Ashton House

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 remained good. This meant people were safe and protected from avoidable harm.

The service was in breach of 1 legal regulation in relation to safeguarding.

This service scored 66 (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 promoted a proactive learning and safety culture. Safety events, accidents and incidents were appropriately reported, reviewed and investigated. Learning was identified, shared with staff and used to reduce the risk of recurrence and drive improvements in the quality and safety of care. Relatives and staff told us they were encouraged to raise concerns about people’s safety and were confident these would be listened to, investigated and acted upon.

Effective systems were in place to identify, monitor and respond to safety concerns. Accidents and incidents were analysed to identify trends, patterns and underlying causes. Learning from these events was used to inform practice and improve people’s safety. Information was consistently recorded within people’s records and shared with relevant staff, supporting staff to understand and act on learning. This helped ensure learning was embedded into practice and contributed to continuous improvement in the service.

The provider worked with people and healthcare professionals to establish and maintain systems to support safe care. Systems were in place to share important information with other services, including ambulance and hospital staff, to promote continuity and consistency of care.

People described positive transitions into the service, with staff working with people, their families and healthcare professionals to plan care around individual needs. Information gathered before admission generally supported staff to understand people’s histories, preferences and risks and contributed to personalised care. Emergency admissions were supported by hospital discharge teams, families and healthcare professionals to ensure key information was gathered promptly to inform safe care. A relative told us, “The hospital was very good and there was a medical discharge to this nursing home.”

The provider was not always able to demonstrate that restrictions on people’s liberty were necessary, proportionate or the least restrictive option. Some people had authorised Deprivation of Liberty safeguards (DoLS) because they were unable to leave the care home without assistance. However, the extensive use of keypad-operated internal doors to segregate areas of the home significantly restricted people’s movement and independence inside the care home. This included people who did not require a locked environment and those who only required external doors to be secured for their safety. Some people had risk assessments in place for their risk of ‘absconding due to their cognitive decline’. The risk was mitigated by locked doors in corridors however there was no evidence these measures had been assessed to determine whether it amounted to a deprivation of liberty.

People were unable to move freely between areas of the care home, and most areas did not provide unrestricted access to outside spaces. One person told us, “You are restricted, but that's their regulations, so I have no choice but to follow them.” More than 1 person told us they could not access the garden independently despite wanting to. People described the impact of these restrictions, telling us, “You feel trapped like a prisoner,” And “I can’t go into the garden,because I don’t know the keycode.” As a result of these restrictions people’s freedom, autonomy and independence were not always promoted.

Safeguarding training was completed by new staff during induction and there was a system to ensure staff undertook refresher training. Staff demonstrated an awareness of the signs indicating a person might be vulnerable to, or experiencing, abuse and knew how to report this appropriately. Staff told us they were confident that concerns raised by them were investigated and reported appropriately. People told us they felt safe with the staff who were supporting them.

The provider did not always work with people to understand and manage risks. For example, staff had failed to identify that information displayed in one person’s bedroom, who had a known history of choking, did not reflect professional guidance regarding the safe consistency of their food. The registered manager removed this information following inspection feedback. Staff had also failed to identify and mitigate the risk of scalding from unattended teapots in the dementia unit. Safer processes were introduced following inspection feedback.

Risks relating to people’s health and care needs, including diabetes, wound management and respiratory conditions, were assessed and managed through regular monitoring, clinical assessment and multi-disciplinary working.

People at risk of falls were provided with appropriate equipment and measures to support their safety. People told us staff responded quickly to falls and used equipment such as sensor mats, walking aids and alarms to support their safety. People with compromised swallowing received support to reduce the risk of choking, including appropriately modified diets. Clinical observations identified poor wound healing at an early stage, enabling prompt action to reduce the risk of infection and further deterioration.

A person who described themselves as “A heavy smoker” told us they were supported by staff to access a designated smoking area outside the home, where a lighter was provided for their use. The person’s cigarettes and lighter were not kept in their room, reducing the risk of fire. The person told us they were satisfied with this arrangement.

The environment did not consistently support people living with dementia to navigate their surroundings safely and independently. Limited pictorial signage and meaningful environmental prompts increased the risk of people becoming disorientated, unable to locate key areas or requiring unnecessary support to move safely around the service.

Regular health and safety checks, audits and servicing schedules ensured equipment, utilities and statutory certifications, including gas, electrical, water safety and lifting equipment, remained up to date. Fire safety measures were in place with appropriate detection systems, signage, evacuation equipment, staff training and regular drills in place. Lighting was activated by movement sensors along the corridors, helping people to navigate the environment safely.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. A mixed team of nurses, care and ancillary staff worked well together to provide coordinated care and treatment. Staff received regular supervision, support and ongoing development opportunities.

Dependency profiles were used to assess the level of support each person required and to inform staffing allocation and the appropriate skill mix. People told us there were enough staff to meet their needs, which was consistent with our observations. People told us there was a high proportion of overseas staff. While staff were generally described as kind and helpful, several people said they sometimes found communication difficult due to language barriers.

Recruitment processes were safe and robust, with appropriate pre-employment checks completed before staff started work. Staff received a comprehensive induction which included mandatory training and observed practice. Staff new to care undertook the Care Certificate which is a set of 16 standards that form the basis of training for health and social care support staff in England. Additional training was provided relevant to people’s individual and clinical needs, including supporting people with a learning disability.

The provider assessed and managed infection risks effectively. This included staff practice, clinical interventions and environmental cleanliness. Risks of infection and transmission were identified and controlled, with concerns shared promptly with the appropriate agencies.

People were supported by staff who followed infection, prevention, and control (IPC) processes.Nurses demonstrated good hand hygiene protocols when administering medicines and repeatedly used hand sanitiser, between assisting people. Staff told us they had received training in food hygiene and IPC. They were knowledgeable about how to prevent the spread of infections and the need to use personal protective equipment (PPE) which they said was readily available to them. PPE was used appropriately throughout our visits.

The provider supported people to receive their medicines safely. People told us their medicines needs were met and that staff provided their medicines as prescribed. One person said, “They give me tablets every day to help me with [medical need].” People’s medicines were regularly reviewed to ensure treatment remained appropriate and effective.

Staff worked closely with GPs and other healthcare professionals when people’s needs or preferences changed. For example, when a person found taking medicines in tablet form difficult and was refusing them, staff arranged a GP appointment to explore alternative options.

Medicine records clearly reflected people’s prescribed medicines and were updated promptly when changes were made. PRN (as required) medicine guidance was clear and personalised, supporting staff to understand when medicines were needed and how they should be administered safely.

Medicines were ordered, stored, administered and disposed of safely, including controlled medicines. Regular audits and checks, including external oversight, helped the service identify and monitor safe practice.