Ashford House Care Home

Ashford House is a residential care home providing accommodation and personal care. The service is registered to support up to 27 older people with a physical disability, dementia and mental health needs. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 15 people were suing the service, 1 person did not receive a regulated activity.

Accommodation was split across two floors accessed by a lift and two stairwells.

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

Following the last inspection, quality assurance systems and processes to monitor the quality and safety of the service had improved. However, many of the improvements required to the premises identified at the last inspection had not taken place.

The registered manager was accessible, open and inclusive. People, relatives and staff told us they were supported by and had confidence in the registered manager.

People felt safe and risks were mostly assessed and managed. Some improvements were required to ensure all risks were identified, the registered manager agreed to take this action. There were enough staff with the right skills and experience. Some people had complex needs and at times staff were very busy attending to people’s needs in different areas of the service. This meant at times people had to wait for staff to attend to them and on one occasion there were no staff available to support people in the communal lounge.

People received their medicines in a safe way. When things went wrong, the registered manager used this as an opportunity to learn. Systems and processes were changed to reduce any further risks.

Staff were kind and caring and had developed positive relationships with people. People were involved and included in decision making about their care and support. People were supported to maintain relationships with people important to them. Social activities were provided. However, opportunities for people to follow their interests and hobbies were limited.

People liked the meals provided and were mostly supported to eat and drink sufficient amounts. Staff identified when people’s health deteriorated. They consulted with health care professionals and followed their advice and guidance.

Staff had the training and support they required to carry out their role.

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. People had appropriate authorisations in place for deprivation of liberty (DoLS) where this was required. Staff did not always follow the DoLS conditions. This meant important information to support least restrictive practices was not always available. For example staff were required to record the action taken when the person became distresses or were resistant to care but they did not always do this.

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

The last rating for this service was Inadequate (published 6 May 2022).

This service has been in Special Measures since 26 November 2021. During this inspection the provider demonstrated that 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

This 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.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified a continuing breach in relation to leadership and quality monitoring 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Rearsby Home Limited is a residential care home providing accommodation and personal care. The service is registered to support up to 27 older people with a physical disability, dementia and mental health needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. On the first day of inspection 15 people were in receipt of personal care, this had reduced to 14 on our second day.

Accommodation was split across two floors accessed by a lift and two stairwells.

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

Following the last inspection, quality assurance systems and processes to monitor the quality and safety of the service had been implemented. These were ineffective as they had not identified or addressed all the concerns we found during this inspection, or the previous two inspections.

Risks to people had not always been assessed or reviewed when people’s needs changed, which meant opportunities to reduce people’s risks had been missed placing them at increased risk of harm. Environmental risks and hazards had not been identified or addressed. Medicines systems and processes were ineffective and unsafe.

People were not always supported to have maximum choice and control of their lives and staff did not always 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. Whilst we observed staff to offer people choices and respect these, the provider had failed to address the concerns we identified at the last inspection to comply with the requirements of the Mental Capacity Act. Mental Capacity assessments and best interest decisions had not been reviewed since the last inspection.

Not all staff had received Safeguarding adults training, this is the third inspection we have found this concern. Since the last inspection a new training programme had been implemented. However, whilst some training had been undertaken by staff, the provider’s training matrix evidenced poor compliance with the training programme. New staff had not received training from the service prior to commencing their role. This meant we could not be assured staff had the skills or knowledge to support people safely and in line with best practice.

Improvements had been made to infection prevention and control systems and processes. However, Improvements were still needed to the environment to address the remaining issues such as replacing stained carpets, worn furniture, vanity units and window frames. The home required redecoration and refurbishment in some areas.

People told us they were bored as there was nothing to do. Whilst we observed kind and caring interactions, we did not observe any activities taking place. People gave positive feedback about the food, and staff at the service. Relatives told us they were happy with the visiting arrangements at the service. There were enough staff available to meet people’s needs.

A new manager had been employed in January 2022. Staff and people spoke about the positive impact they had made in a short space of time. As they were newly recruited, improvements they had implemented were not embedded in practice. We were unable to assess the effectiveness and sustainability of these improvements at this inspection.

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 26 November 2021) and there were six 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 not enough improvement had been made and the provider remained in breach of regulations. The service remains rated inadequate.

Why we inspected

This inspection was prompted in part due to concerns received about infection prevention and control, the environment and the governance at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 Rearsby Home Limited 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 consent, safe care, safeguarding, staff training and development and the leadership and management of the service.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service therefore 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.

About the service

Rearsby Home Limited is a residential care home providing accommodation and personal care. The service is registered to support up to 27 older people with a physical disability, dementia and mental health needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 23 people living at the service at the time of the inspection, 22 received personal care.

Accommodation was split across two floors accessed by a lift and two stairwells.

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

People were not always kept safe from the transmission of COVID-19. Government guidance for testing, visiting, admissions to care homes and the use of personal protective equipment had not been followed. Cleaning schedules did not evidence frequently touched areas were cleaned or deep cleans undertaken. People were not supported to socially distance and people’s risks had not always been appropriately assessed and measures put in place to reduce them.

There was an absence of safeguarding systems and processes and records. Staff had not always been safely recruited.

Staff had not been equipped with the skills and knowledge they required to undertake their role effectively. Staff training was either overdue or had not been undertaken. Some staff had not received an induction to introduce them to their role. Staff had not received regular supervisions to consider their development needs.

There were widespread failings of the leadership and governance of the service. Quality assurance systems and processes were either absent or failed to identify the concerns we found during the inspection. The registered manager and provider failed to ensure the action plan submitted following the last inspection had been implemented.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Whilst we observed staff offer people choices, mental capacity assessments and best interest decisions for people that were unable to make choices had not always been undertaken. Where they had, they were not always fully complete.

We received mixed feedback from relatives about access to healthcare professionals. We received positive about the food and observed people eating well.

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 requires improvement (published 13 April 2021) and there were three 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

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 received concerns in relation to falls management, infection prevention and control, training and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rearsby Home Limited on our website at www.cqc.org.uk.

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 the delivery of safe care, consent, safeguarding, training, recruitment and the leadership and management of the service.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Rearsby Home Limited is a residential care home providing personal and nursing care for up to 27 people aged 65 and over, including people living with dementia. At the time of the inspection 21 people were living at the home.

Accommodation is over two floors and there are dining and communal areas on the ground floor.

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

There was a lack of evidence available to demonstrate management audits and quality checks continuously took place to drive improvement at the service. We found shortfalls in records and working practices relating to safeguarding, complaints, staff recruitment, training and development, staff supervision and infection control systems.

The infection prevention and control policy needed to be reviewed to reflect current government guidance on reducing the risks of transmission of the Coronavirus. Cleaning schedules had not been revised to reflect that the frequency of cleaning high touch points had increased. In addition, systems were not in place to routinely check cleaning schedules were consistently being followed. We signposted the provider to resources to develop their approach.

The environment needed refurbishment and redecoration. At the time of the inspection a plan of refurbishment and redecoration was in the process of being implemented.

Staff were checked for suitability for their roles prior to starting work. This included checks through the disclosure and barring service (DBS), to include a criminal conviction check. The provider needs to ensure they follow the COVID-19 pandemic employment interim guidance when employing staff using an existing relevant DBS. Systems need to be in place to ensure suitable references are obtained timely.

There was enough staff on duty to meet people’s needs. However, the registered manager should review the care of people cared for in bed, and at risk of social isolation. To ensure they receive regular person-centred interactions from staff, other than at times when staff are providing personal care, food and drinks.

Systems to ensure staff receive appropriate support, supervision and training, necessary for them to carry out their role and responsibilities had not been consistently provided. The registered manager said during the COVID-19 pandemic, face to face training courses had been suspended. They recognised they had not kept records up to date and confirmed this was something they were addressing.

Staff supervision one to one sessions had stopped taking place. (These are intended to give staff the opportunity to discuss in confidence, their role, any arising issues, and any other matters). The registered manager said they were working on introducing a plan of group and one to one supervision sessions for all staff.

Systems were in place to ensure people received their medicines safely. However, staff need to ensure the medicines administration records (MAR) are not damaged when placing them in ring binders.

Accidents, incidents and falls were monitored to identify the possible cause, to reduce the risk of similar events occurring.

Meal choices were available for people, and people’s cultural, ethical and religious needs were considered in meal planning. Staff had sought the advice of the speech and language therapist (SALT) to support people that required food and drinks to be modified. Staff worked with other health and social care professionals to deliver effective care and treatment.

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.

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

The last rating for the service under the previous provider was Good, published on 15 October 2019.

Why we inspected

We had received concerns about safeguarding and infection controls at the service. A decision was made to carry out a focused inspection to examine safe and well-led. The findings on the first day of inspection prompted us to request further information from the provider. On review of the information we decided to revisit the service to carry out a comprehensive inspection to examine the remaining key questions, effective, caring and responsive.

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 coronavirus and other infection outbreaks effectively.

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.

You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to safeguarding, training and good governance at this inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.