We carried out a review of the data available to us about Ashley Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashley Care Centre, you can give feedback on this service.
Ashley Care Centre is a care home providing personal and nursing care for 40 people, at the time of the inspection. The service can support up to 49 people in one adapted building across three units.
People’s experience of using this service and what we found
Infection control practices were consistent, and we were assured the provider was following government guidance in relation to protecting people from COVID-19. Following a recent infection control audit the registered manager developed an action plan which demonstrated clear timescales and who was responsible. Some of the furniture required replacing for it to be cleaned effectively, the registered manager was in the process of having these items replaced
People were kept safe and there were suffcient staff to provide support to meet their needs. People were protected from the risk of harm and staff were aware of how to recognise potential abuse and how to act to keep people safe. People received their prescribed medicines safely. Staff had been recruited safely and had received training in order to support people safely.
Systems were in place to assess and monitor the quality of the service. People told us they felt their views were listened to in order to improve the service. Staff worked in partnership with other health and social care professionals to ensure people received the care they needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 19 March 2021) and there were multiple breaches of regualtion.The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 21 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashley Care Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
About the service
Ashley Care Centre is a care home service with nursing, providing personal and nursing care to 43 people aged 65 and over at the time of the inspection. The service can support up to 49 people.
The care home has three units. On each unit people have their own bedroom and can choose to spend time in the communal lounge and dining area within that unit. There are communal bathrooms and toilets on each unit with a main kitchen and laundry.
People’s experience of using this service and what we found
Records of care provision for pressure relief and continence care showed they were not always being provided as often as people’s care plans stated they should be. This put people at an increased risk of developing pressure sores. Some areas of risk had not been identified or risk assessed, and some care plans lacked information.
Infection control practices were inconsistent and while people had been supported to isolate and staff had been cohorted. Basic hygiene practices during lunchtime were not implemented. Staffing levels had been maintained during the COVID-19 outbreak by using regular agency staff and the registered manager had worked alongside staff to provide direct care to people when needed.
The registered manager monitored the service through communicating regularly with people, staff and relatives. Management meetings helped to review the service and identify changes in people’s needs. However, these did not always pick up on the daily provision of care and look at whether this was being met.
The service had recently had an outbreak of COVID-19. The registered manager and staff acknowledged this had been a difficult time which had impacted on care provision and record keeping. Feedback from relatives was very positive about staff’s approach with people and how they were kept informed. The service had worked closely with external professionals to help monitor people’s health and gain advice and support in relation to managing the service during COVID-19.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 7 January 2020) and identified two breaches of regulation. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.
At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
The inspection was prompted in part due to concerns received about infection control, moving and handling, personal care, pressure care, support with nutrition and the care of people with COVID-19. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service remains the same. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashley Care Centre on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service and what we found
Although we found some areas for improvement during our inspection of Ashley Care Centre, overall, people had a positive experience at the home.
People were not always protected from environmental risks and risks associated with people’s care and support were not managed in a consistently safe way. The home was not clean and hygienic in all areas. The management team told us immediate action would be taken to address these issues. People told us they felt safe. Staff and the management team had a good understanding of safeguarding adults’ procedures to protect people from harm. Staff were recruited safely and there were enough staff to meet people’s needs and ensure their safety. People received their medicines as required.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were knowledgeable and had a wide range of training. People had enough to eat and drink. People had access to healthcare when they needed it, and advice was sought from specialist health professionals.
People were supported by staff who were kind and caring, staff knew people well and people were involved in making decisions about their care. People were treated with dignity and respect and their right to privacy was upheld.
The people received personalised care that was flexible to meet their needs. People had opportunities to get involved in meaningful activities within the home and in the community and their diverse needs were met. There were systems in place to respond to complaints and concerns. People were provided with caring and compassionate support at the end of their lives.
Systems to ensure the safety and quality of the service were not fully effective. This had resulted in risks to people’s health and wellbeing not being identified or addressed. The management team were responsive to feedback and took action to address issues identified. The provider had not notified us of all events within the home, as legally required. The management team and staff were passionate about providing high quality, person centred care and there was positive partnership working with health professionals. Feedback from people, families and staff was used to drive improvement.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (report published 22 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in the legal regulation related to safe care and treatment. Please see the action we have told the provider to take at the end of this report. In addition, we found a breach in relation to the providers failure to notify of events as legally required. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection, in June 2015, the service was rated Good. At this inspection we found that the service remained Good. However, the rating for the Effective domain has changed from Good to Requires Improvement.
People continued to receive safe care. Safe staff recruitment processes were in place and people were protected from the risk of harm. Enough staff were in place to provide care and support to people to meet their needs. Safe medicine management processes were in place and people received their prescribed medicines safely.
Since our last inspection we found improvements were needed to the way the principles of the Mental Capacity Act 2005 (MCA) were used when decisions were made for people. People were supported to lead a healthy lifestyle. Records used to record current risks for some people in relation to their nutritional needs required updating. Staff were well trained and understood how to provide effective care and support for people. Staff received regular supervision of their work and were encouraged to develop their roles through gaining relevant external qualifications. Effective relationships were in place with external health and social care professionals to support people with their day to day health needs.
People were treated with kindness, dignity and respect by the staff. People had developed positive relationships with staff which contributed to a positive atmosphere within the home. People’s care records were detailed and personalised which enabled staff to support people in line with their personal preferences. People felt able to make a complaint if they needed and were confident any concerns raised would be acted on. Effective systems were in place to manage any complaints that the provider may receive.
The service continued to be well-led. The registered manager, new to the role since the last inspection and their clinical lead, managed the home enthusiastically and professionally. People, relatives, staff and professionals commented positively about their leadership. There was a positive ethos and an open culture at the home resulting in an enjoyable working environment for staff and a calm and friendly atmosphere for people living there. Effective auditing processes were in place.
We carried out an unannounced inspection of the service on 25 June 2015. Ashley Care Centre provides accommodation for persons who require nursing or personal care, diagnostic and screening procedures and the treatment of disease, disorder or injury for up to 49 people. On the day of our inspection 47 people were using the service and there was a registered manager in place.
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.
At our previous inspection on 18 and 21 July 2014 we asked the provider to take action to make improvements to the areas of care and welfare of people who use services and cleanliness and infection control. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made.
The risk to people experiencing abuse at the home was reduced because staff had received training on safeguarding of adults, could identify the different types of abuse and knew who to report concerns to. Accidents and incidents were investigated and then plans were put in place to reduce the risk people’s safety. Personal emergency evacuation plans were now in place for all people and these were regularly reviewed. There were enough staff with the right skills and experience to meet people’s needs. Medicines were stored, administered and handled safely. Protocols for the administration of ‘as needed’ medicines were in place for the majority of people who needed them, although there were a small number of examples where they were not. There were clear processes in place to reduce the risk of the spread of infection.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately.
People were supported by staff who had received the appropriate training to support people effectively. People spoke positively about the food they received and staff supported and provided specially adapted equipment for people who wished to eat and drink independently. People’s food and fluid intake was monitored and where a risk of a person becoming dehydrated or losing or gaining weight was identified, guidance to manage this effectively was requested from dieticians. People had regular access to their GP and other health care professionals.
People were supported by staff who were caring and treated them with kindness, respect and dignity. Staff spoke respectfully about people. Where people showed signs of distress or discomfort, staff responded to them quickly. Staff listened to people and made them feel that they mattered. People were supported to access an independent advocate if they wanted to, although the information provided needed to be more accessible for people. There were no restrictions on friends and relatives visiting their family members. People could have privacy when needed and there was sufficient space for people be alone if they wanted to be.
People and their relatives were involved with the planning of the care and support provided. Care plans were written in a way that focused on people’s choices and preferences. Adjustments had been made to the service to support people living with dementia. Regular monitoring of people’s assessed needs was conducted to ensure staff responded appropriately. People were able to access the activities and hobbies that interested them. A new mini bus had been purchased to improve people’s ability to undertake activities outside of the home. A complaints procedure was in place, although information about who to report concerns to externally was not always provided.
There was a positive atmosphere within the home and people were encouraged to contribute to decisions to improve and develop the service. Staff understood the values and aims of the service and were aware of how they could contribute to reduce the risk to people’s health and safety. There was a strong registered manager in place who led the service well. People spoke highly of them. The registered manager had clear processes in place to manage the risks to people and the service. They continually used guidance from external professionals and other managers of local adult social care services to improve the quality of the service people received. Robust auditing and quality monitoring processes were in place.
Throughout this inspection we focused on these five key questions; Is the service safe, effective, caring, responsive and well-led?
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We asked people who used the service and their relatives if they felt their or their family member's needs were met by the staff and whether they or their family member were safe living at the home. One person who used the service said, 'I am safe living here. The staff know what I say is what I want and they respect that.' A relative we spoke with said, 'My family member is clean, well presented, not losing weight anymore and taking their medication. They are much safer there than at home.'
Care plans showed there were procedures in place to assist staff should a person experience a seizure as a result of high or low blood glucose levels. These are known as a hypoglycaemic or hyperglycaemic attack.
The home was clean and tidy although there were limited facilities for visitors to wash their hands. Specialised equipment such as wheelchairs and stand aids were stored in a communal toilet which could pose a risk of the spread of infection.
There was not currently an infection control lead within the home and domestic staff did not have a cleaning schedule with them when completing their tasks which could increase the risk of part of their cleaning duties not being completed.
The registered manager showed us the documentation for two people for whom they had applied for a Deprivation of liberty safeguards (DoLS). The paperwork had been completed appropriately. The registered manager also told us they planned to review the current needs of all of the people who used the service to establish whether a DoLS was required for them and submit the relevant applications to the assessing authority where appropriate. Correctly applied DoLS make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that care homes only deprive someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.
Is the service effective?
We saw a person had been assessed as posing a risk to their or the safety others due to their challenging behaviour. One to one care had been allocated for this person to reduce this risk. We observed this care throughout the inspection and the staff were effective in ensuring the person received the appropriate support that met their needs.
People received a balanced diet. People's weight and food and fluid intake was monitored where appropriate. We saw evidence that the home, when required, had appropriately sought advice from a dietician.
Staff received regular assessment of their work. Staff interacted well with people who used the service and were knowledgeable about their needs.
Is the service caring?
The majority of staff provided care in a supportive, safe and caring way. However we did see one member of staff provide a poor level of care. We observed this member of staff transport a person who used the service from one lounge to another in a transportable chair in a way that was inappropriate.
Is the service responsive?
We observed staff respond to people's needs in a timely manner. We saw people were treated with respect and dignity and staff took time to sit and talk to people.
Where people required further support such as assistance with eating their meals, this was provided. Staff responded to nursing call bells in a timely manner throughout the inspection.
Is the service well-led?
The home has a registered and general manager. The registered manager, who is also a registered nurse, manages the clinical side of the service. The general manager manages other aspects of the service such as the ordering of stock and ensuring staff are appropriately trained.
The registered manager had procedures in place to regularly assess and monitor the quality of the service people received. They liaised on a monthly basis with the local authority providing information to them about the current status of the service.
People's views were welcomed. A questionnaire for 2014 had been completed and the results were due to be analysed.
The registered manager had identified an area of concern regarding documentation within some care plans. Some care plans did not have the required paperwork regarding a decision not to resuscitate a person. The registered manager was addressing this issue.
People spoke positively about the management team. A person who used the service told us, 'The manager is great; they are easy to talk to.' A relative we spoke with said, 'The manager is doing a good job.' Another relative said, 'I quite like the manager, they were supportive when I needed it.' A staff member said, 'Both of the managers are approachable, I have no problem with them.' However another staff member said, 'The general manager does not always respond to things as quickly as I would like them to.'
People we spoke with told us that staff gained their consent before providing care and treatment. A relative of a person who used the service told us, 'I am involved; I have seen my family member's care plan. I always have a good chat with the staff. I am kept up to date with what is happening.'
We saw that the food and drink provided met people's needs. A relative told us, 'My family member is a vegetarian; there is always a good vegetarian option available.'
There were enough qualified, skilled and experienced staff to meet people's needs. A person who used the service told us, 'I am never left alone for long, they (staff) always come when I need them.'
We saw there was an effective complaints system available. A person who used the service told us, 'I have never had to complain but do know how to if I need to.'
We looked at records, including personal care plans. We spoke with four people who were visiting the home. We also spoke to the manager and staff who were supporting people, and we observed how they provided that support.
We also knew that the Nottinghamshire County Local Involvement Network (LINk) undertook a visit to the home on 30 April 2012. The overall outcome of the visit was positive and comments made in their report ranged from, 'It is good practice that the staff all appear to take time to sit, talk and listen to residents as part of their duties.' to, 'There are named Dignity Champions although all staff have had Dignity in Care training. The Dignity of the Residents seems to be a matter of huge importance at this home.'
During our visit we saw that staff supported people in a respectful and dignified way, and that they closely followed the care that was set out in people's plans.
We spoke with a community support worker who was visiting one person at the home. The support worker told us, 'We visit regularly to support the person to go to church and maintain local community contacts.'
A relative who was visiting the home told us, 'I have seen a real change for the better in my family members' health and condition since I last came over.'
We saw that people were given support to make choices and decisions for themselves when they needed help to do this, and staff clearly understood each person's way of communicating their needs and choices.