Ash Grange Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question as good. At this assessment the rating has remained as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The providers systems did not always ensure adequate staffing levels were available in the home. There was a system in place to seek cover when expected and unexpected staff absences occurred through various routes including bank, agency and sister homes providing cover. However, this had not been effective on the day of the inspection. The registered manager explained they had a failure in securing agency cover for a planned absence in the catering team and this had meant staff familiar with catering who were scheduled to provide care had to assist to ensure people had their meals prepared and served in line with their dietary requirements. There was also a sickness absence that day which impacted the overall staffing levels. To help prevent this from happening again the registered manager has initiated an additional process of where an agency is rostered, the booking will be confirmed 24 hours prior with the colleague who is planned to attend. The provider has also taken steps to increase the frequency to 2 weekly for staffing dependency checks to review staffing levels, alongside this, the registered manager is working with staff to look at how staff are deployed to improve people’s waiting times.The provider had other systems in place which ensured there were clear responsibilities, roles, systems of accountability and good governance. For example, audits were in place for care plans, medicines administration and care delivery which were effective in ensuring peoples care was delivered in the way they needed.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.