Background to this inspection
Updated
12 September 2019
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses care services. In this instance services for older people and those who live with a dementia type illness.
Service and service type
Ashton Grange 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We did not give the provider any notice of this inspection.
What we did
Before the inspection we reviewed the information we held about the service and the service provider, including the previous inspection report. The registered provider had completed a Provider Information Return (PIR). 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 looked at notifications and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law.
During the inspection we looked around the service and met with the people who lived there. As some people were unable to fully communicate with us, we spent time observing the interactions with people and staff. We spoke with 18 people in more detail to understand their views and experiences of the service and we observed how staff supported people. We spoke with the registered manager, registered provider and 10 members of staff. Following the inspection, we requested feedback from four health and social care professionals.
We reviewed the care records of five people who were using the service and a range of other documents. For example, medicine records, four staff recruitment files; staff training records and records relating to the management of the service.
Updated
12 September 2019
About the service:
Ashton Grange is registered to provide nursing, care and accommodation for up to 31 people. There were 29 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Most people were also living with dementia, some of these people could show behaviours which may challenge others. Most people needed support with their personal care, eating, drinking or mobility. Accommodation was provided over two floors which had been extended to the rear.
People’s experience of using this service and what we found:
The registered manager and provider had made significant improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including with their medicines. The improvements made, needed more time to be sustained, maintained and fully embedded into the culture of the service.
People received care and support that was safe. One person said, “I feel safe and comfortable, the staff are so kind and polite.” One relative explained this was the third experience of residential care and said, “This one has won hands down-really wished this had been the first home.”
People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent.
Staff were committed to delivering care in a person-centred way based on people's preferences and wishes.
There was a stable staff team who were knowledgeable about the people they supported and had built
trusting and meaningful relationships with them.
Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs well. One staff member said, “It’s really lovely here, the people are so special and the staff team supportive.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.
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.
Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One health professional described the service as, “The atmosphere is positive, there have been improvements, especially in the leadership, the presence of the manager on the floor has improved communication.” A visitor said, “It’s a busy home, the activity lady is tremendous fun, a live wire, gets people motivated.” People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.
Activities were tailor-made to people’s preferences and interests. People were encouraged to go out and form relationships with members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as specific sign language, pictures and objects of reference, to gain their views.
People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Visitors told us that they had discussed their loved one’s wishes and one visitor said, “I personally felt they had prepared me, not only my wife.” End of life care was delivered professionally and with compassion.
People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve and plans to develop the service and maintain their care delivery to a good standard.
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 14 February 2019) and there were five breaches of regulation. 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.
Why we inspected:
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from Requires Improvement to Good. 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 Ashton Nursing Residential Home on our website at www.cqc.org.uk.
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.