Background to this inspection
Updated
25 August 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector, a specialist nurse advisor and an Expert by Experience. The specialist nurse advisor had experience of working and caring for people living with dementia. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The inspector and the specialist nurse advisor returned on 6 April 2021 to complete the inspection.
Service and service type
Ashleigh Nursing Home 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.
Notice of inspection
This inspection on 1 and 6 April 2021 was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the commissioners at the local authority and the clinical commission group (CCG) who work with the service. We used this information to plan our inspection.
During the inspection
We spoke with five people who used the service about their experience of the care provided. We spoke with eight members of staff including the provider, registered manager, a nurse, a senior care worker, care workers, the house-keeper and the cook. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We also made a referral to the local authority safeguarding team and shared information with the fire about our findings.
Updated
25 August 2021
About the service
Ashleigh Nursing Home is a care home providing personal and nursing care for up 16 people aged 65 and over at the time of the inspection. The service can support up to 21 people in one adapted building.
People’s experience of using this service and what we found
Risks were not always identified, managed or monitored to ensure people were safe and protected from harm. Staff did not have sufficient guidance in care plans and risk assessments. Medicines storage, administration and management were unsafe.
Infection prevention and control procedures did not protect people and staff from the risk of contagious diseases. Health and safety issues were found in relation to the premises and equipment used in the delivery of care.
Further improvements were needed in relation to meeting people’s cultural dietary needs and monitoring people’s intake of food and drink so action can be taken. People were provided with a choice of meals and their dietary needs had been assessed. People had access to healthcare support when needed.
Systems to protect people’s safety and wellbeing was not implemented fully. Staff recruitment procedures were not always followed. People were at risk of receiving unsafe care from staff whose induction and essential training for their roles was not kept up to date and their competency had not been assessed. Increased staffing levels would promote a person-centred approach to care and enable staff to spend more time with people. Systems and processes to protect people from the abuse and improper treatment was not robust.
People did not receive person-centred care and care plans lacked sufficient guidance to enable staff to provide effective care. We could not be assured people were supported to have maximum choice and control of their lives. Mental capacity assessments were not robust or detailed. This meant staff may not be able to support people in the least restrictive way possible and in their best interests. Further action was needed to ensure the policies and systems in the service were followed.
The premises and equipment were not adequately maintained to meet people’s needs or promote their independence. Further action was needed to ensure the environment was suitably adapted to support people living with dementia.
The provider did not have effective systems and processes to assess, monitor and improve the quality of service and provide good care. Quality assurance systems had not identified widespread issues in relation to people’s care, risk assessments, medicines, infection prevention practices, impacted by staff competence and training and environmental risks. This placed people at serious risk of harm.
The provider and registered manager had not fulfilled their legal responsibilities. Breaches of regulations were found at our inspections of June 2018 and our inspection in August 2019. This demonstrated the lack of lessons learned and limited action had been taken to improve the service as further breaches of regulations were found at this inspection.
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 5 November 2019). We imposed conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to bring about the improvements needed. The service rating has deteriorated to inadequate. Breaches of legal requirements were found, and the service was placed in special measures. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led which contains the requirement. 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.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. 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 Ashleigh Nursing 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 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 safe care and treatment, infection prevention and control, safeguarding service users from abuse and improper treatment, premises and equipment, staffing, governance and quality monitoring and failure to submit notifications to the CQC, 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
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.