Ash Hall Nursing Home

Ash Hall Nursing Home is a care home providing personal and nursing care to 49 people over 65 years some of whom may be living with dementia, physical disabilities, sensory impairments, or mental health at the time of the inspection. The service can support up to 60 people in one adapted building.

People’s experience of using this service and what we found

Risks to people were not always managed effectively to protect them from potential harm. Not all windows had compliant restrictors fitted and radiators were not always covered or not safely monitored in accordance with Health and Safety Executive requirements.

Some lessons had been learnt and improvements made since the last inspection. New systems and processes had been implemented to promote people’s safety, but some building safety concerns had not been found by the provider before our inspection. People, relatives and staff were positive about the management and felt able to approach the management team should they have any concerns.

There were enough staff to support people safely when we inspected, and recruitment is on-going to increase staffing levels, however staff were not always safely recruited.

People’s medicines were safely managed by staff. Staff followed infection control procedures.

People were included and empowered. People told us they were happy and they were involved in their own care. Relatives told us they were involved in care planning and reviews.

The service worked in partnership with other agencies to support people’s physical and mental health needs.

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 24 September 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report. The provider told us they have installed compliant window restrictors where possible and risk assessed windows where not possible as well as monitoring radiator temperatures daily as the heat would be affected if they covered them. We will assess the effectiveness of these measures in the next inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ash Hall Nursing Home on our website at www.cqc.org.uk.

Enforcement and recommendations

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 monitor the service and will take further action if needed.

We have found breaches in relation to Regulation 17 (Good governance) at this inspection. We found a lack of compliant window restrictors to protect people from falls from height and insufficient measures in place to protect people from potential scalding and burns from uncovered radiators. This was not identified by the registered manager and therefore risks were not mitigated for people.

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 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.

Ash Hall Nursing Home is a residential care home providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. Ash Hall Nursing Home accommodates up to 60 people in one adapted building.

People’s experience of using this service and what we found

Improvements were needed to ensure systems were in place to monitor all areas of people’s care needs and to ensure improvements were sustained. Improvements to care records were still needed to ensure they consistently reflected people’s changing needs and preferences in the way they wished their care to be provided.

Improvements were still needed to ensure medicines were recorded consistently. Improvements to the design of the service were in progress to ensure the environment met the needs of people.

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported by staff that understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure lessons were learnt when things went wrong.

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. People’s nutritional risks were monitored and advice was sought from healthcare professionals to maintain people’s health and wellbeing.

People were supported by caring and compassionate staff that supported people with patience. People’s choices were respected in line with their individual communication needs to promote informed decision making. People’s right to privacy was up held and their independence was promoted.

People had the opportunity to be involved in interests and hobbies. People understood how to make a complaint and there was a system in place to investigate and respond to complaints received. People’s end of life wishes were gained to ensure their preferences were respected at this time of their lives.

Feedback was gained from people, relatives and staff. The management team had a plan in place to continue to implement changes at the service to improve people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 08 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Following the last inspection, we served a Notice of Decision to place restrictions on admissions to the service and requested weekly update from the provider to show the actions in place to make improvements to the care people received and to meet the Regulations. At this inspection, we found that improvements had been made to meet the regulations. However, some further improvements were still required.

Ash Hall Nursing home 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.

Ash Hall Nursing Home accommodates up to 60 people in one adapted building. At the time of the inspection there were 34 people using the service.

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.

There was a registered manager at the service who was available on the day of the 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.

Further improvements were needed to ensure that the systems implemented to monitor and mitigate risks to people were imbedded and sustained within the service.

Improvements were needed to ensure people’s medicines were managed and monitored effectively to keep people safe.

Improvements were needed to ensure people’s preferences and diverse needs were included in their care records to enable individualised care provision.

Improvements were needed to ensure that people’s end of life wishes were assessed and recorded.

The provider had taken action to ensure the environment was safe and they had plans in place to make further improvements to the environment to ensure it met people’s needs.

Risks to people’s health and wellbeing were identified, managed and followed to keep people safe from harm.

There were enough suitably recruited staff available to deliver people’s planned care and to keep them safe. Staff had received training to enable them to carry out their role effectively.

People were safeguarded from abuse because staff knew how to recognise and report potential abuse. Infection control risks had been reduced to protect people from the risk of avoidable infections.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. This meant people were supported to have as much choice and control of their care and treatment in their best interests.

People’s nutritional risks were mitigated and advice was sought from health and social care professionals when people were unwell.

People told us they were treated with care and compassion. People were treated with dignity and their right to privacy was upheld. People’s choices were respected by staff.

People had the opportunity to participate in interests and hobbies that met their preferences.

People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.

People and their relatives were encouraged to provide feedback about their experiences, which had been acted on to inform service delivery. The provider had been open and transparent about the improvements required at the service.

People and staff told us that the registered manager was approachable and staff felt supported to carry out their role. Staff were involved in the implementation of the improvements at the service.

The provider had acted on feedback received from professionals and lessons had been learnt when things went wrong. The provider had a clear overview of the service and an action plan was in place to ensure the service people received continued to improve.

The registered manager understood their responsibilities of their registration with us (CQC).

Ash Hall Nursing home 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.

Ash Hall Nursing Home accommodates up to 60 people in one adapted building. At the time of the inspection there were 45 people using the service.

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.

There was a registered manager 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.

At this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 lack of governance in the service and the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the manager and provider.

Risks to people’s health and wellbeing were not consistently identified, managed or followed to keep people safe.

We found there were not enough staff available or effectively deployed to deliver people’s planned care or to keep people safe. Staff had not always received training to enable them to carry out their role effectively.

We found that medicines were not administered in a consistent and safe manner and they were not always administered as prescribed.

People were not always safeguarded from abuse because staff had not always recognised possible abuse, which meant people were at risk of unlawful restrictions.

Infection control risks had not been mitigated to protect people from harm.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves

People did not always get the support they needed to drink sufficient amounts. This meant some people’s hydration needs were not met.

Advice was sought from health and social care professionals when people were unwell. However, we saw that these were not always followed to ensure their health needs and social care needs were met effectively.

Improvements were needed to ensure the environment was safe and met people’s needs.

People told us they were treated with care and given choices. We saw that improvements were needed to ensure that staff were available to provide care in an unrushed way and choices were not always promoted in a way that met people’s individual understanding. People were not always consistently treated with dignity.

Improvements were needed to ensure people’s preferences including cultural and diverse needs were assessed and considered to enable individualised care provision that met people’s preferences.

Improvements were needed to ensure that people’s end of life wishes were assessed and recorded.

People had the opportunity to participate in interests and hobbies that met their preferences.

People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.

People and staff told us that the registered manager was approachable and staff felt supported to carry out their role.

The service was registered to provide nursing and accommodation for up 53 people at the time of our inspection 48 people were using the service.

The service had a registered manager in post. 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.

When needed people did not always have capacity assessments or best interest decisions in place. Staff did not demonstrate an understanding of DoLS or how to support people in the least restrictive way whilst approvals were considered.

Risks to people were not always managed safely. When people had been assessed to use equipment they were not always supported to use the correct type. When people had behaviours that may challenge there was no guidance for staff to follow to offer a consistent approach. There was no guidance available for staff when people needed as required medicines to ensure people received this medicine appropriately.

Staff did not always receive formal supervision and some staff training was out of date and had not been updated. Staff did not always know people’s preferred routines. The systems in place to monitor quality of the service had not been completed and were not always effective to identify areas of improvement. The provider did not formally seek feedback from people who used the service to make changes based on their opinions. The provider had not ensured that staffing shortfalls in the home had been addressed to ensure the management tasks in the home could be completed.

Staff knew how to recognise and report potential abuse and staff suitability to work within the home was checked by the provider. There were enough staff available to offer support in a timely manner. People were happy with the staff and were treated in a kind and caring way. People were encouraged to be independent and make choices about their day. People’s privacy and dignity was upheld.

People enjoyed the food and were offered a choice. Relatives and visitors felt welcomed and could visit anytime. People were happy with how they received their medicines. When needed people had access to health care professionals. People knew how to complain and felt happy to do so. The provider ensured complaints were responded to in line with their policy. People were happy with the activities that were offered within the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service told us that the staff were caring and helpful and supported them with their personal and nursing needs. A visitor commented, "I think the care X gets here is very good. They look after her very well."

We met with two commissioners of care during the inspection and they were satisfied with the level of care and support provided. They also thought that records of care were good. They had no concerns about how people were cared for by the provider.

We saw that the provider had made improvements to the outcomes where we had previously assessed them as non compliant. We found that they were now compliant in these areas.

We saw that the dining experience had improved overall but that people felt that the choices of food on offer could be better.

We saw that care was delivered in a task orientated way rather than on an individual basis. The provider could look at how people could receive individual care and support in a way they would prefer it.

The provision of staff had improved at the home but some people felt that they were sometimes waiting too long for attention. The provider could look at how this could be further improved.