Archived: Ashurst Place

Ashurst Place is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashurst Place is a large detached converted property, set in 23 acres of parkland and fields in the village of Langton Green, three miles from Tunbridge Wells. The home is located in a rural area where there are some shops, a church and a bus service. There are bedrooms over two floors of the service and a lift is available for people to move between the floors. The service is registered to accommodate 37 people and there were 19 people living at Ashurst Place at the time of our inspection.

At our last inspection in January 2017, the service was rated requires improvement. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we found. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. At this inspection we found that the breaches of regulation we previously found in relation to keeping care plans up to date and having effective systems to monitor the quality of the service continued. We also found seven new breaches in relation to four regulations and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the 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

There was a registered manager employed at the service. 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.

Medicines were not being managed safely as people with PRN (as required) medicines did not have specific and detailed guidance instructions on how to administer PRN medicines. Other medicines were being administered safely to people.

Risks around possible infections were not consistently being managed with control measures. Some parts of the service were not clean and some national guidance had not been implemented. We have made a recommendation about this in our report.

People were protected from abuse by staff who understood their role in keeping people safe. The safeguarding adults policy was up to date so staff had up to date information to refer to about how to keep people safe from abuse. Staff we spoke with understood how to keep people safe from abuse.

Recruitment procedures had not consistently been followed. Some historical convictions had been risk assessed but some gaps in employment had not been explained. We have made a recommendation about this in our report.

People were at risk of not having their health needs met as care plans did not reflect their diagnoses and explain all conditions. Not all training had been delivered as per the providers’ policy. We found that some staff had not received equality and diversity training frequently enough. Other training had been sourced and provided to staff who told us that their training was effective.

Pre-admission assessments were not detailed enough and did not contain all relevant information and there was a lack of clinical monitoring tools used to check people’s skin, weight and nutrition intake. The building met people’s needs and there were extensive and well-kept grounds. Some parts of the building looked a little dated and were in need of redecoration. We have made a recommendation about this in our report.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People living at the service were deemed to have capacity to make day to day decisions.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked their staff and enjoyed their company. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible.

People received personalised care but it was not planned systematically. The care people received relied on staff verbally handing over information to each other and care plans were not person centred. People were supported in their last days and weeks to have a pain free and dignified death. However, end of life care plans did not cover areas such as how families should be supported, or personalised details such as which music people wanted to be played at their funeral.

There was a complaints policy and form, including an accessible format available to people. Complaints had been used to improve the service delivered to people.

There had not been an improvement in the quality auditing system and issues identified at this inspection were not picked up and put right by management audits. The registered manager had failed to notify us of all incidents.

There was an open and homely culture in the service and staff worked well as a team. People, their relatives and staff members were engaged in the running of the service. There was a culture of working collaboratively with other professionals and local health providers to ensure partnership working resulted in good outcomes for people.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so people, visitors and those seeking information about a service can be informed of our judgements. The provider had displayed the rating conspicuously in the service and on their website.

This is the second time the service has been rated as required improvement.

Ashurst Place is registered to provide personal care and accommodation for up to 37 people. There were 22 people using the service during our inspection who were living with a range of care needs. These included diabetes and mobility support.

Ashurst Place is a large detached converted property, set in 23 acres of parkland and fields in the village of Langton Green, three miles from Tunbridge Wells. The home is located in a rural area where there are some shops, a church and a bus service.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Ashurst Place was last inspected in May 2016, when it was rated as inadequate overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 at that inspection and issued requirement actions and warning notices. The breaches of regulation related to risks around maintenance, the safe storage of medicines, sufficient staffing levels, the risk of people being socially isolated, effective quality auditing systems, compliance with the MCA 2005 and failure to respect people’s privacy. The provider sent us an action plan to tell us how they would address these breaches by September 2016. At this inspection we found that previous breaches and warning notices had been met. However we also found two new breaches and made some recommendations. You can see the recommendations in the main body of the report and you can see what action we asked the provider to take at the end of this report.

People had access to a range of healthcare professionals to have their needs met. However, there was a risk that people’s assessed needs may not be met as care plans were not always updated to reflect peoples’ changing needs.

People were living in a safe environment as the home's equipment was well maintained. Staff understood the importance of people's safety and knew how to report any concerns they may have. Risks to people's health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. However, there were risks to people’s health as not all risk assessments and care plans had been updated in a timely manner.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the individual’s prescribed medicine, the reason for administration, dosage and any side effects.

Environmental risk assessments had been completed and a maintenance system was in place. However, some people told us there was not a sufficient supply of hot water and one upstairs bathroom needed to be renovated.

There were sufficient numbers of staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective recruitment and selection procedures in place.

People had enough food and drink to meet their needs and to stay healthy and people could see a GP when they wanted to.

The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Not all staff felt confident speaking about the principles of the MCA 2005 and some requested further training. People’s mental capacity was assessed but the bed rails assessment tool did not have a space for people to consent to the use of bedrails.

Care plans contained people’s preferences and had details of people’s backgrounds and personal histories. However, people’s involvement in care planning was not always recorded.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. Staff were skilled to approach people in different ways to suit the person and communicated in a calm and friendly manner which people responded to positively.

People who wanted to be occupied had busy lifestyles which reflected their lifestyle choices and likes and dislikes. However, people told us that they were not always happy with the frequency and range of activities and that there were not enough outings.

Complaints were recorded and logged and were used to improve the quality of the service. Verbal complaints were not being recorded at the time of our inspection but the registered manager told us they will record all verbal complaints formally.

There was an open, transparent culture and good communication within the staff team. Staff spoke highly of the registered manager and their leadership style.

The registered manager took an active role within the home and led by example. The provider had systems in place to assess and audit the quality of the service but these were not yet robust enough to identify area needing improvements and audits did not happen frequently enough to capture all shortfalls.

Ashurst Place is a large period home set in 23 acres in the village of Langton Green near Tunbridge Wells. The service provides personal care and accommodation for a maximum of 37 older people. At the time of our inspection there were 29 people living at the home some of whom required support to manage health conditions such as diabetes and some of whom were living with dementia, the effects of stroke and learning disabilities. Some people required assistance with moving around the home.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People told us they felt safe and staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. However we identified risks that the registered manager and registered provider had failed to identify or act upon including areas of poor maintenance which placed people at risk of harm.

The registered provider followed safe recruitment procedures to ensure staff working with people were suitable for their roles. However, staffing levels were not based on people’s needs and did not promote their safety and wellbeing.

Medicines were not always stored safely and necessary checks had not been made to ensure medicines were safe to use.

The registered provider had not ensured that the requirements of the Mental Capacity Act 2005 were followed and people were therefore at risk of having their liberty restricted unlawfully.

People received medical assistance from healthcare professionals including district nurses, GPs, chiropodists and the local hospice. However, staff did not have the guidance they needed to ensure people’s health needs were met.

People and their relatives told us staff were kind and caring however the registered provider had not ensured that people’s privacy was respected.

People could not be assured they would receive responsive care as assessment and care plans did not provide staff with up to date detailed information and guidance. People’s preferences and social needs were not always respected even when known and people told us that their days were often without meaningful occupation.

The registered provider had not ensured that monitoring checks and audits undertaken were effective, identified concerns and led to improvement. Where people and their relatives had given feedback this had not always been acted upon.

People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed and their involvement encouraged.

We have taken enforcement action and issued two warning notices. Details of the warning notices can be found at the end of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

People told us, "The food is always good, and there is plenty to eat", "I can always ask for something different, or something extra, and they bring it to me"; "They encourage me to eat. They do lovely home-baked cakes and come around with tea or coffee three times a day between meals", and, "I have piled on the pounds since I've been here, the food is good".

People's needs were assessed before their admission and care plans were written, reviewed and updated with people's participation. One relative said, "They always go the extra mile to meet each resident's needs". A member of staff told us, 'I would have a member of my own family staying here without reservation'.

We found that the premises were suitably designed and laid out and the building was well maintained. A person told us, "It is lovely here, bright and spacious, there is plenty of room and the grounds are absolutely beautiful".

We found there were effective recruitment and selection processes in place. One care worker told us, "I am in a probation period and have to demonstrate I can do the job well".

We found that staff received individualised and group support from the manager. They were encouraged to study and followed a comprehensive training programme. A member of staff told us, "There is an open door policy, we just share our concerns on the day with management without problem. It is just like a family".

People's personal records, staff records, and other records relevant to the management of the service were accurate and fit for purpose.

We found that the manager promoted and monitored good practice and focussed on respecting dignity and privacy. One person told us "I like it here, I can have a say and do as I please". People were positive about the care they had received. One person said "The staff never rush me and I am encouraged to be as independent as possible".

People told us they felt safe in the home and could talk to the staff and manager about any problems. One person said "The staff are ever so kind, they are gentle and efficient". We found that people who used the service had comprehensive care plans which reflected their individual needs. We saw that clear action plans about their care and treatment were implemented. A relative commented "The home have taken such good care of my dad. He has felt comfortable and they have made such great improvement to his health". Another relative said "They welcome us with warmth, this reflects the care given at Ashurst Place".

People were complimentary about the quality of the food. One person said " The meals are always tasty and hot". Another person stated "I like the breakfasts in bed".