Ashton Manor Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment, particularly around the environment and infection control.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were clearly recorded, actioned, reviewed and signed off by management. Information entered onto the electronic system triggered follow up action. For example, if related to a fall, post fall checks were triggered. This helped ensure that all appropriate actions had been taken by staff in response to the accident or incident.

Lessons learnt and information sharing was done through individual and group supervisions as well as during handovers. The registered manager told us, “We do a lot of reflective practice. We recently had 2 medication errors and we addressed this through reflection and workshops for nurses. In this situation we met with the pharmacist and reviewed the information we each viewed on our systems. This enabled us to come up with an action plan to help ensure it didn’t happen again.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service used an electronic care planning system to enter information about people transitioning from home or hospital into Ashton Manor. The registered manager told us, “Last year we changed our electronic system. One of the reasons was because we were having to re-enter a lot of information. Now from the moment we get an enquiry we start populating the information about the person. We will speak to the hospital if someone is coming from there so we can gather as much information about the person as possible. We also have ‘Connected Care’ which means we can see a person’s medical history and prescriptions, etc. This all helps to make sure the person is not being asked for the same information several times.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The registered manager worked with the local authority safeguarding team to investigation any potential allegations of abuse. The registered manager told us, “We had a safeguarding raised against us recently and we have been asked to provide evidence. We also raised a safeguarding concern for the recent medication errors and we’ve told the local authority what measures we’ve put in place.”

Staff received safeguarding training on induction. This helped ensure they knew how to recognise signs of abuse and report appropriately. A staff member said, “I would document anything and mark it on a body map if it was related to bruising or redness. I would report it to the senior and also raise it during the handover.”

A healthcare professional had no concerns about the service, telling us, “You see occasional bruising (due to people’s frail skin), but there are no concerning patterns.” A relative commented, “None of us have seen anything untoward.”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found the service was meeting the principles of the MCA.

The provider did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We received positive feedback from relatives who told us they felt their family member was safe living at Ashton Manor. However, we found information and actions by staff did not always ensure they were considering the needs to people consistently. We found 2 people on pressure-relieving airflow mattresses set to incorrect weights. One person’s was set at 110kg despite them weighing 72kg. Another person’s (who weighed 60kg) was set at almost 150kg. We showed this to the deputy manager who commented, “It shouldn’t be that. [Person] isn’t that heavy. Could that be why it was beeping?” Setting an airflow mattress correctly is critical to prevent or treat pressure areas which 1 person had.

At lunchtime, although 1 person was recorded as requiring supervision when eating, we did not see this happen. Despite staff being in and out of the room, no staff member consistently monitored the person and we were aware of them coughing a lot when eating.We also found more than 1 person recorded as being at risk of constipation who did not have an associated risk assessment. Risk assessments are important to ensure staff have clear guidance on the monitoring and actions required where people may not have opened their bowels for several days.

There were however risk assessments and safety information available in other people’s care plans and during moving and handling tasks, staff consistently followed safe practices. Both helped ensure staff understood what a person needed to help prevent them from being harmed. Relatives had no concerns, telling us, “He’s never had any hospital admissions and I’ve never found bruises on him” and “I am happy with the care she is getting and don’t have any safety concerns.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service was checked for its safety. This included testing the water and electrical items. There was a contingency plan in place and overall the building was safe. However, we identified several maintenance concerns. Some areas required repair or general upkeep, as they appeared tired, outdated, and worn. In addition, where maintenance and repairs had been carried out, the quality was often poor, with ill-fitting finishes. This lack of high-quality maintenance added to the overall impression of a building in need of refurbishment. Relatives shared similar views, with one commenting, “It’s just a shame that the home looks so old and needs to be worked on.”

Staff received fire training to help ensure they understood what they needed to in the event of a fire. A staff member told us, “We move to the car park or the church hall, but first of all everyone (staff) goes to reception and the fire warden will instruct. Each person has information about how many staff or what equipment they need to safely evacuate.”

Although the provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development staff deployment needed to be reviewed.

Staff were present throughout the visit, but their presence was inconsistent. At lunchtime (from 12:30) although several staff were assisting, there was poor coordination, and some people did not receive the support they needed. One person (who was losing weight) was prompted by multiple staff, but no one stayed to support them to eat. Although we were told this happened later, by this time their food would have been cold. Two other people waited nearly 20 minutes for their meals because they required assistance, leaving them watching others eat.

Lunchtime lacked a clear system with no one overseeing consistent support. In the lounge, 3 people struggled with their starter without staff support. As a result, 1 person spat the food into their clothing. At one point, 1 person had 2 drinks, a starter, and a main meal placed in front of them without adequate support. By 12:46, 1 person had still not started eating, and by 13:00, despite receiving their meal, another had not eaten anything. At no time did staff sit with these individuals to provide sustained support, instead offering only brief prompts while moving in and out. We also observed some staff taking their breaks when lunch was being served, which meant there were fewer staff available at mealtime to support people effectively. A staff member said, “Supper is allocated but not lunch as staff also have to have their breaks.”

We received mixed views on staffing levels from people and relatives. People said, “I think there’s enough staff here. They don’t rush around”, “They never rush and I feel they’re really well trained” and “I think there is enough.” Relatives said, “I don’t have any concerns, but they’re not always around when you actually need them” and “There are a lot of staff but they can’t be everywhere at once. They are always helpful.”

Staff gave equally mixed views, telling us, “Some days it’s harder than others. It goes down to 5 carers in the afternoon and a lot of people need 2 staff to transfer them”, “There were staffing level issues last year, but now we have a good number of staff”, “We have enough staff to respond to call bells in a timely manner”, “There are less carers in the afternoon. I find in the afternoon it impacts me as I’m waiting for staff to come and help. I will work until 18:00 because of this” and “We just get stuck in. We don’t have specific allocations at lunch. It would be better if it didn’t go down in the afternoon as sometimes it can be really busy.”

New staff were recruited through a robust process which meant they provided references from their previous role, a full employment history and their right to work in the UK. Once recruited, staff were allocated a mentor and they commenced a 4-week induction period where they shadowed more experienced staff and completed their training. Staff had the opportunity to meet with their line manager on a 1:1 basis every other month and through annual appraisals. Staff said the training they received prepared them for the role. Telling us, “The training is really good. We have face to face and e-learning training and we get prompts when it’s about to expire”, “I have had several training modules and I understand the importance of good skin integrity” and “We have enough in person and online training. I can always reach out if I wanted more training.”

The provider did not assess or manage the risk of infection effectively. While some people and relatives said that rooms and communal areas were clean and tidy, and staff were observed using personal protective equipment (PPE) appropriately in the dining room, there were gaps in practice.

Some bedrooms and bathrooms were very poorly maintained, with issues such as rusted radiator covers, peeling sealant around the base of toilets, exposed materials such as wood, and inadequate storage. We observed continence pads frequently stored out of their packaging and exposed to the air. Some equipment such as a pressure cushion, shower chair, toilet frame, as well as a thermometer were found to be worn, damaged, or unclean. In addition, some areas were cluttered or unhygienic, and 2 rooms had strong urine odours. This indicated that infection risks were not consistently identified or controlled and thorough cleaning would be difficult and potentially ineffective. This demonstrated a failure to maintain appropriate infection prevention and control standards, placing people at an increased and avoidable risk of harm. We did, however, observe staff taking PPE and wearing it when they entered the dining room and change their PPE if they left the room and returned during lunchtime and people reported they were happy with the cleanliness. Comments received included, “My room is nice and clean”, “Dad’s room, including the shower and all communal areas are always clean and tidy” and “The whole home and mum’s room is kept very clean and tidy.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received the medicines they were prescribed. Each person had a medicine administration record (MAR) which was completed by the nurse when administering the medicines to people. We found the MARs were completed accurately with no gaps and we observed the nurse administering medicines in an unhurried way.

Staff used a robust system for ordering repeat prescriptions for people and as well for disposing of unused medicines. Regular audits were completed to check stock counts and to review people’s MARs for their accuracy.

Only trained and competency assessed staff dispensed medicines which helped ensure that practices were safe.