Ash Hall Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 36 (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 demonstrate a shared vision, strategy and culture which consistently promoted a person-centred approach, equality, inclusion and continuous improvement.

Leaders had not embedded an effective culture of learning and improvement. Although some action had been taken following concerns identified at the previous inspection, improvements were not sustained across the service. We continued to identify concerns relating to the environment, staffing deployment, person-centred care practices and quality assurance processes. This demonstrated leaders had not been effective in driving and maintaining improvements.

The provider had not established a culture which consistently placed people at the centre of care delivery. We identified task-focused practices, including the allocation of designated staff to support people with their continence needs, which resulted in some people experiencing delays in receiving support. Opportunities for people and relatives to influence the development of the service were also limited, with residents' and relatives' meetings not taking place regularly. These findings did not reflect a culture of engagement, inclusion and person-centred care.

Leaders were receptive to feedback during the inspection and responded to concerns raised. However, the repeated nature of some of the concerns identified demonstrated the provider's vision and values had not been consistently translated into practice or embedded throughout the service.

The provider did not consistently demonstrate effective leadership or maintain sufficient oversight to ensure people received high-quality, person-centred care.

Although the management team were open and receptive to feedback during the inspection, leaders had not addressed or sustained improvements in areas where concerns had previously been identified. We continued to identify issues relating to staffing deployment, person-centred care, the physical environment and quality assurance processes. This demonstrated leaders did not have effective oversight of the service and had not ensured people consistently received safe, responsive and high-quality care.

The registered manager described several challenges experienced since the previous inspection, including personal circumstances and wider pressures impacting the service. The provider also referred to financial constraints. However, governance arrangements had not been robust enough to identify, monitor and address risks arising from these challenges. Leaders had not ensured appropriate systems were in place to maintain effective oversight and drive improvement during periods of difficulty.

Leaders had not established an inclusive culture which fully considered people's individual needs and experiences. Shortfalls in person-centred care, limited opportunities for people and relatives to influence the service, and delays in responding to some people's preferences demonstrated leaders did not always understand the impact service delivery practices had on people's experiences and outcomes.

Despite these concerns, staff spoke positively about the registered manager and felt able to raise issues when needed. Staff told us they had confidence concerns would be listened to and acted upon.

Staff consistently reported feeling listened to and supported to raise concerns, whilst people were not consistently supported to raise concerns.

Feedback from people was mixed. Some people were unclear about how to raise concerns or did not feel confident concerns would result in action being taken. One person said, “No I don't know how to complain, staff just pop in and bring meals or medicines.” Another person told us they did not use their call bell because they did not feel anyone would come. These comments indicated some people did not always feel empowered to express concerns or request support.

The provider had not maintained regular opportunities for people and relatives to formally share their views about the service. This limited leaders' ability to gain assurance all people felt listened to and included.

In contrast, staff described a positive culture for speaking up and told us they felt comfortable raising concerns with managers. One staff member said, “We [staff] are all encouraged to share our opinions. The registered manager has an open-door policy and will always listen to any issues raised.”

These findings demonstrated leaders had created an environment where staff felt able to raise concerns, however they could not be assured all people felt equally confident their views would be heard and acted upon.

The provider had not fully assured itself all staff had equal access to the training and development needed to support people effectively in their roles.

Staff spoke positively about working at the service and described an inclusive culture where they felt able to contribute their views. Staff told us they had opportunities to discuss their practice and development through supervision, handovers and team meetings.

However, leaders could not demonstrate all staff had completed training relevant to the needs of people using the service. Records showed gaps in training, including learning disability and autism training. In addition, the provider's training matrix contained inconsistencies regarding which staff were required to complete training and which staff had completed individual courses. This meant leaders could not be assured all staff had been provided with equitable opportunities to develop the knowledge and skills required for their roles. The registered manager responded to our feedback by registering all staff on learning disability and autism training and assuring they would review all staff training.

The lack of accurate oversight of training reduced the provider's ability to monitor workforce development and ensure staff had access to consistent learning opportunities. Despite this, staff told us they received training and felt confident in their roles. One staff member said, “I have completed all of my training, it was good, I am confident in my role.”

The provider did not operate effective governance systems to assess, monitor and improve the quality and safety of the service.

Concerns relating to governance and oversight identified at the previous inspection had not been fully addressed. Although some improvements had been made, leaders had not ensured these were embedded or sustained. We continued to identify concerns relating to the environment, staffing deployment, call bell response times, person-centred care, consent processes, risk management and involving people and relatives in the operation of the service. This demonstrated governance systems were not effective in identifying concerns, evaluating risks or driving continuous improvement.

We reviewed the provider's quality assurance and monitoring systems and found these had not been operated consistently. The most recent care plan audit had been completed approximately three months before the inspection. The most recent bed rail audit and call bell response audit had both been completed around four months before the inspection. The call bell audit had identified numerous occasions where people experienced significant delays in receiving support. Despite these findings, leaders had not completed subsequent audits to evaluate whether improvements had been achieved or sustained.

The provider told us the staff member responsible for completing several audits did not have sufficient supernumerary time to undertake these duties. However, leaders had not taken timely action to ensure governance responsibilities could be fulfilled effectively. As a result, key monitoring activities were not completed, reducing organisational oversight and limiting opportunities to identify and address concerns.

Governance systems had failed to provide leaders with an accurate understanding of the quality and safety of the service. Concerns identified during the inspection had either not been recognised through existing monitoring systems or had not been acted upon effectively. This meant leaders could not demonstrate they were using information about performance, risks and outcomes to drive improvement and ensure people consistently received safe, high-quality care.

The provider did not consistently work in partnership with others to support improvements in the quality of care provided.

We received mixed feedback from external professionals about their experiences of working with the service. One visiting professional told us, “They are responsive to our recommendations for care.” However, another professional described delays in implementing changes and acting on recommendations. This demonstrated partnership working was not always effective in achieving timely improvements.

Leaders had not consistently used information and feedback from external partners to drive improvement. Issues identified at the previous inspection had not all been addressed and some concerns remained at this inspection. This indicated opportunities to learn from feedback, scrutiny and professional input had not always been fully utilised.

Despite these concerns, the provider maintained links with health and social care professionals and staff made referrals to relevant agencies when people's health needs changed. However, leaders had not always ensured partnership working resulted in timely action and sustained improvement for people using the service.

The provider did not focus on continuous learning, innovation and improvement across the organisation. They had not consistently promoted best practice or ensured learning resulted in sustained improvements for people using the service.

Concerns identified at the previous inspection had not been fully addressed and several areas of concern remained evident during this inspection. This demonstrated opportunities to learn from previous findings and use this learning to improve outcomes for people had not been fully embedded within the service.

Leaders had not consistently adopted approaches which reflected current person-centred and inclusive practice. During the inspection, we identified task-focused approaches to care, limited opportunities for people to influence the service, and a lack of accessible information for some people. In addition, people who spent significant periods in their rooms had limited opportunities for meaningful occupation and social engagement. These findings demonstrated improvements had not been driven by a clear focus on equality of experience, choice, independence and quality of life.

The provider responded positively to feedback given during the inspection and took immediate action in some areas. However, the recurrence of concerns and lack of sustained improvement demonstrated learning was not consistently translated into practice. As a result, leaders could not demonstrate an effective culture of continuous improvement across the service.