About the service Ashlands Nursing Home is a residential care home providing nursing care for up to a maximum of 21 people. The service provides support to older people. At the time of our inspection there were 15 people using the service.
People’s experience of using this service and what we found
People were generally happy living in the home and satisfied with the service. However, we found there were significant shortfalls in relation to staff recruitment processes. Whilst we received concerns about the level of staffing, there were sufficient staff on duty during the inspection. Staff understood how to protect people from harm or discrimination, however, not all staff had completed safeguarding training and the provider’s policy and procedure needed updating. We also raised a safeguarding alert following our visit. The nominated individual took immediate action to address the concerns. Individual risks had been assessed, but the assessments were not always updated. There were no environmental risk assessments. People were satisfied with the support they received with their medicines, however, the records for the administration of prescribed creams had not been completed consistently. The home had a satisfactory standard of cleanliness, however, there were no housekeeping staff on duty during the inspection and care staff were carrying out the cleaning duties.
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. However, there were no supporting care plans in relation to Deprivation of Liberty applications. People were mostly satisfied with the food. However, dietary records were not consistently completed, and pureed food was prepared as one meal rather than separate portions. There were arrangements for staff training, however, we made a recommendation about ensuring new staff complete the provider’s mandatory training in a timely manner. The premises were a listed historical building and whilst some refurbishment had been completed, other areas would benefit from attention.
People were mostly satisfied with the care provided. However, we noted most people were cared for in bed, which meant there was little change in their lives. There was no evidence seen to demonstrate people had been involved in their care plan or consulted about the operation of the home. People were generally complimentary about the approach taken by the staff.
People had individual care plans, however, not all plans were fully completed and staff told us they had little time to read the plans. Records of care were maintained, but these did not cover people’s emotional wellbeing and there were also gaps in people’s daily monitoring charts. People told us there were limited activities and we did not see any activities taking place during the inspection. This meant there was an increased risk of social isolation.
We received concerns about the management of the service both before and during the inspection. Whilst staff told us the manager was approachable, they were not sufficiently visible in the home. We discussed this matter with the nominated individual who made immediate arrangements to address this issue. There were some basic audits, but these did not cover the operation of the home. The audits were ineffective in maintaining and improving the quality of the service. There were also gaps in people’s records. Whilst the nominated individual was involved in the home, we saw no evidence of provider audits or oversight reports.
The nominated individual was committed to making the necessary improvements to the service and sent us information on their actions following the inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
This service was registered with us on 21 December 2020 and this is the first inspection. We carried out a targeted inspection, published 25 February 2022, which did not provide a rating for the service.
The last rating for the service under the previous provider was good, published on 20 April 2018.
The rating at this inspection is requires improvement.
Why we inspected
The inspection was prompted in part due to concerns in relation to staffing issues, the environment, medicines management, quality of care, record keeping and the management of the home.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
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
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 the recruitment of new staff, the governance systems and record keeping. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.