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Archived: Ashwood Nursing Home - Etchingham Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 24 June 2015

We inspected Ashwood Nursing Home on 6 and 10 March 2015. The inspection was unannounced. Ashwood Nursing Home is registered for 19 people. There were 9 people living at the home when we inspected. People cared for were all older people. They were living with a range of complex needs, including diabetes, stroke and heart conditions. Many people needed support with their personal care, eating and drinking and mobility needs. Some people were also living with dementia. The manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.

Ashwood Nursing home is a large house, which has been extended. There was a lounge dining room on the ground floor. Bedrooms were provided on both the ground and first floor. There was a passenger lift between the floors. There was a main bathroom and other toilets available for people to use where bedrooms were not ensuite. There was a garden to one side and back of the home. At least one of the unoccupied bedrooms on the first floor was being used for staff accommodation

There was a registered manager in post. The registered manager was also the owner of the home. A registered manager is a person who has registered with the CQC to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The home was last inspected on 6 August 2014. At that inspection, we found the home had not met essential standards relating to safety and suitability of the premises, recruitment of staff, staffing numbers and records. We asked the provider to make improvements. An action plan was received which stated the provider would be meeting the regulations by January 2015. At this inspection, although some improvements had been made, people remained at significant risk. This was because we identified a number of areas of practice which potentially placed people at risk of receiving inappropriate care and support. Risks had not been identified through the manager’s auditing or quality assurance.

The manager’s quality assurance framework was not effective. This meant there was a potential risk across a range of areas, including fire safety, supporting people in moving safely and assessments of appropriate staffing levels at night. Audit processes had also not identified and ensured action was taken to ensure staff were following care plans or updating them if they were no longer what the person needed. Audits had not identified lack of cleanliness and that the home’s medicines policy was not being followed in certain areas.

As at the last inspection, issues were identified in relation to record-keeping. We continue to have concerns. Records were not consistently maintained. This included no records of concerns and complaints raised by people and a lack or records where people may show behaviours which needed support. By not having effective record-keeping systems the home was not following guidelines on record keeping by external bodies such as the Nursing and Midwifery Council (NMC).

People’s complex needs were not always planned for and delivered effectively. This included the prevention of pressure ulcers, supporting people who were living with dementia and diabetic care and treatment. People’s social needs were not assessed and information in their care plans was limited. There was no regular provision of appropriate activities for people.

Medicine management was not consistently safe. We saw a range of errors on the medicines administration records. People’s own prescribed skin creams were not being used for them. Systems were not in place to ensure prescribed skin creams were administered in the way intended by the prescriber.

The manager had not followed their own or external guidelines on reporting occasions where a person may have been subject to abuse. Staff had not been trained on Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were not aware of their responsibilities in these areas. This included assessment of people’s mental capacity, the making of best interests decisions and consideration of whether some aspects of care might be restricting a person’s liberty.

Staff did not have the knowledge and skills in a range of areas to ensure they could meet people’s needs safely. This included ensuring people were correctly supported to move and meeting the needs of people living with dementia. Action had not been taken to appropriately support staff whose first language was not English.

Staff did not always show a caring approach to people and ensure their dignity was respected. This included when they responded to people living with dementia, ensuring privacy in their rooms was respected and supporting them in making choices about meals. People who were living with a disability did not always have the support they needed to eat independently.

Improvements had been made in relation to recruitment of staff, but some areas still needed to be addressed. This included ensuring all staff had two references on file and evidence staff were appropriately supervised on commencement into their role.

We received mixed responses to how people fedback on the quality of the service. Some people were not clear on feedback systems. Other people said the manager was approachable and always ready to receive feedback.

A maintenance log had been set up since the last inspection. This was being used by staff to identify areas for attention. People commented particularly on the improvements in the home environment. Systems were in place in relation to other maintenance, such as checks on hot water temperatures and fire extinguisher servicing.

The registered nurse who gave out medicines did this in a safe way. They supported people throughout the time they were taking their medicines and promptly signed for the medicines they gave out.

People were positive about the meals. Meals were attractively presented and people ate them with obvious enjoyment.

People and staff reported there were enough staff on day duty to meet their needs. This included enough staff to ensure a prompt response time when people used their call bell.

Some staff offered people choice, for example about what they wanted to drink and if they wanted to go into the garden. They explained carefully to people how they were going to support them and all staff were consistently polite and kindly when they did talk to people. Staff ensured people’s privacy at certain times, such as when they were using the toilet.

Staff told us they felt the whole staff team was supportive of each other. They gave us positive comments about the manager and said they listened to them and took action when they raised issues.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to 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 this report.

Inspection areas

Safe

Inadequate

Updated 24 June 2015

The service was not safe.

People were not protected against potential risks relating to fire safety and moving and handling. Where people may have sustained harm or been subject to neglect, the local safeguarding team had not been informed. The systems for ensuring people were administered their medicines were not safe.

Not all previous shortfalls regarding recruitment had been addressed.

People felt there were sufficient staff on day duty to meet people’s needs however, assessments had not been made about the safety of staffing levels at night.

Effective

Inadequate

Updated 24 June 2015

The service was not consistently effective.

Staff did not have the knowledge and skills to provide effective care. There was a lack of mental capacity assessments, best interests’ decisions and consideration of the Deprivation of Liberties Safeguards where people lacked capacity.

However, some health care needs were supported effectively. People commented favourably on the meals and staff provided frailer people with the support they needed to eat and drink.

Caring

Inadequate

Updated 24 June 2015

The service was not consistently caring.

Some people were not involved in relevant decisions about how their needs were met. People’s privacy and dignity was not consistently supported. Some systems in the home did not ensure people were involved in choices about their care.

In other areas staff were caring and people were involved in making decisions about their care. We saw some staff were kind and gentle with people, supporting them in an approachable manner.

Responsive

Inadequate

Updated 24 June 2015

The service was not responsive.

People’s needs were not consistently responded to when delivering care or in care plans to meet their individual care and support needs. This included people’s needs for activities, as well as complex nursing and treatment needs.

Some people felt they were not always listened to if they raised complaints. Issues raised by people were not documented so the manager could not ensure matters had been consistently addressed to people’s satisfaction.

Well-led

Inadequate

Updated 24 June 2015

The service was not well-led

The manager’s systems for quality audits did not identify all relevant areas so action was not taken to address them. The manager did not ensure the staff followed relevant guidelines. Relevant records were not being completed in all cases.

The systems for feedback from people were variable.

Several people and staff commented favourably on the manager. Many staff commented positively on the culture of the home.