Archived: Ashworth Grange

Updated 22 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 January 2016 and was unannounced. The inspection team consisted of three adult social care inspectors.

Before the inspection we had received information of concern from relatives and external organisations as to the level of support people with dementia were receiving. We also liaised with the local authority safeguarding and commissioning team. We had not asked the provider to complete a Provider Information Return (PIR) as the inspection was brought forward due to concerns about the service. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make

We spoke with five people living in the home and six of their relatives. We spoke with eight staff including six carers, the deputy manager, and the registered manager. We also spent much of the day observing people in the specialist dementia provision.

We looked at five care records including risk assessments, mental capacity assessments and food and nutrition charts. We also looked at three staff personnel records including supervision and appraisal records, minutes of staff and resident meetings and audits including accidents, medicines and care plans.

Updated 22 March 2016

The inspection of Ashworth Grange took place on 18 January 2016 and was unannounced. The home had previously been inspected in July 2013 and found to be compliant with the requirements of the Health and Social Care Act 2008 and its associated regulations.

Ashworth Grange is a purpose built care home registered for 64 people, some of whom may be living with dementia. There were 60 people in the home on the day we inspected. The home is organised into four units, two of which specialise in caring for people with a diagnosis of dementia and are accessible only by a secure keypad. There is an integrated garden area on each side of the home with seating areas and shelter.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The home had a registered manager who was there on the day of inspection. 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.

People and relatives consistently told us there were not enough staff. We saw this throughout the day as we observed the length of time to answer call bells and also periods when communal areas were left unattended. This was also stated by staff who felt under pressure to deliver all their key tasks and were aware of people being left unmonitored.

We also found, due to staff swapping units every shift, that knowledge of people’s situations was scant despite there being a handover. This included very basic of information such as how many people staff were actually caring for. This was evidenced by one staff member counting the files in a cupboard.

Risk assessments were not completed properly and lacked detail such as when someone needed equipment to assist them to move. Staff’s knowledge of the fire evacuation procedure was unclear for people nursed in bed and the home did not meet its own requirement for the number of fire marshalls which stipulated six staff.

Staffing levels did not vary according to need. The rota was set at nine staff per day and four at night. The registered manager told us that staffing levels were due to increase to one more per shift but this decision was to provide an extra set of hands and was not based on any analysis of people’s needs.

There were high levels of unwitnessed falls and some of these had resulted in hospital attention. These had not been reported to the Care Quality Commission in line with regulations.

Most staff had received mandatory training but this was out of date, especially in regards to the safe handling of medicines. This included the registered manager who assessed others’ competency but whose own training had expired in 2011. Staff did have supervision and appraisals but these were mostly generic.

The home had not requested any Deprivation of Liberty Authorisations as they were felt these had not been necessary as people were not trying to leave the building. The understanding of mental capacity was poor in terms of the assessments as these often contained conflicting information.

We did not see people offered much choice over their food and nutrition and found that people recognised at being at risk of weight loss were not being monitored effectively as records were not up to date or informative. Staff did not always adhere to people’s identified needs in their care plans such as with pressure care or communication support.

Staff were kind and considerate, demonstrating patience with people who needed extra support. They endeavoured to respect people’s privacy and promote their dignity as far as time allowed. We could not see much evidence of people being involved in their own care planning although staff told us how they supported people to make as many decisions for themselves as possible.

There was a lack of organised activities for people to engage with, especially in the specialist dementia care units.

We found only one complaint logged and this had been dealt with in a timely manner.

There was a mixed view as to the atmosphere in the home. Some people and relatives spoke very highly, others told us that staff were always busy and so this impacted on their response. Some staff found the registered manager accessible but others felt things did not change despite them raising concerns.

Despite a comprehensive audit programme, we found that much of the audits were tick lists rather than a source of seeking to change and improve the service.

We found breaches in regulations concerning staffing, safe care and treatment, consent, safeguarding service users, nutrition, person-centred care and good governance in addition to notifications.

You can see what action we told the provider to take at the back of the full version of the report.