Asquith Hall

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.

Enforcement

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.

Follow up

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.

Asquith Hall is a residential care home providing personal and nursing care to up to 53 people. The service provides support to people living with dementia and people with mental health needs. At the time of our inspection there were 36 people using the service.

The service is purpose built with accommodation provided in two separate wings; Willow on the ground floor and Meadow upstairs. Each wing has its own facilities including lounge and dining areas.

People’s experience of using this service and what we found

People were not safe. People were at risk of harm because the provider did not always identify or mitigate risks. This included risks relating to people's health and care needs as well as risks from other people they lived with. Medicines were not managed safely. Accidents and incidents were not always appropriately recorded and staff did not always follow safe practice when using restraint.

Care was not always person-centred and care records did not fully reflect people’s needs. People were not always treated with dignity and respect, and their experience of care varied. Some staff interacted very little with people and other staff were very caring and skilled when diffusing potential risky situations. Some activities were taking place and the registered manager had plans to further develop these when a second activity worker finished their induction.

Staff did not receive the training and formal support they needed for their roles. Staff did not always have time to be flexible and respond to changing needs.

The service supported people to access appropriate healthcare support and a team of specialists employed by the provider were involved in people's care. The service worked in partnership with health and social care professionals. Other agencies told us the service was engaging.

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 practice.

The service had made some improvements but they were still not always identifying, capturing and managing quality and safety. The service carried out a range of checks, but these did not identify some key issues and secure improvements. The service had improved systems for preventing and controlling infection and communication. We observed several team meetings; these were well attended and informative.

The registered manager and provider took some action during and after the inspection although not all actions were completed as agreed.

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 25 October 2021).

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We found the provider had not taken appropriate action to mitigate these.

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.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, safeguarding people from abuse, person-centred care, dignity and respect and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Asquith Hall is a residential care home providing personal and nursing care for up to 53 people, some of whom are living with dementia and/or mental health needs. At the time of the inspection there were 48 people using the service. The service is purpose built with accommodation provided in two separate wings – Willow on the ground floor and Meadow upstairs. Each wing has its own facilities including lounge and dining areas.

People’s experience of using this service and what we found

People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks.

Parts of the premises were not clean. Infection control procedures were not always followed by staff as personal protective equipment (PPE) was not worn correctly and social distancing was not maintained.

People did not always receive person-centred care and care records did not fully reflect their needs. People were not always treated with respect by staff or had their privacy and dignity maintained. Although some staff were kind, caring and compassionate and treated people well, other staff were task focussed and did not respond appropriately to people's needs. There were no activities taking place and there was little to occupy and interest people.

Staff did not receive the induction, training and support they needed for their roles. Staffing levels were sufficient to meet people’s needs when all staff attended, however there were often last minute absences which impacted on staff numbers. We have made a recommendation about the management of staff sickness.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There had been a recent change in leadership and an ineffective governance structure meant the service was not appropriately monitored at manager or provider level.

People were supported to keep in touch with family and friends through video, phone calls and indoor visits. People had access to healthcare services. People’s medicines were managed safely but guidance relating to pain management needed to improve. People were provided with a choice of food and drinks.

The manager and provider were responsive to the inspection findings, took action during and after the inspection and shared plans to improve their systems and processes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service under the previous provider was good, published on 2 December 2017.

Why we inspected

The inspection was prompted in part due to concerns about staffing levels and the high number of safeguarding notifications received which referred to restraint being used. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see all the sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person-centred care, privacy and dignity and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.