CQC report explained · a residential care home
What the CQC found at Ashgables House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some risk guidance was not followed, including food guidance for a person at risk of choking. Inspectors also found unsafe storage of flammable chemicals and concerns about staffing and lone working, although medicines, safeguarding and infection control were managed safely.
- Effective?
- Requires improvement
- This key question was not inspected during this focused inspection. Its rating was carried forward from the previous inspection.
- Caring?
- Good
- People said staff were kind and thoughtful. Staff supported people respectfully, involved them in care planning and promoted their dignity, independence and personal preferences.
- Responsive?
- Good
- Care plans reflected people's individual needs and preferences. People were supported with activities, trips and access to local shops, cafes, pubs and other community facilities.
- Well-led?
- Requires improvement
- Quality systems had improved but did not identify problems with dietary guidance or fire risk. Staff gave mixed feedback about management support, staffing and whether they felt safe to raise concerns.
What inspectors found, June 2022
Ashgables House is rated Requires Improvement, after previously being Inadequate and in Special Measures; inspectors found kind, personalised care but risks, staffing and leadership still needed improvement.
This was an unannounced focused inspection. Inspectors visited on 5 May 2022 and completed inspection activity up to 20 May. They spoke with five people and 10 staff, and checked care plans, risk assessments, medicines records, recruitment files and quality records.
The home had improved since the previous inspection. People were treated kindly and respectfully, involved in their care and supported to take part in activities and community life. Medicines, safeguarding systems and infection control were found to be safe.
There were still important weaknesses. Staff did not always follow risk plans, including guidance about food for someone at risk of choking. Inspectors also found unsafe storage of flammable chemicals and concerns about lone working and staffing levels. Quality checks had not identified some of these problems.
The overall rating changed from Inadequate to Requires Improvement. The home was no longer in Special Measures, and it was no longer rated Inadequate for any key question. However, the report says there was still limited assurance about safety and that management was inconsistent.
Kind and respectful care
People described staff as kind and thoughtful. Inspectors saw staff speaking respectfully and supporting people in a dignified way.
“[staff] are kind and thoughtful” from the report
Personalised support
People had individual care plans and were offered the chance to help write them. Staff knew people's backgrounds, needs and preferences.
“People received personalised care that met their needs and preferences.” from the report
Activities and community life
People were supported to take part in activities and regular trips into the local community. Staff adapted support when people's choices changed.
“People were supported to be an active part in their local community” from the report
Safe medicines systems
Inspectors found that medicines were administered, recorded and stored safely. Staff also followed safeguards against inappropriate over-medication.
“Medicines were managed safely in the service, staff followed systems and processes to administer, record and store medicines safely.” from the report
Staffing and lone working
seriousSome staff and people said there were not enough staff or that staff were difficult to find. Rotas allowed staff to work alone with people across two buildings, and staff said this did not feel safe.
“There were times staff were lone working with 5 people during the day, and 13 people during the night.” from the report
Fire risk was missed
seriousFlammable chemicals were stored under the stairs near a possible ignition source. The chemicals were moved after inspectors raised the issue, but internal fire checks had not found the risk.
“some flammable chemicals were stored under the stairs close to a potential ignition source.” from the report
End-of-life training
minorNo one needed end-of-life care during the inspection, and people's wishes were recorded. Staff had not received end-of-life care training, although the manager said this would be arranged.
“Staff had not received training in end of life care” from the report
- 01How do you now check that each person's risk assessment and dietary guidance are followed every day?
- 02What staffing levels are in place on each shift, and when will staff work alone across the two buildings?
- 03What has changed in the quality monitoring system since inspectors found that fire and dietary risks had been missed?
- 04How can staff and families raise concerns safely and confidentially?
- 05Has end-of-life care training now been completed by staff?
This was a focused inspection covering Safe, Caring, Responsive and Well-led; Effective was not inspected and its previous rating was carried forward. This explanation was written from the published report of 23 June 2022 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 2022
Rated Inadequate and remains in special measures; inspectors found serious safeguarding and leadership failures despite some improvements.
Inspectors visited on 13 and 15 December 2021. They spoke with seven people, 12 staff and four visiting professionals. They reviewed care plans, monitoring records, medicines records and management documents.
People were not consistently protected from possible abuse. Some allegations, unexplained bruising and complaints were not properly investigated or referred to safeguarding teams. Staff did not always respect people's wishes or dignity. The home also failed to keep adequate evidence of staff COVID-19 vaccinations.
There were improvements in staffing, medicines management, activities, care planning and staff morale. However, the home remained rated Inadequate overall for the third consecutive time. Safe and well-led were Inadequate, while caring and responsive were Requires Improvement. Effective was not assessed in this inspection.
More activities
The home had introduced a structured programme with three planned activities each day. Activities were based more closely on people's interests and choices.
“There was now a structured plan of activities for a month in advance” from the report
Staffing improved
Inspectors saw enough staff during both visits. The home had recruited a cleaner, used regular agency staff and introduced a staffing tool.
“During both inspection visits we saw that people were being supported by sufficient numbers of staff.” from the report
Medicines systems improved
No gaps were found in the medicines administration records reviewed. Staff training and competency checks were recorded.
“No gaps were observed in the administration records reviewed, including that for topical creams.” from the report
Some improvement in morale
Staff and professionals described better communication, support and teamwork than at the previous inspection.
“Staff told us there had been much improvement in staff morale since our last inspection” from the report
Safeguarding failures
seriousAllegations, unexplained bruises and a person's complaint about feeling unsafe were not always investigated or referred appropriately. This put people at risk of avoidable harm.
“People continued to not be protected against potential abuse.” from the report
Dignity and choice
seriousStaff sometimes discouraged people's requests and did not always pass on important wishes. Routine night checks had not been agreed with the people affected.
“During this inspection we saw some examples of practice where people were not treated respectfully or in a dignified manner.” from the report
Weak quality checks
needs fixingManagement systems did not reliably identify problems. For example, cleaning records were sometimes signed before checks took place and abuse notifications were missed.
“The quality monitoring of documentation completion was not always effective or accurate.” from the report
Incomplete risk information
needs fixingSome behaviour support plans and monitoring guidance were missing or incomplete. One person's fluid intake was calculated only at the end of the day, which could delay action.
“Behaviour support plans were not in place for everyone who needed this.” from the report
Vaccination records
seriousThe home had not gathered acceptable evidence for all staff COVID-19 vaccinations and did not record checking dates as required.
“The service had not gathered sufficient evidence to ensure all staff had received both COVID-19 vaccinations.” from the report
- 01How are allegations of abuse, unexplained injuries and complaints about feeling unsafe now investigated and reported?
- 02What evidence do you now hold for every staff member's COVID-19 vaccination status, and when was it checked?
- 03How are you making sure people's choices, including requests to leave, go to another room or stay up, are acted on and shared with the right professionals?
- 04How do you check that cleaning records, incident investigations and other quality records are completed accurately and at the right time?
- 05How are behaviour support plans and health monitoring records being completed and reviewed for each person who needs them?
This was a follow-up inspection covering Safe, Caring, Responsive and Well-led; Effective was not assessed and its previous rating carried over into the overall rating. This explanation was written from the published report of 2 March 2022 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 Ashgables House
7 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- June 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2022Inadequatestayed InadequateSafe: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- August 2021Inadequatestayed InadequateSafe: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2021Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementWell-led: Inadequate
- November 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2016Requires improvementSafe: GoodEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Good
- June 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 3 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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about two hours of Wiltshire
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 £1,020 to £1,340 a week. 82 can care for a couple. 12 years' experience on average.
“Linet became her carer and all changed, my daughter started eating, taking her medications and more important her happiness came back.”
“I cannot recommend Prisca highly enough, she is one in a million.”
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.