We carried out a review of the data available to us about Ashgate House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashgate House Care Home, you can give feedback on this service.
Ashgate House Care home is a residential care home providing regulated activities personal and nursing care to up to 45 people. The service provides support to adults of all ages some of whom were living with dementia. At the time of our inspection there were 39 people using the service.
Ashgate House Care Home provides care and support to people across two floors in one large adapted building. Ashgate house has multiple communal areas for people to spend their time. Most bedrooms were equipped with ensuite facilities.
People’s experience of using this service and what we found
People were protected from the risk of abuse and neglect. Staff received training in safeguarding and explained in detail how they applied their knowledge. Risks were assessed, monitored and risk reduction measures were in place. Medicines were managed safely, and people received their prescribed medicines on time by trained staff. People and their relatives told us they were supported by kind and compassionate staff who knew them well. Infection control measures were in place to protect people from the risk of infection.
People’s needs had been fully assessed. Induction and training programme's were in place for all staff. A wide choice of nutritious food was on offer and people told us they enjoyed the food at the home. The premises and environment had been adapted to meet people’s needs. 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.
The registered manager was universally praised by staff, people and their relatives for their leadership skills and the positive changes they had made. Systems and processes in place ensured all care plans were accurate and reflective of people’s needs. People and their relatives were involved in planning the care they received. The provider worked in partnership with others to improve the quality of care people received.
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 inadequate (published 25 November 2022).
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 improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since 14 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 24 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing, dignity and respect, safe care and treatment, safeguarding and governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.
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 changed from inadequate to good. This is based on the findings at 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashgate House Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
About the service
Ashgate House is residential care home providing personal and nursing care to up to 45 people. The service provides support to adults of all ages and people living with dementia. At the time of our inspection there were 35 people using the service.
Ashgate House Care Home accommodates people across two floors in one adapted building. Ashgate House has communal areas and bathrooms as well as providing ensuite facilities in most bedrooms.
People’s experience of using this service and what we found
People were not always protected from the risk of abuse, actions had not always been taken following incidents and accidents to reduce the risk of reoccurrence. We found risks relating to people’s skin had not been safely managed as wounds and active skin conditions had not been included in people’s care plans. This placed people at increased risk of harm as staff did not have any recorded strategy to follow. Medicines had not been safely managed as they had not always been in stock, expired medicines had not been disposed of appropriately. We also identified that medicines had not always been administered in accordance with the prescriber’s instructions and medicines that posed a risk to people had been left in communal areas. This placed people at increased risk of harm.
Care plans did not always provide person centred direction to staff. Where people’s choices and preferences had been recorded, care records showed staff had not consistently followed this information. Training records evidenced not all staff were up to date with training this placed people at risk of receiving unsafe care. People's care plans clearly detailed their eating and drinking needs. We saw that people's food and fluid intake was monitored when appropriate.
The provider had not always ensured they had adequate oversight of the service. Action plans in place did not identify or address all of the issues found during this inspection. The service worked in partnership with other professionals such as speech and language therapists to support people to access healthcare when they needed it.
People were not always supported to have maximum choice and control of their lives and staff
did not consistently support people in line with their best interests; the policies and systems in the service did not support this practice.
For more details, please see the full report which is on the CQC website at
Rating at last inspection
The last rating for this service was good (published 4 September 2021).
Why we inspected
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.
We received concerns in relation to the management of medicines, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. You can see what action we have asked the provider to take at the end of this full report.
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 changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashgate House Care Home on our website at www.cqc.org.uk.
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, dignity and respect, staffing and the oversight of the service 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
Ashgate House Care Home is a residential care home providing personal and nursing care to 45 people aged 65 and over at the time of the inspection. The service can support up to 45 people.
The home is split into two units, the older original building with lift access to the second floor and a newer ground floor extension. Both areas had communal spaces and the rooms in the new extension had ensuite facilities.
People’s experience of using this service and what we found
The provider and registered manager had reviewed their auditing processes and we found there to be a robust system in place. These systems and audits enabled ongoing improvements and opportunities for changes.
People, relatives and staff felt supported by the management team. Staff had received a range of training to support their roles. These had provided a focused approach to dementia care and end of life. Staff were able to share the benefits of these. Staff were recruited safety in line with the providers recruitment policy. There were sufficient staff and when agency staff were used these were regulars to ensure consistency of care.
People were safe from harm and staff have received training in safeguarding and understood how to report any concerns. Risk assessments had been completed to cover all aspects of care and mitigation measures were in place. Medicines were managed safely and in line with people’s prescriptions.
Lessons had been learnt from the previous inspections and measures were now in place to review falls and incidents. Staff and management worked in partnership with health and social care professionals and people’s health care needs were met.
Peoples hydration and nutrition was monitored, and we saw a range of options and snacks available. The home had a range of spaces for people to use and there was an opportunity to use the garden.
Care was provided in a caring and dignified way. Ensuring peoples independence and personal daily choices were considered. Opportunities were provided for people to enjoy activities or pastimes old and new.
The home complied with all the infection, prevention and control measures. There was a complaints policy and any concerns raised had been addressed formally. The registered manager recognised the importance of duty of candour and this was reflected in the open approach and shared communication as required.
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 The last rating for this service was Requires Improvement (Published 2 September 2020)
Our last inspection was a focused inspection and only reviewed the domains of Safe and Well-led. The provider completed an action plan after the previous inspection to show what they would do and by when to improve. At this visit we completed a full inspection and found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating, further prompted in part due to concerns received about staffing levels and the care people were receiving.
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.
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.
Ashgate House Care Home is a care home providing personal and nursing care, providing support for up to 45 people. On the day of inspection 39 people were residing at the home. All of the people living in the home were living with dementia, some with complex needs. The home is split into two units, the older original building with lift access to the second floor and a newer ground floor extension. Both areas had communal spaces and the rooms in the new extension had ensuite facilities.
People’s experience of using this service and what we found
The home had made many changes, providing a more open approach which was evidenced in the improvements seen at the inspection. Audits were more robust, however some areas still required further development and the need for staff to embed the changes made. Other changes needed to be considered in respect of the sharing of information on people's care and updates to staff returning from leave, or days off.
We saw many improvements within the home and the way support was provided by the staff. Staff told us they felt confident actions would be taken if any concerns about risk were raised.
Improvements to medicines management had been implemented since the last inspection to make sure recording was accurate and regular audits highlighted any areas for improvement. Medicines were managed safely, PRN (as required) medication instruction was clear and monitoring of stock was in place.
Risks to people’s care were monitored and actions reviewed. Any risk to infections had been reduced. There were enough staff to support people’s needs and the required checks for recruitment were completed. However, further consideration as to the deployment of staff over the night shift and how to cascade feedback to all shift members was still being considered.
Staff had received training in a range of areas to support their roles. Their skills and competency had been checked and any further support was going to be addressed. Further training had been identified for knowledge around specific areas of dementia and consideration had also been made to share information in order to support families.
People's nutritional and dietary needs had been catered for. People were supported with their interests and activities were available. Care plans were detailed and included people’s preferences as well as specifying their care needs. Health care needs were monitored and liaison with health professionals was in place.
Since the last inspection, assurance systems had been put in place to monitor the quality of service being delivered. The manager had an action plan in place which identified areas for development. Some staff felt supported by the new management and the changes throughout the home.
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 Inadequate (13 March 2020).
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 improvements had been made in the areas inspected and the provider was no longer in breach of regulations in these areas.
This service has been in Special Measures since 13 March 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall, or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced inspection of this service on 28 January 2020. Breaches of legal requirements were found and a Warning Notice was issued. We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 17, (1) (2), Good governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. To check they had followed their action plan and confirm they met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashgate House Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.
Ashgate House is a care home providing personal and nursing care providing support up to 45 people. On the day of inspection 39 people were residing at the home. All of the people living in the home are living with dementia, some with complex needs. The home is split into two units, the older original building with lift access to the second floor and a newer ground floor extension. Both areas contained communal spaces and the rooms in the new extension had ensuite facilities.
People’s experience of using this service and what we found
People’s care and treatment needs were not always managed safely. Risks associated with people's care and support had been identified, however, from records and observations staff were not supporting people in line with their assessments. Therefore, risks were not managed safely. We identified concerns about out of date risk assessments, prevention of pressure ulcers, nutritional risk and poor moving and handling practices. Further improvement was also needed in accident and incident reporting and auditing systems.
Care plans were person centred, however not all staff had seen or were aware of the contents of plans. Staff we spoke with understood people's needs however, as they had not seen the care plans we could not be sure they respected people’s choices or were guided to people’s current needs. End of life care plans were very sparse and did not contain people's preferences.
There was a high turnover of staff which was affecting recommended staffing levels and a high use of agency staff. Recruitment processes were ongoing to increase staffing, systems and processes were not sufficiently robust to support new staff. Improvements were needed to ensure all staff adhered to best practice guidelines. Staff told us more incidents and accidents occurred due to reduced staffing levels. New staff to the home were not sufficiently supported or orientated to the environment.
Medication systems were in place however, guidance for these were not always followed such as requirement for as required medication instructions. Further improvement was needed in medicines storage management.
There was not a positive culture within the service. Several staff expressed concern about some people's wellbeing and told us they were unable to provide appropriate support to some people. The approach to promoting people's independence was inconsistent. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.
On the day of our inspection we saw limited activities taking place and there wasn’t enough to occupy the majority of people. Activities were dependent on the availability of the activities co-ordinators and were dependent on staffing levels.
Systems to monitor and improve the quality of the service were not always effective due to lack of oversight of poor practices. Systems were in place to ensure equipment was safe and in good working order. We found the home was generally clean however, noted a malodour in some communal areas. Bedrooms had been personalised and communal areas were comfortably furnished. However, areas of the service were not adapted to meet the needs of people living with dementia in relation to signage to support orientation. Where audits had identified areas for improvement, action had not always been taken to address issues.
Following our feedback, the provider responded immediately and increased staffing levels and voluntarily agreed not to admit any new people for a period of time until improvements are made. An action plan reflecting all the areas requiring improvement was developed.
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 4 August 2017). At this inspection the rating has deteriorated to Inadequate.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to dignity and respect, person-centred care, safeguarding, safe care and treatment, staffing, and leadership and oversight at this inspection.
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
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
A registered manager was 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.
The service was last inspected on 12 and 16 September 2016, when we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not taken appropriate steps to ensure sufficient staff were available to meet people’s needs and ensure their safety. We found the service did not promote person centred care towards people and their care needs. We also people’s medicines were not safely managed and risks to people’s health and safety were not identified and reduced and the provider had not taken appropriate steps relating to auditing and ensuring the requirements of the Mental Capacity Act 2005 had been met.
We asked the provider to send us an action plan to demonstrate how they intended to make improvements to meet the regulations. The provider sent us an action plan about the actions they intended to take to make improvements. At this inspection, we found improvements had been made.
The provider’s arrangements for medicines administration, recording and storage were safe. People were supported to have their medicines when they needed. People were supported to maintain good health and were supported to access appropriate health and social care professionals when this was required. Guidance from healthcare professionals was followed to help ensure people’s needs were met.
Staff understood the need to include people with decision making; staff considered people’s capacity and followed the key principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed and people were supported to have choice and control over their lives where this was possible. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).
Staff had been provided with training so they were able to meet people’s needs and provide them with safe and effective care. New staff participated in a period of training and shadowing a more experienced member of staff as part of their induction.
People had sufficient to eat and drink, though not all people were supported effectively to have adequate nutrition during meal times. Special diets were catered for. People’s individual needs were assessed and care plans were developed and reviewed. People’s dignity and privacy was respected and staff showed kindness and compassion to the people they supported.
There was a complaints procedure and people and relatives knew who to complaint to if they felt it was necessary. Staff felt supported by the management team and supervision was provided to staff. Audits were carried out to help ensure people received safe and effective care.
There was 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 of the Health and Social Care Act and associated Regulations about how the service is run.
As all the people living in the home were living with dementia the information and evidence in this report is mostly drawn from relatives, observations and discussions with staff.
Relatives told us they were satisfied with the care and support provided and felt the needs of their family members were being met. People were treated with kindness and respect and relatives told us they felt their family members were safe living in the home. Plans were in place for health care if this was required. However, risks to people’s safety were not monitored consistently. Also people’s needs were assessed and plans put in place to meet those needs but these were not always followed through.
We saw people were supported by a staff team that, mostly, understood their individual needs. We saw that staff were friendly and kind and supported people to maintain their dignity. However, on several occasions we saw people try to attract the attention of staff and they did not receive a response.
People were not supported to follow their own interests or wishes and there was no specialist equipment in place for people living with dementia to enable them to engage in meaningful activities.
People’s nutritional and dietary requirements were met and a nutritionally balanced diet was provided.
Staff recruitment procedures were in place and there were appropriate checks carried out before staff started work. Staff received an induction and felt they had received the appropriate training to provide the support to people that was required.
Staff were aware of how to protect people from the risk of avoidable harm and were aware of safeguarding procedures, however, these procedures were not always followed through. There were insufficient staff on duty in all locations, at all times, to ensure people were kept safe.
The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 were not met in all instances.
Medicines were not always managed safely.
Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Ashgate House Care Home provides care and support, and nursing care, for adults with a variety of needs. At the time of our visit we were told that all the people in the home were living with dementia.
At the last inspection Ashgate House Care Home was in breach of two regulations. These were in relation to consent to care and treatment and management of medicines.
At this inspection we found that improvements had been made and the home was no longer in breach of these regulations.
There was 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 and associated Regulations about how the service is run.
People and their relatives were satisfied with the care and support provided and all felt their needs were being met. People were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this. As the majority of the people living in the home were living with dementia they were unable to comment about whether they were involved in the planning and delivery of their care. However, relatives informed that this happened as far as was possible and, also, their views were sought.
We saw that people were well supported by a staff team that, mostly, understood their individual needs. We saw that staff were friendly and kind and supported people to maintain their dignity. Staff we spoke with had a good understanding of people’s needs and felt valued.
Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received a thorough induction and felt they had received appropriate training. Nursing staff had support for their continuing professional development.
Staff were aware of how to protect people from the risk of avoidable harm and were aware of safeguarding procedures. This ensured that any allegations of abuse were reported and referred to the appropriate authority.
The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 had been met and improvements had been made in this area since the last inspection. People’s needs were assessed and plans put in place to meet those needs. Risks to people’s health and wellbeing were identified and addressed. People were supported to access health care professionals when this was required. People’s nutritional and dietary requirements were met and a nutritionally balanced diet was provided.
During our visit we observed staff speaking with and asking people for their consent or views before supporting them around the home. We found however that the provider had not acted in accordance with legal requirements where people did not have the capacity to consent.
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.
There were appropriate arrangements in place in relation to the obtaining and disposal of medicines. However we found that people's medicine administration records were not being completed accurately or clearly and that appropriate protocols were not in place for medicines prescribed 'as required'.
People were being supported by suitably qualified, skilled and experience staff. The provider had an effective system in place to regularly assess and monitor the quality of service that people received.
As it was not possible to speak with people using the service, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
We also spoke with the relatives of three people living at Ashgate House. Everyone we spoke with was happy with the care their relative received. One person said 'If (my relative) can't be at here, I'm happy they're there'. People told us that when they had had concerns about their relative's care, they had been dealt with appropriately and quickly.
We observed staff taking people's welfare and safety into account during day to day activities, including at mealtimes and when moving around the home. Relatives we spoke with spoke highly of staff in the home and told us 'the staff are very helpful, if I ask for anything its usually done straight away' and 'they are very friendly and kind, including to me when I visit'.
We observed largely positive interactions with people which contributed to their well being and acknowledged people as individuals.
Staff took time to have conversations with people and were observed being attentive. For example, one staff member noticed the chair a person was on needed a cushion and quickly put this in place for them.
We did observe some staff walking through the lounge asking generally how people were as they went by. There were occasions where people responded and tried to engage staff in conversations, some of these attempts were responded to positively but some staff carried on walking by.
We spoke to one person who told us that they did not like the main meal of the day being served at tea-time but that they did like the main meal foods that were served.