Ashcroft Nursing Home

Updated 31 December 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 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 and two Experts 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

Ashcroft Nursing Home 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. Ashcroft Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we received about the service since the last inspection. This included details about incidents the provider must notify us about, such as serious injuries. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with eight people who lived in the service and nine relatives about their experience of the care provided. We observed multiple interactions between people and staff throughout the day. We spoke with nine members of staff including the registered manager, operations director, nurses, care workers and support staff. We reviewed a range of records including four peoples’ care records and multiple medication records. We looked at four staff recruitment files. A variety of records relating to the management of the service were reviewed including policies, health and safety checks, meeting notes, training records and audits.

Updated 31 December 2022

About the service

Ashcroft Nursing Home is a residential care home providing accommodation with personal and nursing care to up to 88 people. The service provides support to people with nursing needs, physical disabilities and people living with dementia. At the time of our inspection there were 48 people using the service. The accommodation is arranged across two floors with lift access. There is a third floor, currently out of use.

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

Audits on the service had been completed but quality assurance processes were not robust enough to identify shortfalls and take appropriate action. People had been asked their opinions of the service, but their feedback had not always been acted on.

People and their relatives told us they felt safe living in Ashcroft Nursing Home. One person said, “I am safe here, all the people are friendly.” Another person said, “I feel safe, permanent staff are good and make it safe, but there are a lot of agency.” One relative said, “Yes, I believe [relative] is safe. The staff respond.” Another relative said, “Oh yes, it’s a very good home. I can’t praise them enough. There’s plenty of people to keep an eye on them.”

Peoples’ needs were assessed before they moved into the service to make sure their needs could be met. Potential risks to peoples’ health and welfare had been assessed. There was guidance in place for staff to minimise the risks and keep people as safe as possible. Checks had been made on the environment including fire safety and electrical checks.

The service had been adapted to meet peoples’ needs. There were signs around the service and pictures on communal areas to help people find their way around. The service had cleaning schedules in place. People and relatives said the home was kept clean. One relative said, “The room is very clean and I’m very impressed.”

People received care from staff who knew them well and people and relatives used words to describe the staff, such as kind, caring, lovely, helpful and friendly. One relative said, “The staff are excellent, gentle, patient and go above and beyond. I see enough staff present. You see a change of faces with agency coming in.”

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 good (published 7 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, training and standards of care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of the full report. However, we found evidence the provider needs to make improvements. Please see the well led section of the full report.

The overall rating for the service has remained good 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.

Follow up

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