Archived: Ashington Grange

Ashington Grange is a residential care home providing personal and nursing care to up to 59 older people, some of whom are living with dementia. At the time of our inspection there were 44 people using the service. People’s bedrooms were arranged over two floors with communal lounges and dining areas on each floor.

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

People and their relatives spoke positively about the service they received. Comments included, “The home was brilliant through Covid-19; we had to test, sanitise, and so on. The staff, bless them, were working extra with staff off but there was no drop in the care, the care is always there” and “I’m really happy within the home, there is always good care. I go in regularly. It’s totally safe, there are never any issues. [Relative] was like a different person when she went to Ashington Grange. Happy, chatty. There are no issues on safety. There are never any issues with the care. The staff are lovely.”

All staff understood their responsibility to keep people safe from harm. Systems to assess, monitor and manage risk were in place. Care plans contained information and guidance for staff on how best to support the person to minimise and manage risks.

There were enough staff to safely provide care and support. Safe recruitment processes were in place and followed.

Medicines were safely managed, and people received their medicines as prescribed.

People, their relatives and staff all had an opportunity to feedback and be engaged with the running of the home. “Resident Champions” were in place and played an active part in the running of the home.

Staff spoke positively about the registered manager. They felt listened to and could share their views on the running of the home and what this should look like. They felt the registered manager was both approachable and visible around the service.

Systems were in place to monitor the safety and quality of the service. Audits were completed and fed into a ‘home action plan’ which identified what actions were required and when they were subsequently completed. Actions had been taken to address the shortfalls identified at the last inspection.

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 27 April 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We carried out an unannounced focused inspection of this service on 17 March 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 their infection, prevention and control, risk management and governance systems to monitor the quality and safety of the service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 Ashington Grange on our website at www.cqc.org.uk.

Follow up

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

Ashington Grange is a care home providing nursing and personal care for up to 59 people, some of whom are living with a dementia. At the time of the inspection, there were 32 people living at the home.

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

Action had been taken in relation to the IPC issues identified at our previous inspection, which led to enforcement action. However, we found new shortfalls relating to infection control and the management of risk. Staff were not using the correct PPE required for a specific medical procedure associated with one person’s care, to ensure they were protected from the risk of infection. One person’s care plan and risk assessments had not been updated following several behavioural incidents to ensure staff were aware of the actions to take to manage and minimise the risk to others. These issues had not been identified by the provider’s governance system.

Safeguarding allegations were reported to the local authority. However, it was not always clear which incidents should be reported to the police by staff. We have made a recommendation about this.

Medicines were managed safely. There were sufficient staff deployed to meet people’s needs.

Information requested by CQC during the inspection was not always sent in a timely manner. We have made a recommendation about this.

There was a cheerful atmosphere at the home. Staff spoke positively about working at the home and the people they cared for.

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 29 December 2020)

Why we inspected

We carried out a focused inspection of this service on 26 November 2020. A breach of legal requirements was found in relation to safe care and treatment. We undertook this inspection to confirm if the provider was now meeting legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contained those requirements.

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 remained the same. This is based on the findings at 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.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Ashington Grange 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so

We have identified two breaches of the regulations in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Ashington Grange is a care home providing nursing and personal care for up to 59 people; some of whom are living with dementia. At the time of the inspection there were 34 people living at the home.

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

People and staff were at an increased risk of infection because a safe and effective infection control system was not fully in place.

Staffing levels had been affected by current events at the home. Staff told us that whilst there had been issues with staffing on certain shifts, they had worked as a team to ensure people received appropriate care and support. Medicines were generally managed safely. We have made a recommendation relating to medicines storage.

The service had been through a difficult period. However, staff spoke positively about working at the home and the people they supported. One staff member told us, "The bond we have with the residents is amazing. I love coming here every day." We observed positive interactions between staff and people.

The provider had a system to assess and monitor infection control across its services. This had been updated and amended in response to the COVID-19 pandemic. However, this system had not been robustly implemented at the home to ensure an effective infection control system was in place. We have made a recommendation about this.

The registered manager and senior management were open and honest and told us that improvements had been made and lessons had been learned.

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 (8 December 2017)

Why we inspected

We undertook this targeted inspection to look at specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and infection control. A decision was made for us to inspect and examine those risks. When we inspected, we found there was a concern with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. 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 Ashington Grange 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 have identified a breach in relation to safe care and treatment regarding infection control. 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 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.

Ashington Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide support for up to 59 people over three area. The lower floor predominantly supported people with nursing care issues. The upper floor is divided into two units, one supporting males and one supporting females, who have a cognitive impairment or mental health issue. At the time of the inspection there were 51 people living at the home.

The home had a registered manager who had been registered since February 2015. 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.

People told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. The registered manager was able to describe lessons learned from previous safeguarding events. Maintenance of the premises had been undertaken and there was evidence of safety checks and risk assessments being carried out. People had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. Some people and staff members told us there were times when more staff would be helpful, but overall there were enough staff at the home. We found minor issues with the recording of some medicines at the home, which were addressed immediately. We found the home to be maintained in a clean and tidy manner.

Staff had an understanding of issues related to equality and diversity and what it meant for people using the service. They told us they had access to a range of training and updating and records confirmed this. They confirmed they had access to regular supervision and an annual appraisal. The registered manager described how technology was being used to enhance care delivery.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found some the registered manager had system in place to review and resubmit DoLS applications. People were asked for their consent on a day to day basis. Where this was not possible there was evidence of best interest decisions being made.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements. Risks associated with diet and weight loss were monitored.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. We observed staff had positive interactions with people throughout the time of the inspection. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. Relatives told us they were regularly involved in care decisions.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.

Care plans were detailed and related appropriately to the individual needs of the person. A range of activities were offered for people to participate in. The service had two dedicated activities co-ordinators, who also had an understanding of how to engage people with a cognitive impairment. Formal complaints in the last 12 months had been addressed appropriately. The majority of people and relatives told us they had no reason to raise concerns.

The registered manager told us regular checks on people’s care and the environment of the home were undertaken. The area manager also visited the home to undertaken checks, speaking to both people who used the service and staff. Relatives, staff and visiting professionals had a positive view of the registered manager and the way she ran and developed the service. Staff felt well supported by the registered manager, who they said was approachable and responsive. Records were largely up to date and well maintained. The home was meeting legal requirement related to its registration through the display of its current quality rating and ensuring the CQC was notified of significant events.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashington Grange on our website at www.cqc.org.uk.

We found action had been taken to address the shortfalls identified at our last inspection and the provider was now working within the principles of the Mental Capacity Act 2005 (MCA).

People's capacity to make decisions had been assessed. Records of mental capacity assessments and best interests decisions were detailed. People's choices and decisions about their care and treatment were respected. All staff had received additional training in MCA, and how it was applied in practice was discussed regularly at both group and individual supervisions sessions.

This meant that the provider was now meeting Regulation 11.

We have changed the rating of the effective domain from 'requires improvement' to 'good'. This was because records showed the improvements had been sustained over a significant period of time. This has not affected the overall rating for the service which remains at 'good'.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People's privacy, dignity and independence were respected.

We saw staff delivered care in a calm and pleasant manner. We found they were aware of people's needs. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The home was clean. We saw there were effective systems in place to reduce the risk and spread of infection.

People received care in a calm and unhurried manner. There were enough qualified, skilled and experienced staff to meet people's needs.

People were asked their views about the service. Systems were in place to monitor the quality of the service.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us that staff spoke to them respectfully and they were consulted about their care preferences. We saw good interactions between staff and people during our visit.

Individual records were detailed and provided clear information about the care and support provided.

The provider had in place appropriate systems to manage medicines safely and this protected the people living in the home.

The provider used questionnaires to seek the views of people about the service. Information collected was used to help plan changes and improvements.

Quality monitoring systems were in place and these took account of people's views about the service.