Ashton View Nursing Home

Ashton View is a care home with nursing operated by HC-One Ltd located in Wigan. Ashton View is registered with CQC to provide care for a maximum of 58 people. There were 55 people using the service at the time of the inspection.

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

At our last inspection we identified concerns regarding the documentation of the Mental Capacity Act and best interest decisions, record keeping and governance systems. We found improvements had been made in these areas at this inspection.

People said they received enough to eat and drink and staff told us they received the necessary training and supervision to support them in their roles. People had access to the necessary healthcare as needed, such as dentists.

There were systems in place to seek feedback from people living at the home, including the use of satisfaction surveys and staff/residents’ meetings. The home also had a number of links within the local community and worked well with partner agencies including the local authority.

Rating at last inspection

The last rating for this service was requires improvement (published July 2021) and the provider was in breach of regulations relating to good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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 Effective and Well-Led. For those key questions not inspected (Safe, Caring and Responsive), we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed 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 Ashton View 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. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice. Accurate and contemporaneous records were not always maintained by staff, particularly regarding the personal care people should receive.

Auditing and governance systems were in place at both provider and managerial level. However, further improvements were required to ensure regulatory breaches identified at the previous inspection were met so the service could improve.

People living at the home and their relatives told us they felt Ashton View was a safe place to live. Safeguarding allegations were reported to the local authority for further investigation, medicines were managed safely, and we observed people being supported to maintain good mobility. These had been some of the concerns identified at our previous inspection.

Staff received the necessary induction, training and supervision to support them in their roles. People told us they liked the food provided at the home and the home had good links with other health care professionals such as dieticians and the speech and language therapy (SALT) team. Deprivation of Liberty Safeguards (DoLS) applications were submitted to the local authority as required.

There were a range of activities taking place during our inspection and the home worked closely with the local hospice to ensure people received appropriate end of life care. Each person had their own care plan in place, which provided and overview of the care staff needed to provide.

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 January 2021) and the provider was in breach of regulations relating to safe care and treatment, safeguarding people from abuse and improper treatment and good governance. At this inspection, not enough improvement had been made and the provider was still in breach of some regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service in November 2020. 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 improve.

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, effective, responsive and well-led which contain those requirements.

Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (Caring). We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this at all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service remains 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 Ashton View on our website at www.cqc.org.uk. You can see what action we have asked the service to take at the end of this report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashton View is a residential care home located in Wigan and is operated by HC-One Care Limited. The home is registered with the Care Quality Commission (CQC) to provide care for up to 58 people, some of whom are living with dementia.

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

We found improvements were required to ensure people maintained safe mobility and were not placed at risk of falls. We identified concerns regarding some aspects of people’s medication. Where potential safeguarding allegations had been made, these were not always being reported to the local authority for further investigation.

Although we observed there were sufficient numbers of staff to care for people on the day we visited the home, there was a high use of agency staff and some of the feedback we received was this did not ensure continuity of care. Where people were at risk of developing pressure sores, accurate records were not always maintained by staff when positional changes had been completed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice.

Although staff supervisions took place, records of these discussions were not always clearly documented. We had concerns regarding how people’s nutritional intake was recorded. Care plans did not always provide sufficient information about the care people required and personal care charts were not being accurately completed by staff.

Auditing and governance systems were in place at both provider and managerial level. However further improvements were required to ensure the concerns from this inspection were identified, to ensure the service could improve. Some of the feedback we received was there needed to be more oversight on the units to ensure staff were being monitored effectively. Not all staff felt there was a positive culture within the service.

Statutory notifications (incidents the home legally have to tell us about) were not always reported to us as required. We are following this issue up separately from this inspection.

People living at the home and their relatives told us the home was a safe place for people to live. Staff wore personal protective equipment (PPE) when delivering care and the home was seen to be clean and tidy throughout. Staff told us they received enough training to support them in their roles. Appropriate referrals were made to other health professionals as needed. Complaints were handled appropriately, and we observed several activities taking place on the day we visited the home.

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 (published June 2019).

Why we inspected

We carried out an unannounced inspection of this service between 3 and 24 November 2020.

Before the inspection, we received several whistleblowing alerts and complaints in relation to people’s care needs not being met and risks not being managed. We took the decision to carry out an inspection of the home to look at these risks.

The information we received included allegations about a neglect of personal care, staff taunting residents, sensor mats being unplugged, unexplained bruising, poor skin care, low staffing levels, not enough food and drink for residents, staff sleeping at night and poor record keeping. We undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only, which looked at these areas of concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvement. Please see the safe, effective, responsive and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this report.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashton View Care home is owned and managed by HC-One and is situated in the centre of Ashton in Makerfield, Wigan. The accommodation is provided in three separate units. Evans unit (General Nursing) is situated on the ground floor, Gerrard unit (Dementia Nursing) is situated on the first floor and Pilling unit (Residential) is on the second floor.

People’s experience of using this service:

We carried out this comprehensive inspection on 15 and 20 May 2019. At the time of the inspection there were 55 people living at the home. We found improvements had been made since our last comprehensive inspection in March 2018.

We have made two recommendations regarding the recording of safeguarding concerns (Safe) and dementia friendly environments (Effective).

People said they felt safe living at the home, with staff demonstrating a good understanding about how to protect people from the risk of harm.

Staff were recruited safely, with appropriate checks carried out to ensure there were no risks presented to people using the service.

Maintenance checks of the premises and the servicing of equipment was carried out throughout the year to ensure they were safe to use.

There were enough staff to care for people safely.

People received their medication safely.

Accidents and incidents were monitored and any actions taken to prevent future re-occurrence were recorded.

People’s mental capacity was kept under review and deprivation of liberty safeguards (DoLS) applications were submitted to the local authority as required.

Staff received the necessary training and support to help them in their roles. Staff supervisions and appraisals were carried out and gave staff the opportunity to discuss their work.

People told us they liked the food available and we saw staff supporting people at meal times, if they needed assistance. Where people needed modified diets due to having swallowing difficulties, these were provided.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

There were a range of activities available for people to participate in and we observed these to be well attended by people living at the home during the inspection.

We received positive feedback from everybody we spoke with about management and leadership within the home. Staff said they felt supported and could approach the home manager with any concerns they had about their work.

Rating at last inspection:

Our last inspection of Ashton View Nursing Home was in March 2018. The overall rating at that inspection was ‘Requires Improvement’. The report was published in May 2018. The ratings for each key question were as follows:

Safe – Requires Improvement

Effective - Good

Caring - Good

Responsive - Requires Improvement

Well-led – Requires Improvement

We identified regulatory breaches regarding person centred care and good governance and issued requirement notices which were then followed up at this inspection.

Why we inspected:

This inspection was carried out inline with our inspection methodology timescales services rated Requires Improvement.. This meant we needed to re-inspect within 12 months following the publication of the last report.

Follow up:

We will continue to monitor information and intelligence we receive about the home to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for ‘Good’ rated services, however if any further information of concern is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ashton View 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; both were looked at during this inspection.

Ashton View is in Ashton-in-Makerfield and is part of HC-One. The home provides residential and nursing care as well as care for people living with dementia. The home provides single occupancy rooms, across three units, which are known internally as Evans (general nursing), Gerard (providing nursing care for people living with dementia) and Pilling (residential). At the time of the inspection there were 52 people living at the home.

There was a registered manager in post. 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.

At the last inspection carried out on 10 May 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were relating to regulation 12; safe care and treatment (two parts), regulation 13; safeguarding service users from abuse and improper treatment (two parts), regulation 14; meeting nutritional and hydration needs and regulation 17; governance (two parts). We also made three recommendations in relation to reviewing the dependency tool used to calculate staffing levels, the environment and activities.

Following this inspection we asked the provider to complete an action plan to show what they would do and by when to improve the overall rating to at least good.

At this inspection we found the provider had taken remedial action and was no longer in breach of the parts of these regulations.

However we found during this most recent inspection the service was in breach of two different regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were relating to Person centred Care and Good Governance. You can see what action we told the provider to take at the back of the full version of this report.

People were not always receiving support in line with their care plans and some people’s files did not contain any historical information including likes and dislikes.

The service had been subject to an electrical installation audit in May 2017 where multiple improvements were required, however, ten months later some of these tasks were still outstanding.

Staff received adequate training and supervision support from the provider and were knowledgeable about the people they supported. This was also confirmed by people’s comments during the inspection; people told us they felt staff were competent and well trained.

People's care files contained information in relation to their dietary requirements, skin integrity, falls management and further perceived risks associated with daily living tasks.

Environmental risk assessments were in place for both internal and external areas and the provider employed a maintenance team to oversee daily internal and external maintenance issues.

Safeguarding policies and procedures were in place to ensure people, staff and visitors were aware how to raise concerns and what abusive practice looks like. Staff received training in this area and a record of safeguarding referrals was kept securely.

Safe recruitment procedures were adhered to and the provider ensured new staff received a period of induction before being assessed as competent to work alone.

Risk assessments were in place in each person's file we looked at to manage identified risks associated with daily living and also recognise individual risk taking.

Business continuity plans were in place to offer information and guidance in the case of adverse weather or any other unforeseen circumstances which could affect the day to day running of the service. People also had personal evacuation plans in place.

Medicines practice was managed well and people received their medicines in a safe way.

People's human rights and diverse needs were reflected within each plan and we received positive feedback during the inspection which evidenced people were being treated fairly and in line with their personal preferences.

Consent to areas of care and support were evident in people's care files.

Staff were caring, respectful and understanding in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives.

People's opinions were routinely sought and acted upon by means of questionnaires, residents meetings and resident committee meetings. This enabled people to provide input into the service they received.

Positive feedback was received from people who used the service and staff about the management structure. People told us the service had improved dramatically under the new manager.

At our inspection on 22 October 2015, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in regards to safe care and treatment and governance.

The home was rated as requires improvement overall and in the key lines of enquiry (KLOEs) for; safe, effective and well-led. The home was rated as good in caring and responsive.

At this inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to regulation 12; safe care and treatment (two parts), regulation 13; safeguarding service users from abuse and improper treatment (two parts), regulation 14; meeting nutritional and hydration needs and regulation 17; governance (two parts). We also made three recommendations in relation to reviewing the dependency tool used to calculate staffing, the environment and activities. We served a warning notice in regards to regulation 17; good governance (two parts) and received an action plan from the registered provider detailing how the areas of concern would be addressed to ensure the home was compliant with the regulations.

Ashton View is in Ashton-in-Makerfield and is part of HC-One. The home provides residential and nursing care as well as care for people living with dementia. The home provides single occupancy rooms, across three units, which are known internally as Evans (general nursing), Gerard (providing nursing care for people living with dementia) and Pilling (residential). At the time of the inspection there were 53 people living at the home.

At the time of the inspection, there was no registered manager in post. The home’s registered manager had left in April 2017 and a regional support manager from HC-one was providing daily oversight and management whilst recruitment was underway for a new registered manager. 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.

The regional support manager was on leave when we undertook the inspection and management oversight was being provided by another manager from within HC-One. The interim manager had only been post for two days prior to our visit and acknowledged they were unable to answer some of our historical enquiries as they had not been present at the home during that period.

People who used the service and the majority of relatives told us they felt the service was safe. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We received a mixed response from people living at the home, staff and visiting relatives with regards to staffing levels at the home. Whilst a formal dependency tool was used to determine staffing numbers and staff said they felt people’s care needs were not compromised as a result of current staff numbers, they reported feeling rushed and unable to spend time with people. We have made a recommendation with regards to staffing levels in the detailed findings of this report.

We found staff received online safeguarding training but staff indicated they would benefit from face to face training in this area. We found two specific incidents which involved a person living at the home that had not been reported to the local authority for investigation.

We identified issues with the management of stock levels and re-ordering of medicines, which meant people had missed doses of medicine until new supplies arrived. We also identified some issues with the recording of as required medicines (PRN) to establish a clinical picture.

The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Mental Capacity assessments had not been conducted when they had been required. The provider had no oversight as we found granted authorisations which had expired and referrals had not been made timely. This meant that people were being deprived of their liberty unlawfully.

People were not always protected from the risk of losing weight and we identified two people who had continued to lose weight and their Malnutrition Universal Scoring Tool (MUST) score indicated a referral to the dietician for assessment was required. We found this had not been done. There were no food and fluid records which meant we could not ascertain people’s calorie intake and whether snacks had been offered. These measures could have helped peoples weight to increase over time.

People were complimentary about the staff and support they received. People’s privacy and dignity was maintained and their independence was encouraged. People told us that staff were respectful of their wishes.

People’s care plans were reflective of their preferences and needs and reviewed regularly in conjunction with them and their relatives.

There were systems in place to seek feedback from people living at the home and their relatives. This included residents/relatives meetings and satisfaction surveys. The results of these were then analysed, with action plans put in place to drive improvement.

There were systems in place to investigate and respond to complaints appropriately. The people we spoke with said they would speak with staff or the manager if they were unhappy with the service they received.

The systems in place to monitor the quality of service being provided required strengthening. There were comprehensive audits undertaken which had not identified the areas of concern that we highlighted during the inspection.

During feedback, we found the management to be honest and transparent and they acknowledged that further progress was required. The management demonstrated a commitment to address the issues identified and sent an action plan following the inspection detailing how the areas identified would be addressed in a planned and structured way.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. Some of the staff and relatives we spoke with felt there was not enough staff to meet the needs of the people living in the home. The registered manager said that staffing levels were adequate during the day but she deliberately overstaffed the rota for the night shift. A member of the management team was available on call in case of emergencies. One relative said: 'There is a good feeling. He's so safe.'

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults,could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us that they were happy with the care that had been delivered. A person who lived in the home said: 'They look after you well.' Another person said: 'I have no complaints whatever.'

Care records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. One person said: 'It is wonderful. I am so relaxed.'

We heard that information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: 'My mum is settled here. They care for her as much as they can do.' One person who used the service said: 'Everyone is so kind.'

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs were carefully described so that care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the nurse team leaders and they briefed care staff at handovers and via the updated care plans.

One relative said 'They know that if there's anything wrong I want contact.' They also commented that the district nurse visited regularly, a doctor called as did an advanced nurse practitioner. They felt their relative was receiving good care from the team.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and that staff listened to their concerns. The manager met informally with families and we saw an invitation to the next meeting in the reception area. The manager was also available whenever they visited. Staff told us they were clear about their roles and responsibilities and said : ' She (the manager) is easily approachable.'

During our visit we met with eleven of the people living at Ashton View Care Home and seven of their relatives. We also met with other people living there and observed the support provided to them.

In addition we spoke with fourteen members of staff who held various roles within the home.

Relatives told us that in their opinion people had received the support they needed with their personal care. They said that staffing levels were adequate but felt the home would benefit from having more staff members especially on Evans unit.

People told us they were happy with the services but wished that there were more staff around to assist them. They said staff worked very hard but were not always able to provide support when it was required. One person told us that staff were wonderful but could only do so much as a lot of people had high levels of support needs. A visiting relative told us that they assisted to feed their relative as they were fully aware of the pressures on staff to provide care and support to many vulnerable people.