12 April 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The first day of the inspection was carried out by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day of the inspection was carried out by 2 inspectors. An assistant inspector also spoke with staff who worked at Asquith Hall on the telephone.
Service and service type
Asquith Hall is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Asquith Hall is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced on both days.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We observed care and support in communal areas. We spoke with 4 relatives about their experiences of the care and support provided. We spoke with 18 staff including the registered manager, operations and quality assurance managers, the senior housekeeper, nurses and care staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included 12 people’s care records and multiple medication records. We reviewed records relating to the management of the service including policies, training records and audits.
12 April 2023
About the service
Asquith Hall is a residential care home providing personal and nursing care for up to 53 people. The service provides support to people living with dementia and with mental health needs. On the first day of the inspection there were 35 people using the service. On the second day of the inspection there were 33 people using the service. Asquith Hall is purpose-built with accommodation provided in two units. Willow is on the ground floor and Meadow is on the first floor.
People’s experience of using this service and what we found
Medicines were not managed safely which put people at risk of harm. Risks to people’s health, safety and well-being were not always effectively assessed and monitored. Some care plans contained contradictory information and robust monitoring was not in place. Audits were in place, but they had failed to identify the shortfalls we found. The issues we identified had been raised at the last inspection.
We found the provider had made some improvements to the quality of the service which had led to improved experiences and outcomes for people.
There were enough staff to support people safely. Staff had the knowledge and skills to meet people’s needs. Recruitment was managed safely. People appeared relaxed and comfortable in the company of staff, and we observed warm and caring interactions. Relatives praised the standard of care.
The home was organised and well maintained and there was a team of ancillary and clinical staff to support the care team. There were close links with health professionals and other agencies to ensure people’s health needs were met.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practise.
There was a new registered manager in post. They provided leadership to the team and promoted an open team culture. Staff said the registered manager was accessible and supportive. They confirmed they had seen improvements in the quality of the service provided to people and the morale of the team.
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 inadequate (published 24 August 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
This service has been in Special Measures since 5 October 2021. During this inspection the provider demonstrated some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
The inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Asquith Hall on our website at www.cqc.org.uk.
We have identified breaches in relation to the safe administration of medicines, the management of risk and good governance.
Please see the action we have told the provider to take at the end of this report.
The provider took action immediately during and after the inspection. They submitted an action plan after the first day of the inspection and provided regular updates on other steps they had taken to mitigate the risks to people’s health, safety, and welfare.
The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.
We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.