Ash Hall Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained Requires Improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care.

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 ensure people were at the centre of decisions about their care and treatment.

People did not always receive care and support at the time they requested it. During the inspection, we identified concerns regarding a task-focused approach to supporting people with personal care needs. We also raised concerns about the use of language, which was not person centred, including referring to staff as ‘toileting staff’ and describing people by their abilities rather than as individuals. The registered manager told us this would be addressed with the staff team.

People were not always supported with their preferred morning routines. We observed concerns regarding staff allocation for morning support, resulting in some people not receiving assistance until early afternoon. The registered manager explained staffing had been affected by a member of staff leaving work due to illness on the day of the inspection. However, staff told us people were typically supported by around midday, and one person said, “Staff come and wash me and sort me out in the morning. Sometimes it’s not until 12.00 midday staff come to support me.”

People’s access to baths and showers was managed through a scheduled list. This approach was prescriptive and did not demonstrate people were consistently enabled to exercise choice and control over when they received this aspect of their care.

Despite these concerns, people told us they felt safe and were supported by caring staff.

The provider did not consistently understand or respond to people's wider health, social and emotional wellbeing needs.

People's physical health needs were monitored and referred to relevant healthcare professionals when required. However, there were gaps in how people's social and emotional wellbeing was supported.

Some people spent prolonged periods in their bedrooms with limited opportunities for meaningful occupation and engagement. We identified concerns regarding the availability of activities, particularly when the activity coordinator was on annual leave. During these periods, people had limited access to activities and social interaction, increasing the risk of social isolation for those who remained in their rooms.

People told us staff responded to their healthcare needs when required. However, people also told us there was little to do during the day. This demonstrated people's social wellbeing needs were not always given the same consideration as their physical health needs.

The provider did not always ensure information was provided in a way people could easily access, understand and use.

We reviewed how information was made available to people, particularly as the service supported people living with dementia and people with a learning disability. The registered manager told us an easy read version of the complaints policy was available; however, this had not been printed or made accessible to people. The registered manager printed this off and ensured it was placed in a communal area. When we reviewed the document, we found it was not presented in a recognised easy read format. Although simplified language had been used, it did not contain pictures, symbols or other visual aids to support understanding. This meant people may not have been able to fully understand information about how to raise concerns or make a complaint. The registered manager acknowledged this and told us they would review the document to improve its accessibility.

We also identified limited use of signage and visual prompts throughout the service to support people to orientate themselves within their environment. Whilst there were signs identifying certain rooms, accessible menus and activity information, there was limited directional signage to help people navigate the service. Accessible information and dementia-friendly signage can help people locate key areas of the service, understand their surroundings and maintain independence. The limited use of these measures meant information was not always provided in a way that met people's individual needs or promoted their independence.

People's communication needs were recorded within their care plans, and staff were able to describe how they adapted their communication to meet individuals' needs.

The provider did not consistently make it easy for people and those important to them to share feedback, raise concerns and contribute to the development of the service.

During the previous inspection, concerns were identified regarding the length of time since a residents' and relatives' meeting had been held. We reviewed this again during the inspection and found limited progress had been made. Records showed the most recent meeting had taken place approximately 18 months before the inspection. This meant people and relatives had not been provided with regular opportunities to share their views, discuss their experiences or contribute to ideas about how the service could be improved.

The absence of structured engagement arrangements increased the risk that some people and relatives may not have their views heard or feel fully involved in decisions about the service. Following our feedback, the provider arranged a residents' and relatives' meeting. We will assess the sustainability and effectiveness of these arrangements during the next inspection.

People told us they felt able to approach staff and raise concerns when needed. Relatives told us they knew how to raise concerns. One relative said, “I haven’t had any problems but if I did, I would speak to the manager.” However, without established systems to gather feedback from all people and relatives, the provider could not be assured everyone had an equal opportunity to share their views and experiences.

Staff understood the importance of listening and responding to concerns. One staff member said, “I help people as best I can, if someone was not happy, I'd listen to them, and either try to resolve the issue or encourage them to make a complaint.”

The provider ensured people could access the care, support and treatment they needed when they needed it.

Relatives told us people had access to healthcare professionals when required. One relative said, “The doctor has been out to see [person] and is coming to see them again tomorrow. The nurses have been checking [person’s] pulse and their oxygen levels and statistics.”

Staff understood people's healthcare needs and monitored long-term health conditions, including diabetes. Records showed concerns about people's health and wellbeing were escalated appropriately to relevant healthcare professionals when needed.

People received support to access healthcare services, which ensured their health needs were identified and responded to in a timely way.

The provider did not consistently recognise or respond to factors which could lead to inequalities in people's experiences and outcomes.

Some people were at risk of social isolation due to limited opportunities for meaningful engagement and occupation, particularly those who spent most of their time in their bedrooms. The availability of activities was reduced when the activity coordinator was absent, meaning people did not always have equal access to social opportunities and stimulation.

Staff knowledge of people varied. While staff were generally able to describe people's health conditions and risks, some were less familiar with people's life histories, hobbies and interests. This limited staff's ability to provide personalised support which reflected what was important to people. One staff member said, “We have handovers where we discuss any concerns but there is not enough time to read care plans. So, we get to know the people who talk to us, but not everyone.”

We observed activities taking place in communal areas during the inspection. However, the range of activities available appeared limited and may not have met the needs and preferences of all people. One person told us, “Mainly the TV is on. We just sit here most of the time. I think the activity person has been on holiday.” Another person had a more positive experience and said, “There is always something to join in with. I don’t watch TV. I enjoy reading.”

These mixed experiences demonstrated people did not always receive the same opportunities to pursue their interests, maintain social connections and achieve positive outcomes.

People were supported to plan for important life changes, including decisions about their future care and wishes at the end of their life.

Although no one was receiving end of life care at the time of the inspection, staff had received training to help them provide compassionate and appropriate support when needed. One staff member said, “Every year we have a top up face to face session on end-of-life care, also online 1-2 hours. We have access to the NHS training hub too.”

People's care records included discussions about their end of life wishes and preferences. We saw the service used ReSPECT forms to record people's wishes regarding emergency care and treatment. ReSPECT forms provide a summary of a person's preferences and clinical recommendations to support decision-making in an emergency.

The provider had systems in place to ensure people's future wishes and choices were discussed, recorded and available to guide care and treatment decisions.