CQC report explained · a nursing home
What the CQC found at Ashton Grange Nursing & Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from avoidable harm. Staff were trained, recruitment checks were completed, risks were assessed, and medicines were generally stored and given safely.
- Effective?
- Good
- People's nutrition, health needs and consent were supported well. Staff received relevant training, and care plans had improved to reflect recognised guidance.
- Caring?
- Good
- People and visitors consistently described staff as kind, caring, patient and respectful. Inspectors saw people treated with dignity and supported to remain as independent as possible.
- Responsive?
- Good
- Care plans were personalised and reviewed regularly. People were supported with communication, relationships, activities, complaints and end of life care.
- Well-led?
- Requires improvement
- Leadership and quality monitoring had improved but were not yet fully established. Records for refused medicines and the effectiveness of as-needed medicines were not always complete.
What inspectors found, September 2019
Rated Good overall, but inspectors found that leadership and some medicines records still needed improvement.
Inspectors visited without notice on 12 and 14 August 2019. They spoke with 18 people, staff, the manager and health professionals. They observed care, checked five care records and reviewed medicines, recruitment, training and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found people were safe, treated kindly, supported to make choices, and given personalised care. Staff knew people well, and activities were tailored to their interests.
Well-led was rated Requires Improvement. The home had made significant improvements since the previous inspection, but its checks and action plans needed more time to become fully established. Some records about refused and as-needed medicines were not complete.
The overall rating improved from Requires Improvement to Good. The home was no longer in breach of regulations found at the previous inspection, but CQC said it would continue monitoring the service.
Kind and respectful care
People and visitors consistently praised staff for being kind and respectful. Inspectors saw relaxed and positive relationships between staff and people.
“Feedback from people and visitors consistently described staff as kind, caring, patient and respectful.” from the report
Personalised support
Care plans included people's needs, preferences, routines and interests. Staff knew people well and adapted support when their needs changed.
“People received personalised care that was responsive to their needs.” from the report
Activities and relationships
The home offered varied activities, including exercise, crafts, pet therapy and individual sessions. People were supported to keep in touch with relatives and take part in community life.
“The activity programme was varied and included skittles, exercise classes, art and crafts, pet therapy and one to ones for people in their rooms.” from the report
Food and health support
People were offered choices of food and drink, and staff monitored nutrition and hydration. Health and social care professionals were involved when needed.
“People were offered and shown choices of food and drink.” from the report
Improvement since the last inspection
The home improved from Requires Improvement overall. Inspectors found that the previous breaches had been addressed.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Quality checks not fully established
needs fixingThe home's systems for checking quality had improved, but a full cycle of audits had not yet been completed. Action plans still needed to be finished so inspectors could judge whether improvements would last.
“However, time was still needed for a cycle of all audits to be completed.” from the report
Medicines records
needs fixingRecords did not always show when medicines were refused or whether they were offered later. Records about whether as-needed medicines had worked were also incomplete.
“Records for medicines refused had not always been completed and did not state whether it had been offered later.” from the report
Older parts of the building
minorInspectors noted narrow corridors and some rooms without daylight. The provider was aware of these challenges and had plans for extensive development.
“The building layout does have challenges, corridors were narrow and rooms on one side of the building lacked daylight.” from the report
- 01How do you now record medicines that are refused, including whether they are offered again later?
- 02How do you record whether an as-needed medicine has worked for the person?
- 03Has the new medicines monitoring form been used consistently, and what have your recent checks found?
- 04Which quality audits and action plans are still outstanding, and when will they be completed?
- 05What changes are planned for the narrow corridors and rooms with limited daylight?
This was a planned inspection covering all five CQC questions and the overall rating, following the previous Requires Improvement rating and five regulatory breaches. This explanation was written from the published report of 12 September 2019 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, February 2019
Requires Improvement overall, with well-led rated Inadequate; inspectors found risks in care planning, medicines, nutrition, dignity and quality checks.
This was a comprehensive inspection on 2 and 9 October 2018. The first visit was unannounced. Inspectors spoke with people, relatives and staff, observed care, and checked care plans, medicines records, staff files and quality audits.
The home had enough staff and recruitment checks were safe. Some moving and handling, safeguarding and medicines practices were safe. However, inspectors found inconsistent care, poor recording of some risks, hygiene problems, gaps in medicines records and people not always receiving the help they needed with food and drink.
All five areas were rated Requires Improvement except well-led, which was rated Inadequate. The provider was in breach of five regulations. This means the service was not consistently providing safe, effective, caring or personalised care, and its systems for finding and fixing problems were not reliable.
Enough staff
People and staff said there were enough staff. Inspectors saw people receiving help without long waits at lunchtime.
“Everyone we spoke with, including staff, told us they felt there were enough staff to support people.” from the report
Safe recruitment
The staff files checked included employment histories, references and DBS checks. Nurses' professional registrations were also checked.
“These checks identify if prospective staff had a criminal record or were barred from working with children or adults.” from the report
Training and support
Staff spoke positively about their training, supervision and induction. Records showed regular training and supervision.
“The registered manager had a training plan which showed all staff were regularly trained in key areas such as moving and handling, safeguarding and equality and diversity.” from the report
Activities
The activities worker provided group and one-to-one activities and included people with different abilities.
“People responded well to this approach, clearly enjoying what was provided.” from the report
Complaints handled
The complaints process was available to people and supporters. Records showed concerns were investigated and responses were given in writing.
“We saw the registered manager investigated all complaints and concerns, including verbal concerns.” from the report
Risks not consistently managed
seriousCare plans and staff knowledge did not clearly explain how to reduce some people's risk of pressure damage. Unsecured areas also contained items that could cause harm.
“The provider had not taken appropriate action to ensure this person's risk of pressure damage was reduced.” from the report
Medicines and hygiene
seriousInspectors found problems with insulin records, PRN medicine records, cleaning and infection control. These issues were addressed or being addressed by the second inspection day, but had not been found earlier by the home's systems.
“Information in people's PRN records and on people's MARs did not agree.” from the report
Food and drink support
seriousSome people were not given suitable help to choose or eat their meals. Inspectors saw food left untouched and staff support that was sometimes task-focused or distracted.
“The provider was not consistently ensuring the nutritional needs of people were met.” from the report
Inconsistent kindness and dignity
seriousSome staff used a functional approach and did not offer enough reassurance, conversation or help. People were not always asked for consent before clothes protectors were put on.
“The provider had not ensured all people were consistently treated with dignity and respect.” from the report
Care plans not followed
seriousCare plans did not always reflect people's needs, preferences or communication requirements. Staff gave different accounts of how some people should be supported.
“The provider had not ensured people's care met all of their needs and reflected their preferences.” from the report
Weak oversight
seriousQuality audits did not identify a wide range of problems, including cleanliness, risk prevention, medicines, meal choices and care planning.
“The provider's system for auditing the quality of the services provided was not robust in all areas.” from the report
- 01What has been done to make sure pressure damage risks are assessed clearly and that repositioning plans are followed?
- 02How are insulin records, PRN medicine records and catheter drainage bag changes checked now?
- 03How do staff support people living with dementia to choose meals and make sure food and drinks are not left untouched?
- 04How are care plans reviewed and shared with all staff so that people's preferences and communication needs are followed?
- 05Who is responsible for checking the home's quality, and how does the provider make sure problems are found and fixed promptly?
This was a comprehensive inspection covering all five key questions, and the previous Good ratings from 2016 were reassessed. This explanation was written from the published report of 14 February 2019 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 Ashton Grange Nursing & Residential Home
3 rated inspections over 3 years: the service has held its Good rating throughout.
- September 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Ashton Grange Nursing & Residential Home →
- February 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
Read what inspectors found at Ashton Grange Nursing & Residential Home →
- April 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 24 March 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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