18 October 2023
During a routine inspection
Asher Nursing Home is a nursing home which provides personal care to those with long standing, complex mental health needs. The service can support up to 17 people. At the time of our inspection, there were 14 people using the service.
People’s experience of using this service and what we found
The service was not well-led. There was no robust or effective governance system in place to ensure the service was meeting regulations. The registered manager and provider had not maintained oversight of the service to ensure that people's safety was maintained.
There was not an effective system in place to ensure the environment was safe and clean. There was a significant risk of fire at the service due to people smoking in their rooms and this had not been robustly risk assessed.
Documentation had not been maintained to an appropriate standard. Care plans and risk assessments were out of date, inaccurate or missing. People's care was not always planned or delivered in a person-centred way as staff did not have access to up to date and relevant information about people's care and support needs.
Accident and incidents were not being accurately recorded and reported. It was not clear what investigations were being done following an allegation of abuse to prevent further risk. Not all safeguarding matters had been reported to CQC, this is a legal requirement.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There was a significant lack of meaningful activity planned or taking place. This meant a condition of one person’s Deprivation of Liberty Safeguards (DoLS) was not being met.
Infection prevention and control (IPC) concerns were identified. Areas of the home were not suitably clean and this needed improvement to ensure people were safe and their dignity upheld.
Staff were not receiving regular supervision and told us that they did not always feel supported. There was a lack of consistent team meetings to allow ideas to be shared and improvements to be made to the service. Nurses had monthly meetings to specifically discuss clinical matters, however individual clinical supervision was not occurring consistently.
People told us they liked staff; we saw staff engaging with people in a kind and caring manner. The service worked with outside agencies to support people's mental health needs.
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 requires improvement (published 17 September 2021).
Why we inspected
The inspection was prompted due to concerns received about lack of reporting or investigating potential safeguarding concerns, staffing levels, nutrition and hydration, and lack of activities. A decision was made for us to inspect and examine those risks. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Asher Nursing Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment; person-centred care; safeguarding people; need for consent; and good governance at this inspection.
Please see the action we have told the provider to take at the end of this 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.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.