Ashfield House

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.

Ashfield House provides accommodation, personal and nursing care for up to 47 older people. At the time of our first inspection visit 35 people lived at the home and 31 lived people at the home when we returned on day two. Accommodation is provided across two floors in a converted residential house.

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

The provider had not learned lessons. The quality and safety of the service had deteriorated since our last inspection which showed the provider was unable to make and sustain improvements to benefit people. The lack of provider and management level oversight meant previously demonstrated standards and regulatory compliance had not been maintained. The provider’s systems and processes designed to identify shortfalls, and to drive improvement were not effective and had not identified the concerns we found.

Some people did not feel safe. The inconsistency and limited availability of staff who provided people’s care impacted negatively on their lives. The risks associated with people’s care and fire safety were not consistently identified, assessed and well-managed. This placed people at risk of harm. The prevention and control of infection was not managed safely and in line with government guidance. The management of medicines required improvement. Staff had been recruited safely. Some staff did not understand their responsibilities to keep people safe and safeguarding procedures had not been followed to protect people from avoidable harm.

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. People had access to health and social care professionals. However, the advice of health care professionals was not always sought in a timely was to promote people’s health and well-being. Some staff training was not up to date. Some agency staff had not received an induction which meant they did not have all the information they needed to keep people safe.

People and relatives spoke highly of the regular staff who cared for them. Staff were caring in nature but did not have the time they needed to provide person centred care. People's right to privacy and dignity was not always considered, upheld or respected.

People's needs were assessed prior to moving into the home. Care records did not always provide staff with the information they needed to deliver personalised, safe care and some records contained conflicting, out of date information. Daily care records had not been consistently or accurately completed to demonstrate people had received the care they needed to keep them safe and well. People continued to have limited opportunities to take part in meaningful activities. Complaints had not been managed in line with the provider’s procedure.

The provider had not created opportunities for people and relatives to feedback about the service provided. Staff felt supported by the registered manager. However, staff did not feel able to raise concerns or share their ideas. The registered manager had identified some areas of the service required improvement and acknowledged they needed additional support to achieve this. People and relatives had different levels of satisfaction with the service provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 10 February 2020).

Why we inspected

This was a planned inspection based on the previous rating to establish if required improvements had been made and to review information, we had received from the local authority which indicated risk.

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.

The overall rating for the service has changed from requires improvement to inadequate. 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, caring, responsive and well-led sections of this full report.

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 breaches in relation to people’s safety, staffing, promoting and upholding people’s rights, personalised care, protecting people from avoidable harm and governance of the service.

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

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. We will work alongside the provider and local authority to monitor actions taken to address the concerns we identified.

Special Measures

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.

Ashfield House is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 47 people over two floors.

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

The provider had made improvements in the service since taking over in December 2020. The improvements will need to be sustained over time and as the number of people living in the home increases. There is a new registered manager in post who will need time to establish and maintain standards of people’s care in the home.

Risks to people had been identified and recorded and, where needed, action had been taken to keep people safe.

The overall management of infection control within the service was effective. However, further actions are needed to ensure best practice in correct use of personal protective equipment (PPE) and the guidance given to visitors.

People’s safety had been considered and their medicines were administered as needed. The number of staff on duty ensured they were able to provide people with the care and support needed. Staff training was in place and staff were supported in their roles. People’s nutritional choices and preferences were known and appropriate healthcare professionals were involved in people’s care and treatment.

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 did not support this practice.

People chose how they spent their time and staff were able to spend time with them. Staff were able to tell us about each person’s needs and wishes and knew how to meet these

Care plans detailed people’s care needs and took account of the person and their preferences. Where complaints had been made, the provider had investigated and responded to these.

Rating at last inspection

This service was registered with us on 8 December 2020 and this is the first inspection. The last rating for the service under the previous provider was inadequate, published on 20 May 2020.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and management in the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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.