CQC report explained · a nursing home
What the CQC found at Ashley Grange Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, January 2023
Ashley Grange Nursing Home rated Requires Improvement; inspectors found important improvements, but safety checks and record keeping were not yet consistent.
This was an unannounced follow-up inspection on 19 December 2022. Inspectors spoke with people, relatives, staff and other professionals. They reviewed care records, staff recruitment and training records, medicines records and management information.
The home had improved since its previous inspection. People said they felt safe, staffing had improved and medicines were managed safely. The home was clean, infection control arrangements were suitable, and staff understood people's needs.
Some problems remained. Records did not always reflect people's current needs. Checks on fire doors, pressure-relief mattresses and water safety were not always recorded consistently. Four fire extinguishers were overdue for servicing.
The overall rating changed from Inadequate to Requires Improvement. The home is no longer in Special Measures, but CQC said further work is needed to make improvements last and provide a consistently good service.
Improved staffing
Inspectors found enough staff to meet people's needs. People, relatives and staff said staffing numbers and consistency had improved.
“There are more staff available. It seems to be enough to meet people's needs.” from the report
Medicines managed safely
Medicines records were complete, including records for medicines given when needed. Staff followed the instructions for these medicines.
“Medicines administration records had been fully completed.” from the report
Clean and infection controls
The home was clean and had updated infection prevention procedures. Inspectors were assured that the home could prevent and manage infection outbreaks.
“The home was clean and the provider was undertaking renovation and redecoration.” from the report
Action after the previous inspection
The provider had created detailed action plans, assigned responsibilities and reviewed progress. Several specific improvements had been completed, including a new call bell system and better access to drinks.
“The provider had developed detailed action plans to address all the shortfalls identified at the last inspection.” from the report
Incomplete safety checks
seriousChecks of fire doors, pressure-relief mattresses and water safety were not always recorded consistently. Four fire extinguishers were overdue for servicing.
“Further work was needed to ensure environmental safety checks were completed consistently.” from the report
Conflicting care records
needs fixingSome summary records had not been updated when people's needs changed. More detailed information elsewhere was up to date, and staff understood the required actions.
“Some records contained conflicting information, for example, a summary sheet for 2 people had not been updated when their needs changed.” from the report
Improvements not yet sustained
needs fixingCQC found that improvements had been made, but said more work was needed to make them consistent over time. Audits had also found some gaps in morning repositioning records.
“Further action is needed to ensure these improvements are sustained over time and people receive a consistently good service.” from the report
- 01Have all four overdue fire extinguishers now been serviced, and how do you make sure no equipment is missed?
- 02How often are fire door, pressure-relief mattress and water safety checks completed, and where are the results recorded?
- 03How do you make sure care records are updated whenever a person's needs change?
- 04What action has been taken about the gaps in morning repositioning records?
- 05How will you show that the improvements found at this inspection are being sustained?
This was an unannounced follow-up inspection focused on Safe and Well-led, including infection prevention and control; the other key-question ratings were carried forward from the previous inspection. This explanation was written from the published report of 17 January 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, December 2022
Ashley Grange Nursing Home was rated Inadequate and placed in special measures; inspectors found unsafe staffing and care, with problems in food and drink, dignity, personalised care and management.
This was an unannounced inspection on 13 and 15 July 2022. Inspectors spoke with people, relatives, staff and a health professional. They reviewed care plans, medicine records, staff records, complaints, audits and the home’s environment.
Inspectors found there were not enough staff, call bells were sometimes unanswered for up to 20 minutes, and risks such as pressure sores, dehydration, choking and falls were not always managed. Some areas and equipment were not clean or easy to clean. People did receive their medicines safely overall, and recruitment checks were in place.
People often described staff as kind and compassionate, but their privacy, dignity, choices and personal routines were not always respected. Food and drink records were poor, care was not always personalised, and activities were limited for some people. Quality checks had identified many problems, but action plans had not been put into practice.
The overall rating fell from Good at the previous comprehensive inspection, published in July 2019, to Inadequate. Safe and well-led were rated Inadequate. Effective, caring and responsive were rated Requires Improvement. The home was placed in special measures and CQC said it would monitor progress and normally re-inspect within six months.
Kind staff
People and relatives often spoke warmly about permanent staff. Inspectors also saw staff respond gently and compassionately to people who were upset.
“People spoke highly of the staff. Staff spoke with compassion about the people they supported.” from the report
Medicines systems
Electronic records showed that medicines and prescribed creams were usually given. Storage temperatures and controlled medicine balances were checked.
“The electronic records showed people received their medicines, and had their topical creams applied as prescribed.” from the report
Healthcare links
People could access a range of health professionals, including a weekly GP service, tissue viability nurses and speech and language therapists.
“People had access to a range of services to meet their healthcare needs.” from the report
Communication support
The home assessed communication needs and included guidance in care plans, such as support with glasses, hearing aids and speech difficulties.
“The service met the AIS.” from the report
Too few staff
seriousPeople, relatives and staff consistently said staffing was insufficient. Call bells were sometimes unanswered for up to 20 minutes, and communal areas were sometimes left without staff nearby.
“There were not enough staff to support people safely.” from the report
Health risks not managed
seriousCare plans and records did not always show how staff should manage pressure sores, poor fluid intake, choking risks or falls. Some planned repositioning was missed.
“Risks to people's safety were not always identified, or acted upon.” from the report
Food and drink monitoring
seriousPeople were not always supported to drink enough, particularly in hot weather. Food and fluid records were incomplete, and concerns were not consistently escalated.
“People were not supported to have enough to drink. Monitoring systems were not effective.” from the report
Consent records
seriousMental capacity assessments and best-interest decisions were missing for some restrictive equipment, including bed rails and sensor mats.
“Consent to care was not always sought in line with guidance.” from the report
Dignity and personal care
needs fixingSome people were not supported with toileting, personal appearance or their preferred gender of carer. Inspectors also saw a person left in visibly soiled clothing while being directed to their room.
“People rights to privacy, dignity and independence were not always promoted.” from the report
Weak improvement systems
seriousAudits and action plans had identified repeated problems, but these were not reliably put into practice. Staff also reported stress, low morale and feeling undervalued.
“The governance and quality assurance processes in place were not effective.” from the report
- 01How many permanent and agency staff are now working on each shift, and how quickly are call bells answered?
- 02What has changed to make sure people at risk of pressure sores are repositioned and their wounds are measured and reviewed?
- 03How do you monitor food and fluid intake, and what happens when records show that someone is not drinking or eating enough?
- 04Are mental capacity assessments and best-interest decisions now recorded for bed rails, sensor mats and other restrictive equipment?
- 05What changes have been made to personalised care, dignity, activities and the use of agency staff since this inspection?
This inspection covered all five CQC key questions, including infection prevention and control, and the ratings changed from the previous comprehensive inspection published in July 2019. This explanation was written from the published report of 1 December 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. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Ashley Grange Nursing Home
7 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- January 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2022Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- January 2022GoodSafe: Inspected but not rated
- September 2020Inspected but not ratedSafe: Inspected but not rated
- July 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2018Goodstayed GoodSafe: GoodWell-led: Good
- December 2016Goodup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- January 2014
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 20 October 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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