Ashfield House

Updated 18 October 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 Care Act 2014.

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 conducted by three inspectors and an Expert by Experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service. The ExE who supported this inspection had experience of care of older people and those living with dementia.

Service and service type

Ashfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for two months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

The inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority who work with the service. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with 11 people and four relatives about their experiences of Ashfield House. We spoke with nine members of staff including the provider, the manager, the deputy manager, senior carers, care staff and the laundry assistant. We also spoke with three visiting health care professionals.

We observed the care people received in communal areas and reviewed a range of records. This included seven people’s care records and multiple medicines records. We looked at three staff files in relation to recruitment and support and a range of records relating to the management of the service, including audits and checks and policies and procedures.

Updated 18 October 2022

About the service

Ashfield House provides accommodation, personal and nursing care for up to 47 older people. At the time of our inspection visit 35 people lived at the home. Accommodation is provided across two floors in a converted residential house.

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

Risks associated with people’s care, their medicines and fire safety were not always identified and well-managed. This placed people at risk of harm. People felt safe living at Ashfield House. The management and staff team understood their responsibilities to keep people safe. Staff had been recruited safely and there were enough staff available to meet people’s needs. Staff demonstrated safe infection prevention and control practice.

A new management team had been appointed and management level oversight had improved since our last inspection. Whilst some improvements had been made further improvement was needed to ensure the providers governance systems were effective and shortfalls in the quality and safety of the service provided were identified. People, relatives, staff and visiting professionals spoke highly of the management team. The management team recognised they needed further time to embed the changes they had made. They demonstrated their commitment to addressing other aspects of service delivery to continue to improve outcomes for people.

Some staff training was not up to date. Action was planned to address this. 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. People had access to health and social care professionals. However, the advice provided by health care professionals was not always clearly recorded to support safe care. Staff felt supported and valued and they received support through an initial induction and individual, and team meetings.

People were supported to make choices and were involved in making decisions about their care and support. Staff were kind and caring and they had built positive relationships with people which ensured their rights were upheld and their independence was promoted.

Care and support was provided in line with people’s needs and preferences. Action was being taken to improve the detail and accuracy of information contained within care records to help staff provide personalised care. Opportunities for people to follow their interests and do things they enjoyed continued to be limited. Plans were in place to address this. Whilst people knew how to complain complaints were not always managed in line with the provider’s expectations. People and relatives were encouraged to share their views about the service they received. Recent feedback showed satisfaction levels about the service provided and how the home was managed had increased.

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 17 February 2022) and there were six breaches of regulation. 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. However, the provider remained in breach of two regulations.

This service has been in Special Measures since 17 February 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 Ashfield House 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified continued breaches in relation to people’s safety and governance of the service.

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.