Archived: Ashurst Place

Updated 12 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 28 and 29 June 2018 and was unannounced. Three inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We asked the provider to complete a Provider Information Return (PIR) before this inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection reports and any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law. We contacted the local authority safeguarding and commissioning teams for feedback before the inspection.

We spoke with the provider, the registered manager, six members of care staff and the cook. We looked at seven people’s support plans and the associated risk assessments and guidance. We looked at a range of other records including five staff recruitment files, the staff induction records, training and supervision schedules, staff rotas and quality assurance surveys and audits.

During our inspection we spent time with the people using the service. We observed how people were supported and the activities they were engaged in. Some people were unable to tell us about their experiences of care. 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.

Updated 12 October 2018

This inspection took place on 28 and 29 June 2018 and was unannounced.

Ashurst Place is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashurst Place is a large detached converted property, set in 23 acres of parkland and fields in the village of Langton Green, three miles from Tunbridge Wells. The home is located in a rural area where there are some shops, a church and a bus service. There are bedrooms over two floors of the service and a lift is available for people to move between the floors. The service is registered to accommodate 37 people and there were 19 people living at Ashurst Place at the time of our inspection.

At our last inspection in January 2017, the service was rated requires improvement. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that the breaches of regulation we previously found in relation to keeping care plans up to date and having effective systems to monitor the quality of the service continued. We also found seven new breaches in relation to four regulations and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report. 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

There was a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission 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.

Medicines were not being managed safely as people with PRN (as required) medicines did not have specific and detailed guidance instructions on how to administer PRN medicines. Other medicines were being administered safely to people.

Risks around possible infections were not consistently being managed with control measures. Some parts of the service were not clean and some national guidance had not been implemented. We have made a recommendation about this in our report.

People were protected from abuse by staff who understood their role in keeping people safe. The safeguarding adults policy was up to date so staff had up to date information to refer to about how to keep people safe from abuse. Staff we spoke with understood how to keep people safe from abuse.

Recruitment procedures had not consistently been followed. Some historical convictions had been risk assessed but some gaps in employment had not been explained. We have made a recommendation about this in our report.

People were at risk of not having their health needs met as care plans did not reflect their diagnoses and explain all conditions. Not all training had been delivered as per the providers’ policy. We found that some staff had not received equality and diversity training frequently enough. Other training had been sourced and provided to staff who told us that their training was effective.

Pre-admission assessments were not detailed enough and did not contain all relevant information and there was a lack of clinical monitoring tools used to check people’s skin, weight and nutrition intake. The building met people’s needs and there were extensive and well-kept grounds. Some parts of the building looked a little dated and were in need of redecoration. We have made a recommendation about this in our report.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People living at the service were deemed to have capacity to make day to day decisions.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked their staff and enjoyed their company. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible.

People received personalised care but it was not planned systematically. The care people received relied on staff verbally handing over information to each other and care plans were not person centred. People were supported in their last days and weeks to have a pain free and dignified death. However, end of life care plans did not cover areas such as how families should be supported, or personalised details such as which music people wanted to be played at their funeral.

There was a complaints policy and form, including an accessible format available to people. Complaints had been used to improve the service delivered to people.

There had not been an improvement in the quality auditing system and issues identified at this inspection were not picked up and put right by management audits. The registered manager had failed to notify us of all incidents.

There was an open and homely culture in the service and staff worked well as a team. People, their relatives and staff members were engaged in the running of the service. There was a culture of working collaboratively with other professionals and local health providers to ensure partnership working resulted in good outcomes for people.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so people, visitors and those seeking information about a service can be informed of our judgements. The provider had displayed the rating conspicuously in the service and on their website.

This is the second time the service has been rated as required improvement.