Ashley Grange Nursing Home

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were recorded and reviewed by management. An analysis of the potential causes was completed to identify areas for improvement or changes needed to ways of working. Learning was shared with staff and if needed refresher training was provided. One member of staff told us, “Incidents are always thoroughly investigated and action taken to prevent a repeat. Information is shared with us through our handovers.”

The registered manager told us there was a learning culture within the organisation with information about incidents being shared regularly. For example, from incidents in the providers other homes or from incidents reported nationally. Nursing staff attended a clinical group meeting and care staff had weekly meetings and handovers to share information and learn from each other.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had systems to make sure people’s needs were shared with emergency medical staff in the event of moving from the service to hospital. The registered manager told us staff would share important care needs and information about medicines as appropriate. In addition, for people who were very high risk of medical emergencies, staff were aware to inform emergency staff at early signs of ill health. This enabled people to get the medical treatment they needed in a timely way.

When people moved out of hospital back into the service, nursing staff obtained handover information from hospital teams. If people’s needs had changed, management would visit the hospital to re-assess people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff received safeguarding training as part of their induction and regular training updates. Staff understood their responsibilities to keep people safe. The registered manager was aware of what concerns needed to be shared with the local authority. Staff were all confident any safeguarding concern would be investigated and reported thoroughly by management.

People and relatives said they felt people were safe at the service. Comments included, “Staff are really lovely, and I feel very safe here. It is very important when you are elderly to feel safe, and I feel 100% safe here” and “[Person] has settled really well here. I feel [person] is safe and well looked after.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the service had appropriately applied to the local authority for DoLS authorisations. For those that had been assessed and authorised there was a DoLS care plan which recorded when the DoLS expired and if there were any conditions. Where conditions were recorded, the service was complying with these.

The provider did not always work well with people to understand and manage risks. People needing 1-1 care did not have enough guidance in their risk management plans for staff to understand what support to provide. It was not clear in people’s plans what the 1-1 staff were to do when the person experienced distress or were sleeping. Staff recording of incidents of distress did not provide a full account of what had happened. This meant it was not consistently clear what interventions staff had used with success. We shared this feedback with the registered manager who said they would update the relevant plans with additional guidance for the staff.

Other risks to people’s safety had clear guidance for staff to follow. Nursing staff reviewed information and if people’s needs changed, they updated the risk management plans which staff could immediately access. Whilst most risk management plans had been regularly reviewed, we did find some that needed a review. For example, 1 person had conflicting information about being able to use their call bell. The registered manager told us this would be updated without delay.

People and relatives told us they had been involved in managing risks. Plans had been discussed with people and there was a partnership approach to agreeing care and support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff carried out regular health and safety checks for equipment and facilities. This included fire systems and water testing for legionella. The provider had a range of audits being completed which also helped identify any risks to the environment.

Staff did fire drill practice during day and nighttime conditions. People told us they had been involved in evacuation practice which they had enjoyed. One person said, “Two staff came and put me on a stretcher and carried me out, they did such a good job.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We observed there were enough staff to meet people’s needs. The service had a full complement of permanent staff and only used agency to cover short notice absence. The registered manager monitored call bells and made sure they were responded to in a timely way.

Staff had been recruited following all pre-employment checks. Staff received an induction when they started which included a range of training and 1-1 meetings. Refresher training was provided as and when needed.

People said overall there were enough staff to keep them safe. Comments included, “Some days, there does not seem to be enough staff, but on the whole, we do see quite a few staff”, “Staff are always busy, but I have never seen people left in the lounge on their own. There is always a carer in there” and “If I use the buzzer, they [staff] come within a few minutes, day or night.” Staff told us at times staffing could be an issue due to short notice sickness, however, there was always enough staff to keep people safe.

People and relatives thought the staff were well trained and had the skills needed to support people safely. One relative told us, “I think they [staff] are all well trained and they understand my [relatives] needs.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service employed a team of domestic staff who carried out regular cleaning, and we observed the service was clean throughout. The registered manager told us they had changed their system of cleaning to help staff carry out ‘deep cleans’. They felt this was working well and helping to make sure all rooms had a regular ‘deep clean’ which was a very thorough clean.

People said they thought the service was clean. Comments included, “They have 3 cleaners, and they do a very good job. They keep the place clean and tidy, and they are nice people” and “The cleanliness is very good.”

The provider did not always make sure that medicines were consistently safely managed. We found for 1 person on time sensitive medicines there were shortfalls in how their medicines had been administered. Whilst the person had not experienced harm, their experiences were different to others who had been given their medicines on time. The clinical lead launched an investigation into these shortfalls during the inspection and took action to ensure the person had their medicines on time.

Topical creams were also not managed consistently. The service had 2 systems of recording for staff which meant it was not clear if people had been given their topical creams as prescribed. We shared this with the clinical lead who told us they were in the process of supporting care staff to use the electronic medicines system. This would mean care staff could record on the electronic system when they applied creams which would provide a more accurate record of application.

People told us they were happy with the support they had with their medicines. Comments included, “They [staff] are strict about medications, they tell you what it is for when they give it to you” and “The nurse comes 3 times a day with my medication, they are very good.”

Staff had training on how to administer medicines and assessments of their competence. Overall nursing staff took the responsibility of administering medicines, but some senior care staff could also complete this task. Medicines audits were being regularly completed which identified areas for improvement. The registered manager told us they would amend their medicines audits to include a check of time sensitive administration times.