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Archived: Ashwood Nursing Home - Etchingham Inadequate


Inspection carried out on 6 March and 10 March 2015

During a routine inspection

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 carried out on 6 August 2014

During an inspection in response to concerns

This inspection was carried out by two inspectors. Some people at the home had complex needs and were not all able to tell us about their experiences. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with the registered manager, two members of staff, two people who used the service and two visiting relatives.

We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were up to date risk assessments in place for people that used the service which explained the risks and how these were to be minimised. This meant that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Not all areas of the home were maintained to an appropriate standard. The d�cor in parts of the home was dated and some carpets were stained and did not appear clean. Some windows on the 1st floor were not restricted and presented a risk of falling to people who used the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were significant gaps in the recruitment checks which were undertaken before some staff started working at the service. Two staff members who were working in the home did not have current criminal background checks. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

There were enough qualified, skilled and experienced staff on duty to meet people�s needs. However, we found that some staff, including the manager worked excessive hours and did not have time to carry out all aspects of their role, other than direct care and support. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We identified a number of gaps in recording which meant that staff records and other records relevant to the management of the services were not accurate and fit for purpose. This meant that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff understood when an application should be made, and how to submit one.

Is the service effective?

Relatives of people who used the service told us that they were happy with the care at the home and that people's needs were met. It was clear from what we saw and from speaking with staff that they understood people�s care and support needs and that they knew them well.

Is the service caring?

We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. For example we saw one person being hoisted in the lounge and they were gently assisted by staff and constantly reassured. We saw that people were treated as individuals and given choices about all aspects of their life. Two people told us they were happy about life in the home and said that they were well looked after during their stays for respite.

Is the service responsive?

People�s needs were continually assessed. Records confirmed people�s preferences, interests, goals and needs had been recorded and support had been provided in accordance with people�s wishes. People's needs were reviewed regularly to make sure that any changes were identified and appropriate support provided.

Is the service well-led?

The manager demonstrated a commitment to providing a person centred service. They were present in the home every day, including weekends. One member of staff told us the manager "Goes out of their way to provide extra support".

Inspection carried out on 14 October 2013

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

We spoke with six people who lived at Ashwood Nursing Home. We also spoke to seven members of staff including the manager and assistant manager. We looked at six sets of records for people who used the service, the service's policies and procedures, and six sets of personnel files.

We found that clear information about fees, contracts, terms and conditions was provided before people were admitted to the service.

People's needs were assessed before their admission and care plans were written, reviewed and updated with people's participation. One person told us, "The staff know me well, they care for me and I am very satisfied with everything they do for me here". One relative wrote, "Thank you for such excellent care you have provided to our mother".

We found that the food was prepared to a high standard. The chef told us, "We only cook with the freshest ingredients and pride ourselves on the quality of our meals. Only the peas are frozen!" A person said, "The food is always delicious".

The service had clear safeguarding policy and procedures in place, supported by appropriate staff training. People told us, "I feel safe here and I trust the staff".

When we inspected Ashwood Nursing Home in November 2012, we found a lack of scheduled one to one supervision and yearly appraisals of staff. During this inspection, we checked and found that the requested improvements had been made satisfactorily to achieve compliance with legal requirements.

Inspection carried out on 28 November 2012

During a routine inspection

There were 13 people in residence when we visited and we were able to speak with five of them about their experience of care at the home. They told us that they were very happy with the care and support they received. They spoke positively about the staff that supported them, who they found �friendly� and �very caring.�

We spoke with four relatives during our visit. They told us that they were very satisfied with the way in which their family member was treated by staff, and the support given them. They were able to share examples of the improved physical and mental wellbeing of their family members since they had come to live at the home. They told us that they liked the fact that the home did not have an "unpleasant odour," and it was very "home like."

Staff told us that they were provided with opportunities for training. They felt a strong sense of loyalty to the home and to each other and said they were very happy working there. They felt confident about talking with the provider/manager who was always available. The provider/manager told us that if a problem arose she would always make a record of this and any actions taken. However, staff meetings, supervisions and appraisals were not formalised and recorded and we have asked the provider to take action to improve this.

A relative said they were aware documentation was not a strongpoint of the home, but, this was outweighed by the positive outcomes for their family member.

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