Ashlands Care Home

Ashlands Care Home is a residential care home providing personal care to up to 30 people. The service provides support to older people and people living with dementia in one adapted building. At the time of our inspection there were 19 people using the service.

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

Risks to people in relation to their personal care were not always managed safely. The provider had not ensured there was an up-to-date fire risk assessment and evacuation plan in place. Staff did not feel confident that they could safely evacuate people at night, which put people at risk. The registered manager and provider took immediate action to address this issue during the inspection visit. The service was not consistently well-led. Although the provider had a range of checks and audits in place, these were not always effective at identifying areas which needed improvement.

People were protected from the risk of abuse. Staff understood how to recognise and report concerns or abuse and felt confident to speak up about concerns. People received their prescribed medicines safely. The service was clean and well-maintained in most areas.

Staff knew how to support people safely. Accidents and incidents were documented and analysed regularly to assess trends and patterns. During the day, there were enough staff to keep people safe. Staff were recruited safely. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination.

People and relatives felt staff had the right training to meet their needs. Staff were able to demonstrate they had the right skills and knowledge to support people safely. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. People were supported by staff to access healthcare services 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.

Since our last inspection, the provider had taken steps to ensure all staff were consistently kind, caring and respectful to people. People and relatives spoke positively about how this had improved. The provider and registered manager had worked with the staff team to ensure that people were involved in developing and reviewing their care plans. People’s confidential personal information was stored securely.

Since the last inspection the provider had regularly shared their improvement plans with CQC. From reviewing these and looking at the evidence found on this inspection, we could see progress in all areas of care. The provider now had systems in place to identify when things went wrong. This meant they had information to improve the service and were working to encourage a culture of continuous improvement. The provider had a refurbishment plan in place for the care home. We could see where improvements had been made, and where work still needed to be done to ensure the environment met people’s needs.

Staff spoke positively about the improvements since the last inspection and felt there had been a positive culture change in the whole staff and management team. The provider had started to get feedback from people, relatives, and staff to help drive improvements in the quality of care. This was still a work in progress, and the provider had not had time to fully embed regular and meaningful consultations with everyone.

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 31 December 2022) and there were multiple breaches of regulations. At this inspection we found the provider was still 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.

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

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. 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 Ashlands Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to managing risks safely and ensuring robust governance procedures were in place at this inspection.

Please see the action we have told the provider to take at the end of this report.

We recommend the provider consider current guidance and best practice on developing their assessment of staffing levels to meet people’s needs.

We recommend the provider consults with people, relatives, and the staff team to try to identify ways to reduce the overall noise level in communal areas.

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.

Ashlands Care Home is a residential care home providing personal care to up to 30 people. The service provides support to older people and people living with dementia in one adapted building. At the time of our inspection there were 20 people using the service.

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

Risks to people in relation to their personal care were not managed safely. Care plans were not accurate and did not reflect people’s current needs. People were not protected from the risk of abuse. There were not enough staff to keep people safe. The provider had not ensured there were robust measures in place for managing the prevention and control of infections.

People's needs and choices were not consistently assessed in line with current legislation and guidance in a way that helped to prevent discrimination. Staff did not always have the appropriate skills and experience to support people safely and effectively. The provider had not ensured people consistently had access to a balanced diet that met their assessed needs and preferences. People did not always have timely access to healthcare professionals.

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.

People were not consistently treated with dignity and respect. People were not offered choices in ways which were meaningful to them. People were not involved in reviews of their care, particularly where they were less able to communicate their needs. The provider did not ensure people’s confidential personal information was stored securely.

The service was not well led. People were put at risk because the provider failed to ensure suitable quality assurance checks identified issues with care and support. The provider did not have systems in place to identify when things went wrong. Feedback from people, relatives, staff and external professionals was not used to improve the quality of care. The provider was unable to demonstrate a commitment to continual improvement and was not delivering personal care in line with current best practice guidance. The provider had not ensured there was a clear set of values or vision of delivering safe, effective and compassionate care.

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 29 September 2021). This service has been rated requires improvement for the last five consecutive inspections.

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.

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

Why we inspected

The inspection was prompted in part due to concerns received about concerns about the quality of care for people, and the recent outcomes of safeguarding investigations. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. On the first day of inspection we decided to also include the key question of caring. 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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring 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.

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

Enforcement

We have identified breaches in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding people from abuse, good governance, staffing and fit and proper persons employed. We also identified breaches in relation to the registered provider’s statement of purpose, and notifications of incidents.

Please see the action we have told the provider to take at the end of this report.

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.

Ashlands Care Home is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 30 people. The service is in an extended two storey detached building, converted and adapted to provide care both for people with dementia and older people.

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

Risks to people in relation to their personal care were not always managed safely. PPE (personal protective equipment) was not always readily available throughout the building. Some areas of the home environment were not able to be effectively cleaned due to damage to surfaces. This put people at risk of preventable spread of infection.

The provider did not consistently assess, monitor and mitigate the risks in relations to the health, safety and welfare of people. Audits of the quality of care were not consistently effective at identifying or rectifying issues. The provider did not ensure that people were as fully involved as they could be in designing their care and support. People’s care plans and associated documents did not demonstrate that people and their relatives had been consistently involved in developing and reviewing care.

The provider was aware of the requirement to notify CQC of certain incidents, but our records showed that these notifications were not always sent in as required. The provider had not provided CQC with an up to date statement of purpose.

People and their relatives felt the service was safe. Relatives spoke positively about the caring attitude of the staff team. Staff understood how to recognise and report concerns or abuse. There were enough staff to keep people safe. People received their prescribed medicines safely. We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

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 1 April 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We received concerns in relation to medicines management, food and fluids monitoring, pressure area care and monitoring and how safeguarding was managed. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

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.

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.

The overall rating for the service has remained the same. This is based on the findings at 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashlands Care 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 will continue to monitor the service.

We have identified breaches in relation to regulations. Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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.

The care home accommodates up to 30 people aged 65 and over in one adapted building. At the time of our inspection 21 people lived there.

People’s experience of using this service:

¿The provider had improved their systems to monitor and review the quality of care people received. This was an improvement from our last inspection and the provider was no longer in breach of Regulation 17 HSCA (Regulated Activities) Regulations 2014 good governance.

¿However, some risks were present in the general environment and these had not always been identified and mitigated. We have made a recommendation about health and safety risk management.

¿We found other areas required improvement. These included checks made during the recruitment of staff, the maintenance plans for the premises and information sharing.

¿Other risks and risks associated with people’s healthcare conditions were identified and managed. Procedures were in place and followed by staff, to ensure medicines were managed safely and infection protection and control practices were effective.

¿Sufficient staff were available to meet people’s needs and staff understood what actions to take to protect people from harm and abuse. The registered manager looked to learn from incidents and make improvements when things went wrong.

¿People’s needs were assessed and monitored and people’s diverse needs were supported. Policies and procedures helped to ensure care was delivered in line with current standards.

¿Staff received support and training to help them work effectively in their roles. Staff made referrals to other professionals for their advice and guidance regarding people’s care when needed. People had access to other healthcare services as required.

¿People had choices of food and drink to help them maintain a balanced diet. Staff supported people with their meals and drinks when needed.

¿People liked their home and were happy with the on-going work to re-decorate the premises.

¿People felt well looked after and liked the staff who cared for them. People’s views were taken into account when their care was planned. Staff took steps to ensure people’s privacy and dignity was respected. People’s independence was promoted.

¿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.

¿People received personalised and responsive care and enjoyed how they spent their time at the service. No-one had a complaint to make however, people knew how to complain should they have need to. People’s communication needs were identified and met.

¿Quality of care was checked by the registered manager through spot checks and audits. The registered manager was keen to ensure care promoted positive outcomes for people. The registered manager was considered to be open and approachable and was keen to ensure the service continuously improved. People and staff felt listened to and had opportunities to be involved in the service; more information is in the full report.

Rating at last inspection:

At our last inspection, the service was rated as 'Requires Improvement.' (Published 12 July 2018). At this inspection we found the service had improved and was no longer in breach of the Act however, the service was still rated 'Requires Improvement.' This is the fourth inspection where the service has been rated 'Requires Improvement.'

Why we inspected:

This is a scheduled inspection based on the previous rating. The previous inspection found there was a breach of Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

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

At the time of our inspection there was not a registered manager in post. A new manager who will be referred to in the report as ‘manager’ had been appointed who was intending to register with CQC. 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 had previously been rated as ‘requires improvement’. At this inspection the service remained 'requires improvement'. We found breaches in regulation. The service had failed to address the issues raised at previous inspections and ensure arrangements were in place to deliver safe care and improve quality. This is the third time the service has been rated Requires Improvement.

Guidance was not consistently in place to ensure people received their medicines when required. Medicines were administered safely, however we found a number of issues in relation to medicine management. Medicine records were not consistently completed.

Where people were unable to make decisions arrangements had not been consistently made to ensure decisions were made in people's best interests. Best interests decisions were not always specific to the decisions which were needed to be made.

A system was being developed to carry out suitable quality checks but appropriate checks had not been regularly carried out. The provider had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care. Sufficient background checks had not been completed before new staff had been appointed according to the provider’s policy.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. There were arrangements to prevent and control infections. Staff did not always follow best practice to avoid cross infection.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a limited range of activities. However people did not access local community facilities. The manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Arrangements were in place to support people at the end of their life.

The manager promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had not been regularly consulted about making improvements in the service. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

We carried out a comprehensive inspection of this service on 21 April 2016 and two breaches of legal requirements were found. These included; insufficient systems in place to maintain cleanliness and hygiene at the service and quality assurance systems in place to monitor quality and safety had not been completed consistently. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashlands Care Home on our website at www.cqc.org.uk.

Ashlands Care Home provides accommodation and personal care for up to 30 older people including people living with dementia. At the time of our inspection there were 21 people living at the service.

During our last inspection there was no registered manager in place. However, a registered manager had been recently recruited and was in post during our inspection. 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.

People felt safe. Staff were aware of the safeguarding adult procedures to protect people from avoidable harm and had received appropriate training. Risks to people’s health were known by staff but these were not always documented or reviewed regularly. Therefore risks were not always managed safely.

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly. However, medicines given as and when required did not have the appropriate guidance or protocols that staff needed to follow. The internal and external environment was monitored and improvements had been identified and planned for.

Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support. There were not always sufficient experienced, skilled and trained staff available to meet people’s needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for, but their weight was not regularly recorded where needed. People received a choice of meals. People’s healthcare needs had been assessed and were regularly monitored.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. Best interest decision were not always recorded.

Staff were kind, caring and respectful towards the people they supported. Staff were task centred in their support. The registered manager confirmed they were looking at changing records so that support is offered in a more person centred way. The provider asked relatives and visiting professionals to share their experience about the service provided. Communication between relatives and external professionals had improved since our last inspection.

People or relatives were not always involved as fully as possible in their care and support. There was a complaints policy and procedure available. Information was available to inform people of independent advocacy services. There were no restrictions on people visiting the service.

Some people were supported to participate in activities of their interest, but these were not always run consistently. An activities coordinator had been recently recruited who was looking at improving this area of support. Staff did not always support people with their goals and aspirations that promoted independence.

The provider had improved in monitoring the quality and safety of the service. However, audits were not always reviewed regularly. The recently appointed registered manager had begun to implement daily, weekly and monthly quality audits. These needed to be sustained over a period of time to confirm their effectiveness.

Ashlands Care Home provides accommodation and personal care for up to 30 older people including people living with dementia. At the time of our inspection there were 27 people living at the service.

A registered manager is required at Ashlands Care Home. 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. At the time of our inspection there was not a registered manager in place. The provider had newly recruited a manager who was having recruitment checks completed. The provider told us that the manager was due to commence their role imminently and they would submit their registered manager application when in post. We will monitor this.

People told us that they had some concerns about the cleanliness of the service. We found that the systems in place to maintain cleanliness and hygiene were insufficient. The provider had failed to implement requirements made by the clinical commissioning group infection control audit that was completed in November 2015.

Staff were aware of the provider’s safeguarding policies and procedures and their role and responsibilities in keeping people safe. The provider was working with the local authority in investigating some current safeguarding concerns.

Risks to people had not always been assessed appropriately, and the control measures identified to reduce risks had not always been put in place. Risk plans lacked detailed information for staff. Accident and incidents were not always recorded appropriately, and there was a lack of analysis to consider patterns, trends and lessons learned to reduce further reoccurrence.

Concerns were identified with the deployment of staff, they lacked direction and organisation. Appropriate dependency assessments to determine staffing levels were not in place. The provider had not always completed recruitment checks before staff commenced employment.

People received their medicines as prescribed but staff did not have information about managing people’s medicine prescribed as and when required. People’s preferences of how they liked to take their medicines were not recorded.

Some shortfalls were identified with the staff induction, training and support opportunities available to staff.

Staff had limited understanding of the principles of The Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. Where people lacked mental capacity to make specific decisions about their care and treatment, some assessment’s and best interest decisions had been made but some people’s capacity required further assessments.

People received sufficient to eat and drink and choices were offered. Where food supplements had been prescribed, people had received these. People said they liked the food but found the portion size a concern. People did not always receive appropriate support from staff with their eating. External health professionals were involved in meeting people’s health care needs. People’s care records did not always show what action had been taken to support people’s health needs.

Staff communication and interaction with people was variable. People described staff as caring and kind. People did not have available information about independent advocacy services should they have required this support. Information about the complaints procedure was not displayed easily for people to see and was not in an appropriate format for people with communication needs.

Staff had limited information available about people’s individual needs, routines and preferences this impacted on their ability to provide effective and responsive care. New care records were being introduced. People received limited opportunities to participate in activities and these did not always reflect people’s preferences and interests.

The quality assurance systems in place to monitor quality and safety had not been completed consistently within the service. The provider visited the service regularly but had not recorded the audits they completed to check on quality and safety. These shortfalls had impacted on the development of the service.

We found the service was in breach of two 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.

We found that people who used the service had their needs assessed and planned for from the start of their admission to the home and care was delivered in a way that was intended to ensure people's safety and welfare.

We found that people who used the service were supported to have adequate nutrition and hydration.

We found that people who used the service were supported by sufficient staff to meet their needs.

We found that there was effective management of risks to the health, welfare and safety of people who used the service. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that care was not always planned in a way that was intended to ensure the safety and welfare of people who used the service. Nutrition and hydration monitoring needed to be improved. Staffing levels were not sufficient to meet the needs of people who used the service and improvements were needed to the way the provider was monitoriing the quality of the service.

We spoke with a relative who told us, 'The new manager has made a difference. I am always kept informed of any changes and they involve me wherever necessary. The food is good and I have no concerns.'

We spoke with a visiting advanced nurse practitioner who provided an urgent response service through a single point of access for all primary care issues. She told us, 'I have absolutely no concerns, the home is managed a million times better. The manager and senior staff refer people to me promptly and appropriately. They anticipate end of life care needs well.'