Archived: Ashdale Care Home

Ashdale Care Home is a residential care home providing the regulated activities of personal and nursing care to up to 22 people. The service provides support to people aged 65 and over and adults with physical disabilities. At the time of our inspection there were 16 people using the service. Accommodation is provided over 2 floors. A communal lounge with a dining room is based on the ground floor.

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

Records relating to people's care did not always contain information and guidance to enable staff to provide the safe care and support people required. Risk management was not in place for some people who were at a high risk of choking, falls and needed to use bedrails to keep them safe.

People were not supported by staff who had been appropriately trained and assessed as being competent to deliver safe care and treatment to people. People were left at risk of being supported by staff without the skills and knowledge to support their identified needs. People had not received their medicines in a safe way and as prescribed by their GP.

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 or in their best interests; the policies and systems in the service did not support this practice.

The service was not well-led. There was no effective governance system in place to monitor the quality of the service provided to people. The provider continued to fail to recognise risks and concerns in relation to risk management, safeguarding, and medicine management. Lessons were not being learnt or action taken by the provider when additional support was provided to them by the local authority in-between inspection visits.

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 this service was requires improvement (published 4 November 2022). The service is now rated inadequate. This service has been rated requires improvement for the last 2 consecutive inspections. 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 improvements had not been made and further risk was found.

Why we inspected

The inspection was prompted by information shared by stakeholders. We received concerns in relation to the management of medicines, people’s nursing care needs, staffing, poor care planning and risk assessing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

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 Ashdale Care Home on our website at www.cqc.org.uk.

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.

Enforcement

We have identified breaches in relation to safe care, consent to care and 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

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.

Ashdale Care Home is a residential care home providing the regulated activities of personal and nursing care to up to 22 people. The service provides support to people aged 65 and over and adults with physical disabilities. At the time of our inspection there were no people living at the care home.

What we found

There were no people living at Ashdale Care Home. We were therefore not able to ask for people’s experiences of care provided.

The provider did not have suitable equipment to support people who were at risk of falling out of bed.

There were environmental risks. The provider had not completed routine water maintenance. This means there is an increased risk from legionella bacteria, which can cause serious ill health. The fire alarm system had a fault, this had not been investigated or resolved. The care home’s heating system was not effective, so the home was cold.

The provider could not provide a list of staff names, their training or full recruitment details. This meant we were not assured that there would be suitable staff to care for people safely.

People using the care home could be at risk of choking. Only one staff member had received relevant training on how to support people’s swallowing needs, there was a lack of guidance in the kitchen for staff to follow.

There was no clear action plan for the provider to make the required improvements. New policies that had been put in place, were not clear.

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 this service was inadequate (published 13 November 2023)

This service has been in Special Measures since the last inspection report. During this inspection, the provider did not demonstrate that improvements have been made. Therefore, this service remains in Special Measures.

Why we inspected

We undertook a targeted inspection to check whether the concerns seen at the previous inspection had been resolved. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has not changed following this targeted inspection and remains rated inadequate

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

Enforcement

The previous inspection identified 3 breaches of regulation. As there were no people living at Ashdale Care Home, we were not able to assess the effectiveness of any action taken since the last inspection. Therefore the 3 breaches of regulation remain in place.

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.

Special Measures

At the last inspection, the service was rated inadequate and therefore entered ‘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.

Ashdale Care Home is a residential care home providing personal and nursing care to 11 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

Medicines were not always managed safely. People told us they sometimes had to wait for staff longer than they would expect. The provider implemented a range of systems including audits and checks to assess, monitor and improve the service. However, these had not been effective in ensuring the safe and proper management of medicines. People gave us mixed feedback about the quality of food served to them.

People told us they felt safe and staff were kind and caring. Staff had received training to keep people safe and manage risks. The manager had reviewed and updated people’s care plans and risk assessments to ensure people’s needs were clearly identified and supported by staff. The service worked very well with other organisations to ensure people's needs were met.

The home was clean and homely but required maintenance work and redecoration throughout. The provider had a refurbishment plan in place.

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 were happy with the care they received and there was a clear direction and ambition to improve the service.

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 July 2022).

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 improvements had been made and the provider was no longer in breach of regulations. However, there were some areas still in need of improvement, not identified by the provider, which they addressed promptly.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

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.

Follow up

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

Ashdale Care Home is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

Risks associated with people’s care and support had not always been updated when their care needs had changed, or incidents had occurred. Medicines were not always managed safely by suitable trained staff. Accidents and incidents were not always investigated.

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

Quality assurance systems were not always robust to identify the shortfalls we found during the inspection. The provider asked people to give feedback about the quality of they received.

People told us they felt safe at the home. Staff were aware of how to safeguard people from abuse. There were enough staff to support people safely and meet their needs. People were supported by staff who used a personalised approach to care and asked people for their preferences and consent.

People, their relatives and staff thought the registered manager was approachable if they had any concerns and they spoke to them regularly about the quality of their care. Where required, the staff referred people to external professionals for more specialised support and advice.

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 good (published 19 March 2020).

At our last inspection we recommended that the provider considers current guidance and ensures all staff fully understand and demonstrate a good working knowledge of the Mental Capacity Act 2005. At this inspection we found that the management team were still not fully aware about the requirements relating to assessing people’s capacity.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care plans, risk assessment and documentation, premises and medicines. 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.

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 changed from good 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 and well-led section of this 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 Ashdale Care Home 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, management of medicines, consent to care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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.

We found the following examples of good practice.

•The registered manager had implemented a robust system for all visitors which included a temperature check, hand sanitising and the requirement to wear a face mask upon entering the home. Detailed information was displayed around the home to remind people how to wash their hands effectively. A COVID-19 assessment was completed on arrival to all external visitors, this was carried out by an allocated member of staff.

•Staff were provided with the appropriate personal protective equipment [PPE]. Staff were knowledgeable on when to change PPE and had received enhanced training.

•The registered manager had registered for 'whole home testing' for staff and residents. The registered manager had a system in place to identify all who had been tested.

•Thorough risk assessments were carried out to assess the impact of COVID-19 on people and staff. Actions were taken to mitigate risks to people when needed.

•The Provider was very supportive of the registered manager and the well-being of the staff team. For example transport was provided to those who would normally use public transport to minimise the risk of transmission of COVID-19.

•Strict cleaning schedules were in place and appropriate decontamination processes were also in place.

•The registered manager undertook contingency planning in case there was a future outbreak of COVID-19. For example, agency staff would be available to cover potential staff absences. Assurances had been sought from the agency that staff had received a negative COVID-19 test and they would work only at this service.

•The registered manager had an admission process in place which minimised the risk of potential transmission of infection to people living at the home. For example, all people were isolated for two weeks following admission to the home.

Ashdale Care Home is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

People felt safe living at Ashdale Care Home. Risks associated with people’s care and support had been identified, monitored and managed. An appropriate recruitment process was followed and there were suitable numbers of staff available to meet people’s care and support needs. Staff followed the provider's infection control policy and medicines were handled safely and in line with GP’s instructions. The registered manager made sure lessons were learned when things went wrong.

People’s care and support needs had been assessed prior to them moving into the service. This ensured their identified needs could be met by the staff team. Staff had the appropriate skills and knowledge to meet people’s needs and they worked together to deliver effective care and support. People were supported to eat and drink well and access the relevant healthcare professionals when required.

People’s consent to their care and support was obtained. They 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. However, some documentation relating to the Mental Capacity Act had not always been completed appropriately.

People were provided with a comfortable place to live and rooms were personalised. Staff were kind and caring and treated people with dignity and respect. Staff involved people in making decisions about their care and support.

Care plans had been developed and staff knew the people they were supporting well. Complaints were taken seriously, investigated and responded to appropriately. Whilst people’s wishes at the end of their life had been explored, work to further enhance this area was required.

Auditing systems were in place to monitor the service being provided. Staff felt supported by the registered manager and their thoughts on the service were sought. Whilst the registered manager sought the views of people using the service and their relatives informally, they planned to reintroduce meetings and surveys to formalise the process.

We have made a recommendation regarding staff's understanding of the Mental Capacity Act 2005.

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 this service was good (published 8 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

They were last inspected on 6 January 2015 and were found to be good overall but to require improvement in providing activities that interested people and recording complaints. At this inspection we found that improvements had been made. People were encouraged to pursue interests and hobbies and regular activities were planned. Partnerships with external organisations had extended the range of activities on offer and completed life histories ensured that they were planned in line with people’s interests.

Complaints were managed within the provider’s procedure and any concerns were resolved promptly. Visitors were welcomed at any time and they were encouraged to provide feedback through meetings and more informally. Families were welcomed to stay when people were being cared for at the end of their lives. Staff were trained and supported to provide care which met people’s wishes at this time. Dignity and privacy was maintained at all times.

Staff developed caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences. They understood the importance of consent and always explained to people what care they were going to provide. People’s capacity to consent to their care and make their own decisions was assessed and reviewed when required.

People received the medicines they were prescribed safely and there were systems in place to reduce the risks associated with them. They were supported to maintain good health and had regular access to healthcare professionals. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

People were kept safe by staff who could identify signs of abuse and knew where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. People told us that there were always enough staff to meet their needs promptly.

Mealtimes were not rushed and people said that the food was good. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk.

The provider completed quality audits to continually drive improvements. They also met their regulatory requirements.