Ash Hall Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the need for consent.

This service scored 54 (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 did not always ensure people's health, care, wellbeing and communication needs were assessed in partnership with them and reviewed to confirm care remained appropriate.

Where people were being nursed in bed, assessments had not been completed to establish whether this remained the most appropriate option for the person. There was little evidence to indicate how people, or those important to them, had been involved in discussions and decisions about these arrangements. The provider told us these conversations took place with people and their relatives; however, this was not recorded. Following our feedback, the provider introduced systems to record and audit these discussions to provide assurance that people and those important to them are involved in decisions about their care.

People's health conditions were assessed and understood by staff. Care records contained information about people's diagnosed conditions and staff were able to explain how they monitored and supported people effectively to manage these needs.

Staff told us they participated in regular handovers where people's needs, wellbeing and any changes in presentation were discussed.

The provider did not always ensure people's care and treatment was delivered in line with their assessed needs. Systems were not effective in monitoring whether planned care had been consistently provided.

Where people had been assessed as requiring regular welfare checks, records contained gaps in monitoring documentation. For example, 1 person required hourly welfare checks; however, there were multiple occasions where these checks had not been recorded. The provider told us staff sometimes forgot to complete the paperwork. However, they had not investigated the omissions. As a result, the provider could not be assured people had received support in accordance with their assessed needs.

People received support to maintain their nutritional needs. Relatives told us people's weights were monitored and people spoke positively about the food provided. One person said, "I eat on my own. The food is very good quality; it is well cooked."

Where people were living with diabetes, care plans contained guidance for staff and people received appropriate support to manage their condition.

Staff demonstrated a good understanding of people's health conditions and were able to describe how they provided care and support in line with people's individual needs.

The provider worked effectively with other teams and services to help ensure people received joined-up care and support.

People had access to healthcare services when required. Visiting health professionals attended the service as needed and spoke positively about partnership working with staff. One professional told us, "We have a good relationship with the nursing team and work in partnership to care for people."

Relatives confirmed people could access relevant healthcare professionals when needed. One relative said, "The doctor does their rounds on a Tuesday. A dentist and a chiropodist also come to the home. Otherwise, they [the provider] will call someone out if needed."

Records showed staff made appropriate referrals to healthcare professionals when people's needs changed or they became unwell. This helped to ensure people received timely assessment, treatment and specialist support when required.

The provider did not always ensure people received consistent support to manage their health and wellbeing and maximise their independence, choice and control.

People's oral health needs were assessed. However, where people required assistance with oral care, there were numerous gaps in monitoring records. In addition, where people had repeatedly declined support with oral care, records did not demonstrate staff had discussed the associated risks with them or considered alternative approaches to encourage and support their involvement in maintaining their oral health.

People did not always receive consistent support with healthcare interventions. Where people required prescribed creams, records did not clearly demonstrate these had been applied as directed, and there were gaps in the application records. As a result, the provider could not be assured people had received all aspects of their care as planned.

Despite these concerns, people spoke positively about the support they received to maintain their health. One person said, "They [staff] look after me well here, I think I have put on weight, they [staff] help me with my medicines." Relatives told us staff sought support from relevant healthcare professionals when required to help people maintain their health and wellbeing.

The provider did not always effectively monitor people's care and treatment to identify where improvements were needed and ensure positive outcomes were achieved.

Where people required routine support, such as welfare checks, records did not consistently demonstrate these had taken place. Nursing staff had identified gaps in documentation and discussed these at staff meetings; however, the concerns continued. This meant the provider could not be assured people consistently received care in line with their assessed needs.

The provider did not always monitor people's wellbeing and engagement to ensure they experienced meaningful outcomes. We found some people spent prolonged periods in their rooms with limited opportunities for activity or social interaction. One person who was nursed in bed told us, "No there's not much to do, I just sit here, the staff pop in and out and on some days, someone comes to talk with me for a little while."

The provider explained staffing challenges, including periods of staff sickness absence, had impacted the delivery of activities and a new activities coordinator had recently been appointed. However, systems were not sufficiently effective in reviewing whether people who remained in their rooms had enough stimulation, meaningful occupation and opportunities to support their wellbeing.

As a result, the provider could not always demonstrate they used information about people's experiences and care to continuously improve outcomes.

The provider did not always ensure appropriate assessments and decision-making processes were in place to support people to make decisions about their care and treatment.

Mental capacity assessments were not always sufficiently detailed. Records did not consistently identify the specific decision being assessed or demonstrate how staff had determined a person's capacity to make that decision. Assessments often lacked details of the questions asked, the person's responses and the rationale for the decision reached.

Records relating to best interest decision-making did not consistently demonstrate consultation with family members, representatives or other professionals involved in people's care. As a result, the provider could not always evidence that decisions had been made in accordance with the principles of the Mental Capacity Act 2005.

Despite these concerns, some people told us they were able to make choices about their day-to-day lives and felt staff respected their preferences. One person said, "You can make a decision if you ask staff. Staff don't make you do things."

Staff demonstrated a good understanding of the Mental Capacity Act and the importance of supporting people's rights. One member of staff told us, "People are allowed to make unwise choices, as we all do throughout our lives, but I will try to minimise the risk as much as possible for the person."