14 December 2022
During an inspection looking at part of the service
Ashill Lodge care home is a residential care home providing personal and nursing care for up to 35 people. At the time of our inspection there were 29 people using the service, most had a diagnosis of dementia. The home had been extended in the last eighteen months to create an additional communal space and 10 bedrooms all with ensuite facilities. The home had a passenger lift and chair stair lift as well as generous outside space.
People’s experience of using this service and what we found
We were given a mixed picture about this service from the evidence collated with most relatives sharing their positive experiences about their family members care, whilst a few relatives were not happy with the service. Through our observations we noted staff were kind and caring, however not always responsive to people’s individual needs.
We found a number of risks associated with people’s safety including unguarded stairs which people could access, hot teapots left unattended, the laundry room with chemicals left open and a stiff fire door which might impede people’s exit in the event of an emergency. People were supported to socialise with each other, and breakfast was observed to be a lively affair. We found however, when staff were busy people were not supervised safely and there was a risk to them or other people. For example, one person was known to go into other people’s rooms, we observed another person picked up a large television from the communal area.
Staffing levels were sufficient during the day, but numbers were significantly reduced at night. Night-time hours had not been reviewed in line with people’s needs and routines. From reviewing records, we identified there was an increase in incidents and falls later in the day and early morning. A twilight shift had been introduced and the provider was introducing an early morning shift as a direct result of increased falls at that time of day.
Medicines management identified continued areas of concern for the second time and concerns were part of a previous breach of regulation 12. This meant we were not assured that robust arrangements were in place to ensure people always received their medicines as directed.
The provider took an active role in the home and knew people, relatives and staff well. They were responsive to feedback and acted immediately on the concerns we raised. They were supported by a deputy and acting manager but there was not a registered manager in post. They had been proactive in sending us regular action plans and were continuously trying to improve their service.
There was a good working relationship with primary health care services who supported the home and told us the home were responsive to people’s needs and felt they identified emerging risks and addressed this quickly. A lot of people had equipment designed to promote their safety such as bed rails and sensor mats.
People were mostly supported to have maximum choice and control of their lives and staff mostly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Documentation was in place which demonstrated people were involved in their care and consulted about what they wanted to do. One person was supported outside the home to maintain contact with family and continue to have an active life in the local community. Prior to our inspection we had received concerns about the restrictive visiting hours and the inflexibility of the visiting policy. This was discussed with the provider and the reasons for this understood but we would expect the provider to consider the person’s wishes and circumstances of family members, for example when working full time.
Rating at last inspection and update
The last rating for this service was requires improvement (published 22 March 2019) and there was a breach of regulation 12: Safe care and treatment including medicines management. 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 the provider was still in breach of regulation 12 for the third consecutive inspection.
Why we inspected
This was a focused inspection that considered safe and well led, we found both key questions required improvement. The overall rating for the service has remained requires improvement with breaches of the regulations, based on the findings of this inspection.
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.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment and the governance and oversight of the service at this inspection. We have also made a recommendation about staff records and ensuring that they demonstrate that staff competencies have been adequately assessed for the role they are doing.
Please see the action we have told the provider to take at the end of this 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.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will
continue to monitor information we receive about the service, which will help inform when we next inspect.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our Ashill Lodge website at www.cqc.org.uk