Ashfield Nursing & Residential Home

Ashfield Nursing & Residential Home is a care home providing personal care to up to 32 people. The home provides support to older adults and people living with dementia. At the time of our inspection there were 24 people living at the home.

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

The provider's processes for monitoring the quality and safety of the home were not effective and had failed to identify, address concerns and drive improvements. The environment was not always safe, as a recent fire inspection showed the home was not compliant with fire regulations. Some areas of the home were worn and required improvements. The provider had not ensured all staff were appropriately trained and received regular supervisions to support their learning and development.

Staffing levels were sufficient to meet people's needs however, staff were not always recruited safely. We made a recommendation to ensure safe recruitment within the home.

Systems were in place to safeguard people from the risk of abuse and people said they felt safe. Incidents and accidents were reported, investigated and measures taken to mitigate future occurrences. However, we did identify one incident which was not reported to CQC. Medicines were mostly managed safely.

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 told us staff were kind and caring. Relatives and friends were encouraged to visit the home and spend time with their loved ones. Staff understood and knew peoples individualised needs. Care plans and risk assessments had been completed when people required measures in place to keep them safe.

People and their relatives knew how to complain and told us they could speak up. People, relatives, and staff were positive about the running of the home.

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 1 August 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to the management oversight at this inspection. We have made a recommendation about the provider's recruitment systems.

Please see what action we have told the provider to take at the end of this 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 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 had a range of policies and procedures to manage any risks associated with the COVID pandemic.

There were sufficient supplies of personal protective equipment (PPE) available for people. Hand sanitiser and hand washing facilities were readily available throughout the home. Staff had been trained in infection prevention and control (IPC) and the use of PPE.

Daily, weekly and monthly cleaning schedules were in place, which included touch point and deep cleaning.

A programme of COVID testing for both people living in the home and staff was undertaken in line with current government guidance. Appropriate procedures were in place should anyone display any symptoms or test positive. All visitors, including healthcare professionals, were subject to a range of screening procedures. This included showing evidence of vaccination and an up to date negative COVID test.

Staff supported the social and emotional wellbeing of residents and had done so throughout the pandemic. Residents were supported to attend external events taking into consideration COVID related risk assessments and testing.

We found the following examples of good practice.

A range of visiting options were available to people. This included garden visits, pod visits and internal visits subject to testing. A separate visitor entrance was in place to reduce the risk of transmission. People had visiting care plans in place detailing how their loved ones visited them.

Clear risk assessments were in place to help reduce the risk of COVID-19 transmission in the home. These were well understood by staff. People, staff and relatives were provided with regular communication about the facts of COVID-19 including testing and vaccination to reduce the risk of misinformation through social media influencing people’s views.

The registered manager was knowledgeable about government guidance and systems were in place to promptly communicate any changes in guidance to staff to ensure they followed the latest infection prevention practices.

At the last inspection in March 2015 the service was rated Good. However a rating of requires improvement had been identified in the ‘safe’ domain with a breach in Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. The registered person did not protect service users against the risks associated with unsafe use and management of medicines. This had now been addressed by the management team and good medication practices were in place.

At this inspection we found the service remained Good.

This inspection visit took place on 04 July 2017 and was unannounced.

We looked at how the registered manager and staff had improved their medication procedures. We found medicines had been ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. The registered manager had audits in place to monitor medicines procedures. These meant systems were in place to check people had received their medicines as prescribed.

People who lived at Ashfield Nursing and Residential Home told us they were happy with the care they received and with staff who supported them. We sat with people who lived at the home in the lounge area and observed staff providing support for people throughout our inspection visit. We found they were kind and patient and treated people with respect and dignity. One relative said, “They were all so caring and respectful.”

We found by looking at appropriate documentation and talking with staff they had been recruited safely, received ongoing training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at the home and nurses were on duty 24 hours of the day.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available around the building for staff to use when required.

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

People told us they had choices of meals and there were always alternatives if they didn’t want what was on offer. We observed at lunchtime people who required support were attended to in a sensitive manner. People spoke positively about the quality of food. One person who lived at the home said, “The food is superb. Today the lunch was beef wellington it was great.” Care records we looked at described people’s food preferences and any allergies.

We looked at the activities at the home and spoke with people about what was provided. The service employed activity co-ordinators and people who lived at the home made positive comments about them. One person who lived at the home said, “We have a lot going on here and that is down to [activity co coordinators] they are very good and caring people.”

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received. However people who lived at the home and relatives we spoke with were aware of the process to follow should they have any concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, surveys sent to relatives/residents. In addition staff and ‘resident’ meetings were held to seek their views about the service provided and improve the service if required.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People's relatives commented positively on the service. They said they felt their family member was safe and well looked after. One commented they felt comfortable to visit less as they knew their family member was 'in good hands.'

We looked at the administration of medication during our review of Ashfield in January 2014. At that time we identified concerns in relation to prescribed medicines and medication records and a Compliance Action was issued.

At this inspection we found that concerns regarding medicines had been acted upon and the provider was now meeting this standard.

As part of our review we looked at medicine records for 13 people, medicine supplies and care plans.

Most of the people who used this service had their medicines given to them by the staff. We watched a member of staff giving people their medicines. They followed safe practices and treated people respectfully. People were given the time they needed to take their medicines. Arrangements were in place for people who liked to have their medicines earlier than the normal medication administration time and arrangements were in place to help ensure special instructions such as 'before food' were followed.

People we spoke with said they were comfortable in the home. They said it was clean and they had a nice room. Comments included: 'I have a lovely room.' and 'They keep on top of everything, decorating, new carpets, it's always nice.'

We carried out observations throughout the home and noted several areas which were not safe. For example, the conservatory was very warm in the morning even with the door open, there was no fan available to keep people cool. There was a pile of items including books on the floor which were a trip hazard.

On the first floor we saw there was a step in the middle of the corridor, this was not clearly visible and could present a hazard to people with poor eyesight. There was also a frayed carpet which the provider said was being replaced, however, we were unable to see documentation confirming this.

We looked in several bedrooms and found in three bedrooms on the first floor the windows did not have 'window restrictors' so could be fully opened. The risk to people had not been formally assessed so we could not be sure people were safe.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. (DoLs). The Registered Manager did not think anyone in the home was at risk of having their liberty deprived but agreed to review this in light of new national guidance that is currently available.

Is the service effective?

The majority of staff told us they received good training and were kept up to date. They said they got regular updates as needed. Staff spoke highly of their induction training and said it had prepared them well for their role. They said they had opportunity to work alongside senior staff during their induction and get to know how to carry out their job properly. They also said they had plenty of time to get to know the needs of the people who used the service. They said they were able to go through people's care records and become familiar with how the records worked. One staff member did not feel they got enough support when they first started work at the home. They said they did not have enough time to get to know how to care for people who used the service.

Some staff said they had received training in dementia awareness and others said they knew they had this training coming up. Staff were able to describe how their training had influenced their practice and the care they gave. They spoke of the need for clear, consistent communication and how they treated people as individuals.

We noted only four out of twenty four staff had completed training on the MCA and DoLS. The training administrator said there was an on-line course available for staff and she was in the process of allocating time slots to staff to ensure this was completed by all staff.

People who used the service or their relatives said they were involved in the development and on-going review of their care plans and risk assessments. They spoke about how staff discussed their care records with them and documented any changes. Relatives of people who used the service said they were always kept up to date on the welfare of their family member. People who used the service said they felt involved in decisions about their care. One said, 'They are always there to give the help you ask for.

Is the service caring?

People who lived in the home said they were pleased with the care and support they received. They said they were happy living at the home and all the staff were kind and caring. Comments included: 'It's all very nice here; a very good service.' 'You get all the help you need.' 'Can't fault them, they are giving all the time, work flat out and they are so patient with everyone.'

All the relatives we spoke with commented on how kind and patient the staff were. Other comments we received included: 'Staff are amazing and so kind.' '(name of person) always likes to wear a hat and staff make sure he has one every day.' 'Mum is always well presented and I feel she is well regarded by all the staff.'

We observed during lunch and found it to be a very pleasant and sociable experience. Staff were attentive to people's needs and were interacting with people whilst serving them their lunch. People were given choice and explanations of food. People who needed assistance were offered it in a sensitive way that met their individual needs.

Is the service responsive?

We asked people who used the service if staff responded promptly when they used their call bells. Everyone we spoke with said staff were always prompt and they never had to wait long when they needed assistance from staff. One person said it was common to wait a bit longer for assistance at busy times such as meal times and added that they thought the home would benefit from more staff at these times.

People who used the service said they had enough to do. They said they enjoyed the activities in the home. We sat in on the morning activities and could see people were occupied and joining in at their own pace and choice. There was a lively positive atmosphere.

Is the service well led?

Staff and people who used the service told us they thought the home was well managed and they had confidence in the Registered Manager and Provider. Staff said the Registered Manager and Provider were approachable and kept them informed of issues affecting the home.

However, two staff told us they were not always confident that issues brought to the Registered Manager were acted upon, for example, length of staff breaks, errors made with medication. We saw in staff meeting minutes that medication errors had been discussed and the Registered Manager had highlighted where improvements needed to be made.

We looked at records of staff meetings that had been held recently. These showed staff were given the opportunity to get together to discuss feedback from people who used the service and/or their representatives, care and support issues and any information updates from the organisation.

Below is a summary of what we found. The summary is based on speaking with people who used the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People were protected against the risks of unsafe or inappropriate care arising from a lack of proper information. The provider had introduced a record keeping policy which outlined responsibilities for the staff team. The registered manager had provided individual training to a number of staff to ensure they understood their responsibilities and what was expected in relation to records. Care records contained appropriate information in relation to people's care and treatment. Staff told us they recorded significant events or incidents and ensured these were followed up where appropriate.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them.

We identified a number of concerns about records which did not protect people against the risks of inappropriate or unsafe care arising from a lack of proper information in relation to the care and treatment provided.

The home was clean and free from any malodours. We looked at several bedrooms and saw generally they were cleaned to a good standard and there was a plentiful supply of personal protective equipment (P.P.E). Some additional cleaning should be carried out to maintain cleanliness.

We spoke with ten people who used the service, six relatives and nine members of staff. People said they thought the home had a, 'Family atmosphere' and 'The staff are caring, sensitive, and pleasant.' Staff interacted well with people, constantly chatting with them and encouraging them to do as much for themselves as possible.

The relatives we spoke with confirmed that care plans had also been discussed with them and were regularly reviewed. One relative said, 'On admission the staff asked what my mother liked and disliked so they could care for her in a more personal way." We looked at four care plans. Daily living and risk assessments had been completed. Instructions on the provision of care were clearly documented, however information about people's care was not always fully recorded.

Staff were aware of how to keep people safe and knew when and how they should report any concerns. They were confident that the provider would deal with any safeguarding concerns they might have.

Some areas of the home were not kept sufficiently clean and arrangements to reduce the risk and spread of infection required improvement.

Appropriate arrangements were in place to ensure that people always had access to their prescribed medication. Medicines were kept safely but some records were incomplete.

The provider had appropriate procedures for the recruitment of new staff and satisfactory checks were undertaken before they began work.

The provider had some systems in place to assess and monitor the quality of service that people received.

People's personal records including medical records were not always kept up to date.

The registered manager had improved monitoring and assessment of the quality of care at the home. The senior staff and nurses now met monthly to review the standards of care. Accidents and incidents were recorded and appropriate changes made to care plans to help keep people safe from harm. Comments made by people who used the service or their relatives were reviewed and acted upon.

We saw evidence that the staff were aware of peoples' individual needs. Each person had a personalised care plan, although the care plans we looked at were not all kept up to date. We observed some good examples of interactions between staff and people who used the service. We saw one member of staff sitting with a resident talking about the places she knew and looking at a map pointing out the various places in the area. However, overall staff interaction with individual residents was limited and primarily in response to meeting immediate needs.

We checked the standard of cleaning and procedures to control the risk of infection. We found several areas of the home which were not kept sufficiently clean. The manager had introduced procedures to monitor standards of care and cleanliness and carried out regular audits. However, we found these were ineffective, issues such as the inappropriate disposal of waste items, decontamination of sanitary ware and the cleaning and tidying of people's rooms were identified in the cleaning audits and staff had failed to respond to reminders from the manager.