1 April 2021
During an inspection looking at part of the service
Ashleigh Nursing Home is a care home providing personal and nursing care for up 16 people aged 65 and over at the time of the inspection. The service can support up to 21 people in one adapted building.
People’s experience of using this service and what we found
Risks were not always identified, managed or monitored to ensure people were safe and protected from harm. Staff did not have sufficient guidance in care plans and risk assessments. Medicines storage, administration and management were unsafe.
Infection prevention and control procedures did not protect people and staff from the risk of contagious diseases. Health and safety issues were found in relation to the premises and equipment used in the delivery of care.
Further improvements were needed in relation to meeting people’s cultural dietary needs and monitoring people’s intake of food and drink so action can be taken. People were provided with a choice of meals and their dietary needs had been assessed. People had access to healthcare support when needed.
Systems to protect people’s safety and wellbeing was not implemented fully. Staff recruitment procedures were not always followed. People were at risk of receiving unsafe care from staff whose induction and essential training for their roles was not kept up to date and their competency had not been assessed. Increased staffing levels would promote a person-centred approach to care and enable staff to spend more time with people. Systems and processes to protect people from the abuse and improper treatment was not robust.
People did not receive person-centred care and care plans lacked sufficient guidance to enable staff to provide effective care. We could not be assured people were supported to have maximum choice and control of their lives. Mental capacity assessments were not robust or detailed. This meant staff may not be able to support people in the least restrictive way possible and in their best interests. Further action was needed to ensure the policies and systems in the service were followed.
The premises and equipment were not adequately maintained to meet people’s needs or promote their independence. Further action was needed to ensure the environment was suitably adapted to support people living with dementia.
The provider did not have effective systems and processes to assess, monitor and improve the quality of service and provide good care. Quality assurance systems had not identified widespread issues in relation to people’s care, risk assessments, medicines, infection prevention practices, impacted by staff competence and training and environmental risks. This placed people at serious risk of harm.
The provider and registered manager had not fulfilled their legal responsibilities. Breaches of regulations were found at our inspections of June 2018 and our inspection in August 2019. This demonstrated the lack of lessons learned and limited action had been taken to improve the service as further breaches of regulations were found 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
The last rating for this service was requires improvement (published 5 November 2019). We imposed conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to bring about the improvements needed. The service rating has deteriorated to inadequate. Breaches of legal requirements were found, and the service was placed in special measures. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led which contains the requirement. 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion 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. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashleigh Nursing 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 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, infection prevention and control, safeguarding service users from abuse and improper treatment, premises and equipment, staffing, governance and quality monitoring and failure to submit notifications to the CQC, 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.