CQC report explained · a residential care home
What the CQC found at Ash Grove Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable risk assessments, enough staff, safe recruitment, safe medicines systems and effective infection control. One PRN medicines administration issue had been found through an audit and corrected.
- Effective?
- Good
- People had thorough assessments before moving in, and staff had relevant training and support. Nutrition, hydration, health appointments, the environment and consent were all managed appropriately.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People's choices, privacy, independence, communication needs and personal or faith preferences were supported.
- Responsive?
- Good
- Care plans were person-centred and reflected people's histories, routines and abilities. People were offered daily group or one-to-one activities, could raise complaints, and received end of life support.
- Well-led?
- Good
- Inspectors found a positive culture, approachable management and regular audits. The rating improved from Requires Improvement at the previous inspection.
What inspectors found, June 2023
Ash Grove Care Home was rated Good; inspectors found safe, kind and person-centred care, with one medicines issue identified and corrected.
This was an unannounced inspection on 17 and 22 May 2023. One inspector looked around the home, spoke with people, relatives, staff and a professional, and reviewed care plans, medicines records, staff files, incident records and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were protected from harm, received their medicines safely, had their health and nutrition needs supported, and were cared for with kindness, dignity and respect.
People had personalised care plans, daily activities and support with communication. The home also had regular audits, feedback systems and links with health and social care professionals. A medicines audit found one PRN medicine had not been given according to its protocol, but this was quickly identified and corrected.
Staff availability
Inspectors found enough staff to meet people's needs, and call bells were answered quickly.
“Call bells were consistently answered within a few seconds.” from the report
Personalised care
Care plans focused first on what people could do for themselves, then described the support they needed.
“Care plans were written and presented in a person centred way concentrating on what people could achieve for themselves” from the report
Activities and interests
People could take part in group activities or individual pastimes, including activities in their rooms.
“People were offered daily choices of activities which we observed in a communal area of the service.” from the report
Kind and respectful care
Staff knew people well and supported their dignity, privacy, choices and independence.
“People were treated with kindness and respect. People's privacy was respected and dignity maintained.” from the report
Management and improvement
The home had regular audits and acted on issues found. Inspectors judged the management culture to have improved since the previous inspection.
“At this inspection the rating has changed to good.” from the report
PRN medicines process
needs fixingA medicines audit found that one medicine given when needed had not followed its protocol. The report says the issue was quickly identified and corrected.
“A recent medicines audit had highlighted an administration of a PRN medicine that was not given in line with the protocol.” from the report
- 01What checks are now in place to make sure PRN medicines are always given according to their protocols?
- 02How will you monitor the service while the registered manager is still relatively new in post?
- 03How often will my relative's care plan and risk assessments be reviewed?
- 04What daily activities would be suitable for my relative, including if they prefer to stay in their room?
- 05How will you involve me in health appointments, care reviews and decisions about end of life care?
This was an unannounced inspection covering all five key questions, including infection prevention and control; the previous ratings were from the inspection published on 21 March 2018. This explanation was written from the published report of 22 June 2023 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, March 2021
Ash Grove Care Home was inspected but not rated; inspectors found good infection control during a COVID-19 outbreak.
This was an announced, targeted inspection on 15 February 2021. It checked infection prevention and control after a COVID-19 outbreak. The home was inspected but not rated.
Inspectors were assured that the home was managing infection risks. This included the use of personal protective equipment, testing, social distancing, cleaning and arrangements for visitors and new admissions.
The home had supported people to isolate in their bedrooms during the outbreak. Visitors were not allowed except for people receiving end of life care, although a visitor pod and digital devices helped people keep in touch with relatives.
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including an up-to-date infection control policy.
“We were assured that the provider's infection prevention and control policy was up to date.” from the report
Cleaning
The home employed a second cleaner during the pandemic. Frequently touched areas were disinfected six times a day, or more often if needed.
“Cleaning involved high touch areas and a specific regime was in place six times a day, or more often if needed” from the report
Support for people with dementia
Staff took time to explain social distancing changes to people who did not understand them, using a kind and supportive approach.
“We saw staff taking time with people, explaining the changes that had been made in a kind and supportive way.” from the report
Keeping in touch
The home had a visitor pod for use outside lockdown and bought an iPad and an extra mobile phone so people could contact relatives during lockdown.
“An iPad and additional mobile phone had been purchased at the start of the pandemic so people could keep in touch with relatives during lockdown.” from the report
Inspectors raised no specific concerns in this report.
- 01What are the current arrangements for visiting, including visits for people receiving end of life care?
- 02How do you manage a new infection outbreak, and how would you keep relatives informed?
- 03How often are high-touch areas cleaned now, and what happens if extra cleaning is needed?
- 04How are residents supported if they do not understand or remember social distancing rules?
- 05How are residents helped to keep in touch with relatives if visits are restricted?
This was a targeted inspection of infection prevention and control under the Safe question only; the service was inspected but not rated and the other questions were not assessed. This explanation was written from the published report of 9 March 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.
Every inspection of Ash Grove Care Home
6 rated inspections over 8 years: the service has improved, from Inadequate to Good.
- June 2023Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2021Inspected but not ratedSafe: Inspected but not rated
- March 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- May 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2015Inadequatestayed InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- March 2015InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- November 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- March 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 3 February 2011.
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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Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
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