Ashill Lodge Care Home

Updated 20 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors one of whom was a medicines inspector. An Expert by Experience made phone calls remotely. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ashill Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ashill Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post but the acting manager had submitted an application to complete the registration process.

Notice of inspection

This inspection was unannounced on the first day, on the second date, additional information was requested.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed all the information we hold about the service which included notifications which the provider are obliged to submit, this included safeguarding concerns. We reviewed the provider action plan, the local authority review and feedback from relatives and stakeholders. We used information gathered as part of monitoring activity that took place in April 2022 to help plan the inspection and inform our judgements.

During the inspection

We carried out initial observations to include activities and the mealtime experience. We spoke with people, but most could not formally tell us about their experiences because they were living with dementia. We had a more in-depth discussion with 2 people using the service and 3 relatives on the day. We asked for feedback from a visiting health care professional and spoke with the registered provider. We spoke with 3 care staff, 1 who was a senior, the acting manager, the domestic, and the kitchen assistant. Our Expert by Experience spoke with an additional 6 family members and representatives.

We reviewed medicine administration and associated records for 17 people, observed medicines being given to people and we spoke with 2 members of staff about medicines. We reviewed 5 care plans and other records associated with the management of the service including staff recruitment records. Following the inspection we spoke with a member of the night staff. We continued to seek validation and ask for additional evidence from the provider.

Updated 20 June 2023

About the service

Ashill Lodge care home is a residential care home providing personal and nursing care for up to 35 people. At the time of our inspection there were 29 people using the service, most had a diagnosis of dementia. The home had been extended in the last eighteen months to create an additional communal space and 10 bedrooms all with ensuite facilities. The home had a passenger lift and chair stair lift as well as generous outside space.

People’s experience of using this service and what we found

We were given a mixed picture about this service from the evidence collated with most relatives sharing their positive experiences about their family members care, whilst a few relatives were not happy with the service. Through our observations we noted staff were kind and caring, however not always responsive to people’s individual needs.

We found a number of risks associated with people’s safety including unguarded stairs which people could access, hot teapots left unattended, the laundry room with chemicals left open and a stiff fire door which might impede people’s exit in the event of an emergency. People were supported to socialise with each other, and breakfast was observed to be a lively affair. We found however, when staff were busy people were not supervised safely and there was a risk to them or other people. For example, one person was known to go into other people’s rooms, we observed another person picked up a large television from the communal area.

Staffing levels were sufficient during the day, but numbers were significantly reduced at night. Night-time hours had not been reviewed in line with people’s needs and routines. From reviewing records, we identified there was an increase in incidents and falls later in the day and early morning. A twilight shift had been introduced and the provider was introducing an early morning shift as a direct result of increased falls at that time of day.

Medicines management identified continued areas of concern for the second time and concerns were part of a previous breach of regulation 12. This meant we were not assured that robust arrangements were in place to ensure people always received their medicines as directed.

The provider took an active role in the home and knew people, relatives and staff well. They were responsive to feedback and acted immediately on the concerns we raised. They were supported by a deputy and acting manager but there was not a registered manager in post. They had been proactive in sending us regular action plans and were continuously trying to improve their service.

There was a good working relationship with primary health care services who supported the home and told us the home were responsive to people’s needs and felt they identified emerging risks and addressed this quickly. A lot of people had equipment designed to promote their safety such as bed rails and sensor mats.

People were mostly supported to have maximum choice and control of their lives and staff mostly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Documentation was in place which demonstrated people were involved in their care and consulted about what they wanted to do. One person was supported outside the home to maintain contact with family and continue to have an active life in the local community. Prior to our inspection we had received concerns about the restrictive visiting hours and the inflexibility of the visiting policy. This was discussed with the provider and the reasons for this understood but we would expect the provider to consider the person’s wishes and circumstances of family members, for example when working full time.

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 March 2019) and there was a breach of regulation 12: Safe care and treatment including medicines management. 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 the provider was still in breach of regulation 12 for the third consecutive inspection.

Why we inspected

This was a focused inspection that considered safe and well led, we found both key questions required improvement. The overall rating for the service has remained requires improvement with breaches of the regulations, based on the findings of this inspection.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and the governance and oversight of the service at this inspection. We have also made a recommendation about staff records and ensuring that they demonstrate that staff competencies have been adequately assessed for the role they are doing.

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

We will request an action plan from 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

continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our Ashill Lodge website at www.cqc.org.uk