Ashmore Nursing Home

Ashmore Nursing Home is a care home providing personal and nursing care for up to 42 older people in one adapted building. At the time of our inspection there were 27 people living in the service.

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

We found shortfalls in the management of risks to people’s safety and welfare including, oversight of environmental risks, catheter care, wound care and medicines management. Audits in place had failed to identify the shortfalls we found at this inspection. These concerns had not been identified or resolved through any governance process.

Not everyone had a care and risk management plan in place. This meant staff had not been provided with formal guidance as to the care support needed and identify any risk to people’s health, welfare and safety.

People were at risk of being supported by unsuitable staff as safe recruitment procedures were not always followed.

We have made a recommendation for guidance to be reviewed to ensure staff wear the correct Personal Protective Equipment (PPE) at all times.

We observed positive relationships between people and staff. There was mostly positive feedback from people and their relatives about staff approachability and good communication. Further work was needed to ensure people isolated in their rooms had sufficient staff to meet their social and emotional needs and planned activities to protect them from the risk of social isolation.

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.

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 good (published 19 March 2020).

Why we inspected

We received concerns in relation to staffing, a lack of training, and people left isolated in their rooms leading to a lack of social stimulation. A decision was made for us to inspect and examine those risks. 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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the list relevant key question sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines management, risk management and staffing.

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.

Ashmore Nursing home is a nursing care home providing personal care to up to 36 older people. 27 people were living at the service at the time of our inspection. The service was one building over two floors that had been extended in recent years.

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

Medicines practice was not always safe; the registered manager took immediate action to address this when we identified concerns.

There were sufficient safely recruited staff to care for people. Staff had a good understanding of how to recognise and report potential harm or abuse and were confident the registered manager would take any action necessary in line with local safeguarding procedures.

Nursing and care staff felt supported and had access to a range of training to provide them with the skills to meet people’s needs. People's nutritional needs were met, and people spoke highly of the food provided.

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.

Staff were kind and caring. Staff understood their roles clearly and knew what was expected of them. Relatives spoke positively about the service and the care their family member received.

People and their relatives were positive about the management of the service and knew how to raise any concerns and complaints should they have had any. Plans were underway to improve the opportunities for people to take part in activities.

People, relatives and staff were complimentary about the registered manager and the leadership of the service. Audits and monitoring of the service was ongoing.

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

Rating at last inspection: The rating at the last inspection was ‘Good’. The last report for Ashmore Nursing Home was published on 29 August 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

At the last inspection of 02 April 2015 the service was rated ‘Good’. At this inspection the service remained ‘Good’ and met all relevant fundamental standards.

There were arrangements in place to protect people from risks to their safety. Staffing levels of nursing and care staff were appropriate to support people meet their assessed needs. There was a robust recruitment process for employing staff appropriately to care for vulnerable people. Processes and procedures were in place to receive, record, store and administer medicines safely.

People were cared for by staff who received supervision and on-going training to develop their skills to support people with their assessed needs. 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 support this practice. Staff encouraged people to eat sufficiently and have drinks of their choice. People were supported promptly as required to see a range of healthcare professionals in order to maintain good health.

Care was delivered in an understanding and empathic way to meet people’s needs. People were supported by staff to make day to day decisions about their care. The staff respected people’s dignity and privacy.

Each person had a care plan which was based on an individual needs assessments and took into account people’s preferences. The care plans were reviewed regularly to remain up to date. People were encouraged to engage with a variety of activities which had been developed from listening to the views of the people. People were aware of how to make a complaint and spoke positively about the staff and registered manager’s practice of acting quickly to deal with any concerns raised.

Systems were in place to ensure the service was managed effectively and to monitor the quality of the service provided. People and relatives reported the service was run by knowledgeable and responsive staff with an open culture to listen to their views.

Further information is in the detailed findings below.

We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate. We saw that staff were knowledgeable about people's needs and promoted their independence.

We saw that the service was clean and tidy and free from offensive odours and the staff adhered to their infection control policies and procedures.

We saw that the provider had an effective recruitment and selection processes in place.

We saw that there was a complaints policy and procedure in place. People who used the service told us they were aware of how and who to complain to. A relative told us 'The staff are very helpful if you let them know if you have any concerns.'