Ashfields

Updated 12 April 2022

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ashfields is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ashfields is a care home without nursing care. 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

This inspection was unannounced.

Inspection activity started on 2 March 2022 and ended on 3 March 2022. We visited the location’s office/service on 2 March 2022

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with one person who used the service and 10 relatives about their experience of the care provided. We spoke with nine members of staff including the registered manager, the deputy manager, the activities co-ordinator, a house keeping assistant, two senior care assistants, and three care assistants, one of which was a bank staff member. We also spoke with three members of staff solely regarding the management of medicines.

We reviewed a range of records. This included six people's care records and 22 people’s medication records. A variety of records relating to the management of the service, including audits and staff files, were reviewed

After the inspection

We reviewed correspondence from the regional director on the actions they were taking to address concerns identified at the inspection. We also reviewed the results of a staff survey.

Updated 12 April 2022

About the service

Ashfields is a purpose built single-storey residential care home providing personal care to up to 44 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 40 people using the service.

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

People did not receive their medicines as prescribed. This was because some medicines were out of stock in the service and therefore could not be administered. Some people were refusing their medicines and staff had not taken appropriate actions in response to this. Further concerns relating to the management of medicines including recording practices were also identified.

Risk assessments and care plans did not always effectively identify and address risk. We identified concerns relating to the management of people’s nutrition and hydration needs, skin care and falls. We observed some instances where personal protective equipment was not being worn correctly to protect people from the risk of infection.

Governance systems in place had not been effective in identifying and improving the quality of the service. Records in respect to people’s care were not always accurate and contemporaneous.

Following our inspection visit the regional director provided an update of initial actions they were taking and assurances that they were addressing the concerns identified.

Staff knew how to raise safeguarding concerns and felt confident to do so. However, concerns and incidents relating to medicines management had not been identified or reported as a safeguarding concern, as specified by local safeguarding guidance.

The environment was clean and hygienic. People and staff were taking part in regular COVID-19 testing. People were supported to maintain important relationships, and this included ensuring family and friends could visit the service. People were supported by enough staff who had been recruited safely. Where incidents had occurred, the registered manager had oversight of these. Incidents were discussed with people, relatives and staff, to facilitate any lessons needing to be learnt.

People and relatives were engaged in the service and feedback was sought from them in a range of ways. The registered manager was approachable and supportive. People were supported by a cohesive and caring staff team. There was a positive and pleasant atmosphere. Staff interacted with people in a person-centred and respectful manner.

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 good (published 01 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, the management of risks in relation to eating and drinking enough, record keeping and governance. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 identified breaches in relation to safe care and treatment and good governance at this inspection.

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.