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Archived: Ashlands Inadequate


Inspection carried out on 11 July 2016

During a routine inspection

This was an unannounced inspection carried out on 11, 25 July and 5 August 2016.

At the last inspection on 22 and 24 September 2015 we rated the service as overall ‘Inadequate’ and in ‘Special Measures’.

At the last inspection we identified seven regulatory breaches which related to dignity and respect, medication, person-centred care, meeting nutritional needs, good governance and the deployment of staff. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and the registered provider voluntarily suspended accepting new placements. Following this inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Ashlands is registered to accommodate up to 44 older people, most of whom have mental health and/or dementia related conditions.

At the time of our inspection the service had a registered manager in place. 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.

Although we found some improvements had been made in respect of privacy and dignity, we found a number of continued breaches in safe care and treatment, staffing, person-centred care, meeting nutritional needs and good governance. We also found a breach relating to premises and equipment.

Relatives and staff told us they thought people living in the home were safe and protected from abuse. Safeguarding notifications had been made to the CQC as required. Appropriate recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people.

We found medicines were not managed safely as medicines were not check in to the home, stored and disposed of appropriately. People did not always receive their medicines on time and there were occasions when medicines were not given as prescribed. The use of topical creams was not robustly recorded. Medication competency was not checked for agency nursing staff.

Staff were uncertain how many people lived in the home and we found different instructions for staff to follow in the event of a fire. The registered manager had not responded to an identified need for further staff training in fire safety. Personal emergency evacuation plans (PEEPs) were in place, although staff were not aware they existed or where they could find them. Wall lights did not have covers fitted meaning people were at risk of harm as the exposed wires were live.

Staffing levels were calculated based on numbers of people in the home and there was no assessment based on level of dependency. On occasions, door sensors were seen to be unanswered or cancelled by staff who did not carry out appropriate checks to ensure people’s needs were met. Staff told us they felt more staff were needed.

The staff training matrix showed high levels of training had been completed. A programme of staff supervisions had commenced, although no staff appraisals had been completed.

The recording of people’s fluid intake was not consistently completed and we saw the quality of support people received from staff at lunchtime was variable.

People did not always receive timely access to healthcare. Healthcare professionals gave mixed feedback about this service.

People were more appropriately dressed since our last inspection and their preferences regarding when to go to bed were respected. However, not all people wore appropriate footwear. We noticed this had improved by the third day of our inspection. People’s privacy and dignity was observed by staff.

Care plans contained information regarding people’s likes and dislikes as well as othe

Inspection carried out on 22 & 24 September 2015

During a routine inspection

The inspection took place on 22 and 24 September 2015 and was unannounced.

We carried out an inspection in August 2013, where we found the provider was meeting all the regulations we inspected.

Ashlands is registered to accommodate up to 50 older people, most of whom have mental health and/or dementia related conditions. There were 40 people living at the home at the time of the inspection.

At the time of the inspection, the service did not have a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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. A new manager was employed in May 2015 and told us they would be applying to register within the next four to six weeks.

On both days of the inspection we saw poor care practice. There was a lack of respect for people who used the service and staff routines took priority. We observed staff members interacting with people who used the service and found these were not always positive. We did observe positive interactions from other members of staff who were caring and patient. We concluded people were not well cared for.

People were not protected against the risks associated with the administration, use and management of medicines. There was a lack of consistency in how people’s care was assessed, planned and delivered. There was only a limited range of activities provided at the home and people sometimes sat for long periods with little stimulation. We saw some people enjoyed the food but arrangements did not ensure people were supported to have a balanced diet that promoted healthy eating and met their assessed needs. There was a lack of consistency with the support people received with their health needs.

Staff had completed a range of training and told us, in the main, they felt well supported, although they had not received formal supervision and appraisal. Staff knew how to report any suspicions of abuse. There were not sufficient skilled and competent staff being deployed to meet people’s needs. The provider had effective recruitment and selection procedures in place which ensured staff were suitable and safe to work with people who lived at Ashlands.

The provider’s system to monitor and assess the quality of service provision was not effective. Actions that had been identified to improve the service were not always implemented. Staff provided positive feedback about the new manager and felt they had already made improvements to the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of 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.

Inspection carried out on 21 October 2013

During an inspection to make sure that the improvements required had been made

This was a follow up inspection to check on the action taken to address concerns identified during our previous visit in relation to poor standards of cleanliness and hygiene within the home.

We spoke with the manager about what action the home had taken to address the concerns. A number of changes had been made to improve the standards of cleanliness and hygiene within the home. This included a review of the cleaning and housekeeping staffing within the home. Some changes had been made to staff roles and responsibilities; increased cleaning staff numbers; and altered times of work to meet service demand. We spoke with a member of the cleaning staff who confirmed this.

We walked around the home and looked in particular in areas we had previously found concerns. We found the bedrooms, bathrooms and toilet areas to be clean. We saw the minutes of cleaning staff meetings included discussion of the findings of the infection control audit and plans to address the issues identified. This demonstrated the home had systems in place to maintain the improved standards of cleanliness and hygiene within the home.

Inspection carried out on 3 April 2013

During a routine inspection

All four of the relatives spoken with spoke positively about the way the staff communicated with people who lived in the home and with their families. The relatives told us the staff worked hard to meet people�s individual needs and to act in accordance with their wishes.

We found people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed three people�s care records and found them to be comprehensive and showed care and treatment was planned and delivered in a way that ensured people�s safety and welfare.

During our visit we found poor standards of cleanliness and hygiene within the home. We inspected five bedrooms and saw appropriate standards of cleanliness and hygiene had not been maintained in three of these. For example, we found sinks looked dirty and surfaces had a layer of dust which indicated it had not been cleaned for some time. We checked two foam pressure relieving mattresses and found the covers were stained and one was damaged.

People living in the home who had capacity to express their views told us they would feel able to speak to any of the staff if they had a complaint or a concern and believed they would be listened to and their concerns acted on. All four relatives spoken with were all complimentary about Ashlands and said they had no concerns or complaints at this time. One relative said: �I couldn�t fault any of it. This is perfect and I have no complaints at all.�

Reports under our old system of regulation (including those from before CQC was created)