CQC report explained · a residential care home
What the CQC found at Ailwyn Hall
Rated Inadequate: inspectors found the home performing badly and the CQC has taken enforcement action.
What inspectors found, April 2021
Ailwyn Hall was inspected but not rated; inspectors found good infection control and person-centred visiting arrangements.
This was an announced, targeted inspection on 17 March 2021. It focused on infection prevention and control during the COVID-19 pandemic.
Inspectors were assured that the home had safe arrangements for visitors, new admissions, testing, personal protective equipment, cleaning and managing outbreaks. The home was following national visiting guidance and had considered people's individual needs.
The home was not given an overall rating or a rating for safety. This inspection did not assess all five areas used for a full CQC rating.
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including safe use of PPE and access to testing.
“We were assured that the provider was using PPE effectively and safely.” from the report
Visiting arrangements
The home consulted relatives and adapted visiting arrangements around people's individual needs. It offered different ways for people to stay in contact.
“The service had taken a person centred approach to visiting.” from the report
Support from healthcare professionals
The manager had completed external infection control training, and the home had supportive relationships with healthcare professionals during the pandemic.
“Effective and supportive relationships have been developed with healthcare professionals” from the report
Inspectors raised no specific concerns in this report.
- 01What infection prevention and control arrangements are in place now?
- 02How are visits arranged, and how are people's individual communication needs supported?
- 03How do you manage visiting and care for people who cannot socially distance?
- 04How often are residents and staff tested, and how is PPE used?
- 05What support do you receive from healthcare professionals if there is an infection outbreak?
This was a targeted inspection of infection prevention and control during the COVID-19 pandemic; it did not provide a full overall rating or assess all five key questions. This explanation was written from the published report of 17 April 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2018
Rated Good overall; inspectors found kind, safe and responsive care, but the home was not yet consistently well-led.
Inspectors visited on 17 and 18 September 2018. The first day was unannounced. They observed care, spoke with people, relatives, staff and a healthcare professional, and checked care, medicine, training and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found risks were managed, medicines were given when needed, staffing was sufficient, and people were treated with kindness, dignity and respect. People received food, drink, activities and healthcare suited to their needs.
Well-led was rated Requires Improvement. The home had introduced better audits, care planning and leadership, but inspectors wanted to see these improvements maintained consistently over time.
The previous inspection in February 2018 rated the home Inadequate. The provider had then breached regulations, faced a registration condition and was placed in special measures. Inspectors found significant improvement by this visit, with no current breaches, so the home was removed from special measures.
Managing safety
Individual risks were assessed and staff took practical steps to reduce harm, including equipment and changes to medicines where needed.
“Risks to people's individual safety had been assessed and managed well.” from the report
Medicines and staffing
People received medicines when needed and inspectors found enough staff to respond promptly and spend time with people.
“People received their medicines when they needed them and there were enough staff to keep people safe and to meet their needs.” from the report
Kind and respectful care
Staff knew people well, listened patiently and protected their dignity and privacy during care.
“Staff were kind, caring and compassionate towards people and treated them with dignity and respect.” from the report
Activities and personal choice
People could choose from group and individual activities, including music, gardening, reading and painting.
“Activities were in place for those that wished to participate.” from the report
Management needs to stay consistent
needs fixingThe new quality systems were working, but inspectors wanted evidence that the improvements would continue over time.
“However, the provider has not been able to deliver good quality care on a consistent basis.” from the report
One cleaning lapse
minorOne commode had not been cleaned and caused an unpleasant smell. Staff cleaned it immediately after inspectors raised it.
“One person's commode had not been cleaned which made their room smell of urine.” from the report
Missing end-of-life care plan
needs fixingOne person's care record did not contain an end-of-life care plan, although the manager understood the person's wishes and agreed to add one.
“However, one person whose care we looked at did not have a care plan in place but we were satisfied the registered manager understood their wishes.” from the report
- 01What checks do you now use to make sure the improvements in management and care have been maintained?
- 02How do you make sure every person has a complete and up-to-date care plan, including their end-of-life wishes?
- 03How do you check that equipment and commodes are cleaned consistently?
- 04What staffing levels are planned for each shift, and how are they changed when people's needs change?
- 05How are complaints, accidents and falls reviewed, and what changes have resulted from them?
This was a full inspection covering the premises and care provided, with ratings given for all five key questions. This explanation was written from the published report of 16 October 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ailwyn Hall
6 rated inspections over 4 years: the service has held its Good rating throughout.
- April 2021Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- October 2018Goodup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2016Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 8 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.