Ashdown House

Ashdown House is a residential care home providing personal care to up to 24 people aged 65 and over in one adapted building. At the time of the inspection 17 people were being supported.

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

Systems to monitor the quality and safety of the service were in place to ensure people received safe and person-centred care. This required time to be embedded in the service to ensure they were maintained, sustained and improvements continued.

Risks to people’s care had been identified and plans put in place to mitigate the risk. Staff understood how to protect people from harm and followed good hygiene practices to prevent and control infection. There were sufficient staff deployed to meet people's needs and people could be assured staff were recruited safely.

People could be assured they received their medicines as prescribed. Staff received training in managing medicines and their competencies had been checked.

People's needs were assessed, and care plans guided staff how to meet those needs. 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 were supported to eat and drink. Mealtime experience could be improved so that people were not assisted to the table too early, leaving them waiting for their meal. Staff were supported to improve their skills and a comprehensive training programme was in place.

Staff were described as caring and gentle. People could be assured their privacy and dignity was respected and their consent gained before any interaction with staff. People were supported to remain as independent as possible.

People were encouraged to remain in touch with their family and friends. There were group activities and opportunities for people take part in individual activities if they wished.

People knew how to raise a complaint. Their feedback was sought to help drive improvements.

The provider and manager were open to suggestions as to how to improve the service and supported staff through regular meetings and supervisions.

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 9 December 2022) and there were breaches in regulations. 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.

This service has been in Special Measures since 8 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

Follow up

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

Ashdown House is a residential care home providing personal care to up to 24 people aged 65 and over in one adapted building. At the time of the inspection 12 people were being supported.

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

The provider continued to fail to have sufficient systems and oversight to assess, monitor and mitigate the risks relating to the health, safety and welfare of people.

The provider had not made enough improvement since the last inspection to ensure people were protected from risks associated with the safety of the environment and maintenance of the home. People living with dementia and at risk of falls were exposed to unnecessary risks.

Systems and processes were not effective in identifying risks to people in relation to fire and water system management. People could not be assured they were living in a safe environment and could safely access the garden.

There was not always enough staff to meet people’s needs. Care staff had additional duties and did not always have the time to provide the level of support people required. Mealtimes were task focussed and people who needed assistance did not always get it in a timely way.

We have made a recommendation about the deployment of staff.

Staff training needed to be improved to ensure all staff demonstrated good practice techniques in relation to moving and handling. Staff lacked confidence to use fire appliances and evacuation equipment in the event of a fire.

We have made a recommendation about the environment for people living with dementia.

People could be assured they received their medicines safely and on time. Staff were recruited safely and knew how to protect people from harm.

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 needs had been assessed and person-centred care plans were in place. There had been improvements made to individual risk assessments since the last inspection.

People were supported to maintain a healthy diet and had a choice as to what they ate. They had access to other health professionals when needed and had their own personal space.

People and relatives were able to raise concerns and staff felt listened to and supported.

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 26 May 2021) and there were 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of people’s nutrition and hydration and overall governance of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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 requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

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

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 assessing risk, record keeping, environment and oversight 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Ashdown House is a residential care home providing accommodation and personal care for older people, including those living with dementia. The service can support up to 24 people and there were 12 people living in the service at the time of inspection.

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

Poor infection prevention and control processes and practice placed people at risk of harm.

During a recent outbreak of COVID-19, government guidance on how to work safely in care homes was not always followed.

The infection prevention and control (IPC) policy had not been updated or reviewed since the COVID-19 pandemic and offered no guidance for staff on COVID-19 IPC procedures.

There was no IPC lead in place in the service. This meant there was no designated staff member to ensure all IPC practices and procedures were up to date and undertaken in line with government guidance.

Management oversight of IPC processes required urgent improvements. There were no quality assurance processes in place to ensure the provider had effective oversight of the management of the COVID-19 within the service.

IPC audits had not taken place for 12 months and there was no auditing of cleaning schedules, including shared bathrooms and high touch areas where the risk of the spread of infection is high.

Personal protective equipment (PPE) was not used effectively to safeguard people using the service and staff. The provider failed to ensure staff were socially distancing where it was possible for them to do so.

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2019).

You can read the report from our last inspection, by selecting the 'all reports' link for Ashdown House on our website at www.cqc.org.uk.

Why we inspected

As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

This inspection took place on 19 January 2021.

We have found evidence the provider needs to make improvements. Please see further detail in the Safe section of this report.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulations in relation to infection prevention and control which meant people's safety could not be assured.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will monitor information which the provider will send to CQC updating us of the actions they are taking to make improvements. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashdown House is a residential care home providing personal care to up to 24 people aged 65 and over. At the time of the inspection 12 people were being supported.

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

We found provider had not made sufficient improvement to provide a safe service. Risks to people had not always been identified or managed effectively. In some instances, risk assessments were not always completed.

Records were not always kept up to date. We found gaps in records for example records relating to the daily wellbeing checks and to monitor health conditions, repositioning checks of people nursed in bed, pressure mattress settings, cleaning records and food and fluid records.

Care plans did not always contain sufficient information to support staff to understand people’s individual needs. Staff had not always completed up to date training for their role.

The environment required improvement. We found wardrobes that had not been secured to the walls to prevent harm and exposed pipes that posed a risk of scalding. The provider had already submitted an action plan to the local authority regarding concerns with décor, carpets, kitchen units, plug sockets and the leaking roof.

The service did not a registered manager, although the provider had appointed a manager who was due to start working in the service

Oversight and governance systems had not previously identified the concerns we found during this inspection. People, relatives and staff had not been asked for their feedback or suggestions to improve the quality of the service.

Infection, prevention and control required improvement. Issues raised at the IPC inspection had not all been rectified or completed.

We received mixed views regarding staffing levels. We were told that people had to wait for support due to limited staff being available, however people told is that staff were kind and caring.

People received their medicines as prescribed by staff who had received training and had their competencies checked.

The provider was working with external agencies to improve the quality of the service. However, systems and processes had not been implemented at the time of inspection.

Staff made referrals to healthcare professionals as required to ensure people’s health needs were met.

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 (18 September 2019).

The last inspection for this service was published 9 March 2021. The inspection was an infection protection control (IPC) inspection and did not rate the service. However, they were found to be in breach of regulation 12.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the environment, staff recruitment, PPE use and person-centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing risk, records, environment, infection control and oversight 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 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.

Ashdown House is a residential care home providing personal and nursing care to up to 24 people aged 65 and over. At the time of the inspection the service was providing care for 20 people.

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

The registered manager and provider had systems in place to closely monitor all aspects of the service. But had failed to notify the Care Quality Commission (CQC) of serious injuries (as required by law).

Risk assessments and care plans were detailed, but more information was needed to fully reflect how staff responded to behaviours that challenged.

People were protected from the risks of abuse. Staff knew the safeguarding reporting procedures and felt confident to immediately report any concerns of abuse.

Staff ensured people received support to eat and drink, they closely monitored the food and fluid intake of people at risk of poor nutrition and hydration. People were referred to dietetic and speech and language services as and when required.

Recruitment checks were carried out on new staff to ensure only suitable staff worked at the service. Trained staff were deployed in sufficient numbers to meet people’s needs.

Staff and people using the service had good relationships. Staff provided kind compassionate care. People’s dignity was maintained, and personal care was carried out in private and in a timely way.

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.

Staff followed advice from healthcare providers to ensure people received their medicines safely following best practice guidelines.

People and relatives were supported to express their views about using the service and be involved in creating and reviewing their care plans.

The service was clean and homely. The provider had a programme of repairs and refurbishments that was in progress.

People were supported to access healthcare. Staff were prompt in referring people to their GP when required. Staff followed infection control procedures.

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 12 January 2017). Since this rating was awarded the service has moved to a new legal entity under a new registration.

Why we inspected

This was a planned inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. We identified a breach in relation to: Regulation 18 of Care Quality Commission (Registration) Regulations 2009. Notification of other incidents.

You can see what action we have asked the provider to take at the end of this full report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.