomed feedback on how to improve the service. People who used the service and their representatives were asked for their views about the service and they were acted on.

We found continuing breaches in Regulation 12 and 17 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.

At our last inspection we identified two regulatory breaches which related to consent to care and safe care and treatment. At this inspection we found the registered provider had not made sufficient improvements in these areas and we also found further breaches of the regulations. Following our inspection the registered provider sent us an action plan which showed how some of our immediate concerns would be addressed.

Ashworth Grange is registered to accommodate up to 64 people. The service provides care for people with residential needs as well as those living with dementia.

At the time of our inspection the service had a registered manager, although this individual had not been in day to day control for 12 months. A manager had been appointed in May 2017 and told us they expected to submit an application to become registered following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their relatives told us they were safe living at this service. However, we found the registered provider had identified safeguarding concerns in February and August 2017 which they had not reported to the Care Quality Commission (CQC). During our inspection, we found there were still concerns regarding people’s safety.

We found medicines were not managed safely as not all staff responsible for the administration of medicines had an up to date assessment of their competency. The management of creams, covert medicines and storage arrangements were not robust.

Staff were uncertain how many people lived in the home and we found there were gaps in staff knowledge regarding how to respond in the event of a fire. Fire drills had not been carried out in line with the registered provider’s policy. Personal emergency evacuation plans were in place, although staff were not aware they existed or where they could find them.

Staffing levels were insufficient to provide timely responses to people’s needs. Staff support through a programme of training, supervision and appraisal was not up to date. Most recruitment checks had been carried out safely to ensure staff were suitable to work with vulnerable adults.

Care plans contained information regarding people’s life histories, although we found there was insufficient detail recorded to ensure person-centred care was provided. Risks assessments did not always contain sufficient information and conflicted with what staff told us. The roles and responsibilities for people’s pressure care were not clear and we found concerns regarding the use of equipment.

Staff knowledge of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had improved since our last inspection. The recording of people’s mental capacity required improvement and evidence of power of attorney was not sufficiently recorded.

We looked at the governance arrangements and found issues identified during this inspection had previously been highlighted through the registered provider’s quality audit in July 2017.

We saw the quality of support people received from staff at lunchtime was variable. People’s special dietary requirements were not always met. People told us they enjoyed the meals provided.

People and their relatives were complimentary about the care provided by staff and there were examples of their involvement in care planning. However, we found concerns regarding people’s privacy and dignity which was not always respected. People received timely access to healthcare, although the recording required improvement.

Healthcare professionals provided positive feedback about this service. A programme of activities was in place. A social committee met on a monthly basis to discuss upcoming events they wanted to see. Relatives knew how to make a complaint if they were dissatisfied. Complaints were found to be responded to appropriately and within identified timescales. Most staff, people and relatives told us they thought the manager was approachable and effective in their role.

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. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

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

Ashworth Grange is a 64-bed home which provides accommodation over four units, two of which particularly care for people living with dementia. On the days we inspected there were 42 people in the home.

The home had a manager in post who was applying for registration. They were present on the first day of the inspection and half the second day. 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.

This inspection found some improvements had been made but there were still serious issues in regards to medication and risk assessments. In addition, there were also issues with the assessment of mental capacity.

People and families said they felt safe and staff demonstrated a sound understanding of what may constitute poor practice, and knew how to report this.

Despite the issuing of a warning notice following the previous inspection the home had still not provided evidence of personalised moving and handling assessments for people and neither were they able to show us equipment checks on hoists or slings as required under the Lifting Operations and Lifting Equipment regulations. This meant people were at risk of harm as the necessary safety checks were not completed and equipment may have been used which was not appropriate for that individual.

Staffing levels had improved and we saw better response times for people in relation to the call buzzer. This information was analysed closely by the manager and investigated where there had been issues.

Serious concerns remained in regards to medication, both for administration where procedure was not always correctly followed and in storage where, again, we found one of the medication trolleys broken.

Some staff training had elapsed but we saw actions in place to tackle this prior to our visit following an audit and the implementation of a new supervision schedule had recently commenced.

The completion of mental capacity assessments was inconsistent and many were void as they were not decision-specific and had been completed incorrectly. There was no evidence within people’s care records of appropriate authorisations where people had consented on behalf of others to show they had the permission to give consent on someone’s behalf.

Nutrition and fluid intake were better managed although there were gaps in recording in some units. We saw people at risk were supported regularly with extra snacks and drinks, and also referrals to external professionals made as necessary. Pressure care relief was generally also improved although we observed one person without their required pressure cushion.

Staff were patient and kind in their interactions with people, and attentive to their needs. We found communication was clearer as staff discussed what they were doing and handover notes were more comprehensive.

Care records were detailed and person-centred, showing evidence of regular evaluations. Daily notes also reflected people’s days and correlated to other parts of the record where necessary, such as an increase in falls and contact with a GP to rule out infection.

The home had a new manager who had been in post for two months and it was evident they had already had a significant impact. Staff spoke with us of changes and feeling more included in decisions which was helping rebuild morale. Audits were more effective as tools to identify areas needing further development but there remained concerns around medication and risk assessments.

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

Ashworth Grange is a home for people needing assistance with personal care, some of whom may be living with dementia. The home has 64 places and on the day we inspected 47 people were living in the home. The home has four separate areas, two of which specialise in caring for people with dementia.

There was a registered manager in post and in the home on the days we inspected. 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 staff knew what may be regarded as a safeguarding concern and how to report these. People and relatives said they felt safe.

Risk assessments were person-centred in their recording style but lacked basic information regarding the method involved in using equipment if this was needed. This meant staff did not have the necessary guidance to manage risk effectively and minimise the chance of harm.

Staffing levels were not always adequate. We observed periods where staff were frequently changing between units. This meant they did not always know everyone or what the key concerns were for that person that day. Both people in the home and relatives mentioned this to us and said there were periods when they had to wait or when communal areas were unattended as staff were supporting with personal care. Call bell logs illustrated this and the lack of analysis as to whether there were any particular periods where pressure was higher masked the issue.

We observed medicines being given to people patiently and supportively. However, we had concerns regarding storage as one of the trolleys had a broken lock and could not be left unattended, thereby restricting another member of staff to overseeing this if the medicine administrator had to attend to a person out of the room. Keys were also left in all cupboards meaning that access to medicines in the treatment room were not restricted to authorised personnel only.

Staff did not always follow necessary infection control measures as we saw bedlinen being handled without appropriate protective clothing and interaction between a staff member and other person in the home again, without appropriate protection despite the staff member knowing the person had an infection.

People and relatives spoke highly of the food and we saw staff support people to eat and drink well throughout both days. However, further detail needed to be recorded on the food and fluid charts to enable accurate analysis of any weight loss.

The registered manager and staff had a basic understanding of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards. The home had applied for appropriate authorisations.

Staff had ensured all their training was current and were being supported in their roles by reflective supervision.

People were supported to access other health and social care services as they needed them, and necessary records were kept which were included in people’s care plans.

Staff displayed kindness, friendship and patience in their interactions with people, and it was evident they knew people well as some staff were working on the same units.

There was a range of activities on offer for both groups and individuals. People were able to join in a variety of events and equally were able to enjoy time in their rooms.

Care records had been written in a person-centred manner, reflecting people’s specific needs and staff demonstrated knowledge of these.

The home had a positive atmosphere with evidence of engagement and staff felt supported. We saw staff meetings were structured and feedback was considered. However, audits had failed to tackle some of the issues we found.

We found breaches in Regulations 12 safe care and treatment, 17 good governance and 18 staffing. You can see what action we told the provider to take at the back of the full version of the report.