Ashley Gardens Care Centre

Ashley Gardens Care Centre is a residential nursing home providing personal and nursing care and treatment of disease, disorder or injury to up to 89 people. The service provides support to older and younger adults with dementia needs and nursing needs. At the time of our inspection there were 76 people using the service.

Ashley Gardens Care Centre is a purpose-built care home, with accommodation across three separate floors Each floor has separate adapted facilities, such as dining room, kitchen area and lounge. People had their own bedrooms and toilets.

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

Risks to people had not been fully mitigated since our previous inspection. Some people with constipation or other health conditions such as diabetes did not always receive their assessed care.

We observed there were times when there was not enough staff, and people, staff and relatives confirmed this. Some people did not receive medicines when they should, meaning they were at risk of experienced discomfort or distress. Accidents and incidents were not always reported to managers which meant that lessons may not have been learned and shared, and improvements made.

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.

Quality audits had not always highlighted where improvements were needed in service delivery and some concerns had not been shared with managers. Some incidents of bruising to people had not been reviewed to ensure risks were mitigated.

Risks to people from falls and complex eating and drinking needs had been addressed by the provider and care plans were improved. A new management team had been driving improvements and a new manager had started and was in the process of registering with CQC.

People told us they liked their staff and we observed caring interactions. One person commented, “The staff are kind and caring; you can’t fault anything to do with that.”

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 14 October 2022) and there were breaches of regulations. 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 some improvements had been made and the provider was no longer in breach of regulations relating to safeguarding. However, despite some improvements the provider was still in breach of regulations relating to safe care, good governance and staffing.

Why we inspected

The inspection was prompted in part due to concerns received about diabetes care and staffing. 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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

Following our last inspection we imposed conditions on the location meaning the provider must send reports of audits completed every month. The provider has been complying with this condition and updating CQC on the improvements they are making in the service.

We have identified continued breaches in relation to safe care, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Ashley Gardens Care Centre is a residential care home providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 89 people. The service provides support to older and younger adults with dementia needs. At the time of our inspection there were 84 people using the service.

Ashley Gardens Care Centre is a purpose-built care home which accommodates the people living there across three separate floors, each of which has separate adapted facilities. People had their own bedrooms and toilets. There are also shared bathrooms, eating and living spaces on each floor.

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

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not always being managed safely. Staff did not always have necessary knowledge or skills to meet people’s needs safely. Lessons were not always learned when things had gone wrong, to help stop them happening again.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Quality assurance and governance systems were not effective in making sure risks to people’s safety were identified and managed safely. Systems had not ensured people received good quality care or people’s care records were accurate and up to date. Staff did not always understand and fulfil their expected roles and responsibilities. Some staff gave negative feedback about the culture of the service, saying they did not always feel well-supported or listened to by the provider.

The service was hygienic and infection control measures were being manged to help prevent the spread of infection. Some people’s relatives told us they were happy with the support their family members received.

After our inspection, the provider gave immediate assurances about actions being planned and taken by staff in partnership with other health and social care professionals regarding unsafe care and risk management issues we identified. This included submitting a plan of actions telling CQC about actions they had or planned to take to ensure immediate risks of harm to people were reduced.

The provider immediately voluntarily suspended admissions of new residents to the service and invested additional resources to support improvements. We have continued to meet with the provider weekly to discuss their progress in making improvements. The local authority enforced an embargo on any new admissions to this service on 08 July 2022.

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 29 March 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to abuse and improper treatment, medicines, falls and choking risks and staffing. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 requires improvement to inadequate based on the findings of 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 Ashley Gardens Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to abuse and improper treatment, safe care, staffing and governance.

On 11 October 2022 we imposed conditions on the provider’s registration. These conditions told the provider how they must act to address concerns regarding fire safety and unsafe care for people with choking and/or aspiration, complex eating and drinking, falls, behaviour that may challenge, diabetes, skin integrity, hydration and personal care support needs at Ashley Gardens Care Centre.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 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.

Ashely Gardens Care Centre is a residential care home providing accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 89 people. The service provides support to older and younger adults with dementia needs. At the time of our inspection there were 87 people using the service.

Ashely Gardens Care Centre is a purpose-built care home which accommodates the people living there across three separate floors, each of which has separate adapted facilities. People had their own bedrooms and toilets there are shared bathrooms, eating and living spaces on each floor.

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

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not being managed safely. There were not always enough staff to safely meet people’s needs and some relatives raised concerns this could mean that their family member’s needs may be neglected. The service was clean and hygienic and infection control measures were being manged to help prevent the spread of infection.

People’s strengths, levels of independence, life histories, personal preferences, interests and quality of life was not always accounted for when planning and reviewing their care. The design of the service did not always meet people’s dementia needs. People were offered support to take part in social activities inside and outside of the service, although this support was inconsistent. Activities were not available for people who were not able to leave their bedrooms, meaning there were risks they could become socially isolated. People had support to maintain relationships with families and friends. People’s medical end of life care needs were met, to help them be as pain-free as possible.

We have made a recommendation to the provider about ensuring the environment of the service meets people’s dementia needs.

Quality assurance and governance systems were not always effective in making sure risks to people’s safety were identified and managed safely, people received good quality care or people’s care records were accurate and up to date. Staff at all levels had not always been supported to understand and fulfil their expected roles and responsibilities. Staff gave mixed feedback about the culture of the service and did not always feel well-supported or listened to by managers. Some relatives told us they were happy with the support their family members received and that they had regular opportunities to give feedback about the service.

After our inspection, the manager gave immediate assurances about actions being planned and taken by staff in partnership with other health and social care professionals regarding risk management, fire safety and medicine issues we identified. This included submitting a plan of actions within 24 hours, along with documentary evidence, telling CQC about actions they had or planned to take to ensure immediate risks of harm to people were reduced.

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 28 September 2017).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns about choking risks which we had received about the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with choking risks and risks to people with behaviours that may challenge, skin integrity, epilepsy, mobility support needs. We also found concerns related to fire safety, abuse and improper treatment, person-centred care, and governance. Due to this, we widened the scope of the inspection to become a focused inspection which included the key questions of safe, responsive, and well-led.

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 have found evidence the provider needs to make improvements. Please see the safe, responsive and well-led sections 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 requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashely Gardens Care Centre 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 identified breaches in relation to safe care and treatment, safeguarding people from risks of abuse, staffing and governance at this inspection.

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.

Ashley Gardens Care Centre is a privately owned nursing home supporting up to 89 older people who have nursing needs and who may be living with dementia. The premises are purpose built and made up of three units over three floors. There were 84 people living at Ashley Gardens Care Centre when we inspected. This was the first comprehensive inspection since the new provider took over the service in February 2016.

At the time of our inspection, there was a registered manager in place who had worked at the service for a number of years. 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 registered manager and management team were passionate and motivated to ensure people received consistent high quality care. The registered manager led by example and role modelled the person centred care and practice to ensure people had a good quality of life. There was a clear management structure in place and oversight from the senior management team. The registered manager had built links within the local community with the aim to increase people’s wellbeing.

Activities were innovative, exceptional and tailored to meet people’s individual needs, outings and events were well thought through, varied and in plentiful supply. Staff were passionate and thought creatively of ways they could enhance people’s participation and reduce social isolation. There was an open culture where the management team led by example to ensure people received a high quality person centred service. There was a culture of continuous improvement, so that people would feel increasingly well cared for. Staff were motivated and felt supported by the registered manager and management team.

People using the service felt safe with the staff that supported them. The safety of people using the service was taken seriously by the management team and staff who understood their responsibility to protect people’s health and well-being. Staff and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and measures put into place to manage any hazards identified. The premises and equipment were maintained and checked to help ensure people’s safety.

There were sufficient staff on duty to meet people’s assessed needs. Additional staff were available to provide support with visits out in the community and one to one sessions. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

Care and nursing staff regularly received training to ensure they had the skills and competencies to provide safe care. New staff received induction training and shadowed established staff before they started to work on their own. Staff met regularly with a senior staff member to discuss their role and practice, and to discuss their training and development needs.

Staff had a full understanding of people’s care and support needs and had the skills and knowledge to meet them. People received consistent support from the same members of staff who knew them well. People and their families were fully involved in the care and support they received and, decisions relating to their daily living. Staff were kind, caring and treated people with dignity and respect at all times. People receiving care at the end of their life were supported in the way they had chosen.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and their relatives and regularly reviewed to ensure people continued to have the support they needed. People were encouraged and supported to be as independent as they were able. People were supported to make choices and decisions and staff followed the principles of the Mental Capacity Act 2005.

People had access to the food that they enjoyed and were able to access drinks and snacks throughout the day. People’s nutrition and hydration needs had been assessed and recorded. Staff met people’s specific dietary needs and received specialist training where required. People were asked for feedback on their food and action was taken if required.

Medicines were stored and administered safely. People had the support they needed to attend health appointments and to remain as well as possible. Staff responded to any changes in people’s health needs; people told us that staff always called their doctor if they felt unwell or were offered pain relief.

The complaints procedure was available and was displayed around the service. People told us they felt comfortable following the complaints procedure and when they did complain they were taken seriously and their complaints were looked into and action was taken to resolve them. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had been very positive and any issues raised were acted on and taken as an opportunity to improve the service. The registered manager welcomed suggestions and saw these as a way of continuous improvement.