Archived: Ashley Down Nursing Home

Updated 9 October 2020

The inspection

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 Care Act 2014.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Ashley Down Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with CQC. There was a manager who told us they were going to apply to register. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed information we had received about the service since the last inspection. This includes details about incidents the provider must notify us about, such as abuse. The provider was not asked to send us a provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We took this into account when we inspected the service and made judgements in the report. We used all of this information to plan our inspection.

During the inspection-

We spoke with two relatives about their experience of the care provided. We spoke with five staff, the manager and the provider. We reviewed a range of records. This included two people’s care records and multiple medicines records. We looked at six staff files in relation to recruitment, training and supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and policies.

Updated 9 October 2020

About the service

Ashley Down Nursing Home is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. The service can support up to 19 people. Some people were living with dementia and people required support to move around the service.

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

People were not supported by enough staff to keep them safe and provide the support to meet their needs. The provider relied heavily on the use of agency nurses and carers. Recruitment practices were unsafe. People could not be assured the relevant checks had been carried out on potential new staff to ensure they were safe to provide their support because the provider did not carry out robust checks. Staff did not complete regular training to make sure their skills and knowledge were up to date with current legislation and best practice. There was no oversight of what training needed to be completed and when it should be completed.

People’s medicines were not managed safely. They were not always ordered on time to make sure people had their medicines when they needed them. Medicines were not disposed of safely and in line with national guidance and best practice. Medicines records were not consistently accurate and there were unexplained gaps in the records.

The premises were not always safe and essential checks, such as gas safety, had not been completed in a timely way. There had been significant concerns with the fire system when fire doors were not closing in an emergency. We contacted the local fire and rescue service who attended the service and instructed the provider to take steps to keep people safe. The service was clean; however, areas of the service had been affected by leaks and there was no maintenance plan to rectify this or redecorate the rooms.

People’s dignity was not always promoted. For example, staff did not notice when a person had large holes in their trousers. People’s privacy was respected.

There was a lack of oversight of the quality of service and there was no plan to drive improvements. Audits and checks were inconsistent and not robust. The previous six inspections identified significant concerns. The provider did not take any responsibility or ownership or give any assurances that immediate action would be taken to address CQC’s concerns at this inspection. The provider and manager did not work cohesively to implement changes and they did not lead by example.

People were supported to eat a healthy and balanced diet and were offered drinks throughout the day to keep hydrated. Meals looked appetising. People’s health care needs were assessed, monitored and reviewed. Staff referred people to the relevant health care professionals, such as specialist nurses, when required and followed advice they were given. When people were supported at the end of their life, staff worked with hospice nurses to make sure they were supported to have a comfortable, dignified and pain-free death.

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.

Relatives told us they were happy with the care their loved ones received and that the staff were kind. Staff knew people well and were knowledgeable about how people preferred to be supported. Staff understood people’s communication needs and spoke with us about how they observed people’s body language when they were unable to express themselves verbally. Information, such as the resident’s guide and statement of purpose were available in an easy to read format. When a complaint had been received, the provider had investigated and responded to the complainant in line with their policy. Complaints had been satisfactorily resolved.

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 06 February 2019).

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. This service has been rated Inadequate or Requires Improvement for the last six inspections.

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.