CQC report explained · a nursing home
What the CQC found at Ashton House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. There were enough staff, recruitment checks were robust, and medicines were generally stored and administered safely, although the report recommended expert advice about covert medicines.
- Effective?
- Good
- Staff were trained and supported, people received appropriate healthcare and nutrition support, and the home worked with other professionals. Consent and mental capacity processes were understood and followed.
- Caring?
- Good
- Inspectors found kind and respectful care. People were involved in decisions and encouraged to remain independent.
- Responsive?
- Good
- Care plans reflected people's needs, preferences and interests. People had choices about daily routines, activities, food and care, with support for communication, culture, religion and end-of-life care.
- Well-led?
- Requires improvement
- Management had introduced better audits and action plans, but these checks missed important shortfalls. Improvements were not yet fully sustained or embedded.
What inspectors found, April 2019
Rated Good overall; inspectors found kind, effective care, but quality checks and some care records still needed improvement.
Inspectors visited without notice on 2 and 5 April 2019. They spoke with people living at the home, relatives, staff and healthcare professionals. They reviewed care records, medicines, recruitment files, accident records, complaints and quality checks.
The home was rated Good for Safe, Effective, Caring and Responsive. People said they felt safe and well cared for. Inspectors found enough staff, good training, safe medicines systems, kind staff, personalised care, activities and good support with food and healthcare.
The home was rated Requires Improvement for Well-led. Quality checks had improved since the previous inspection, but they had not found six incorrectly set pressure-relieving mattresses. Records also did not show some night-time repositioning, and some daily notes and behaviour records lacked useful detail.
The overall rating improved from Requires Improvement at the previous inspection to Good. The report says improvements had been made, but some changes still needed to become consistent and fully established.
People felt safe
People and relatives said they felt safe. Inspectors found risk assessments, safety plans and staffing arrangements that supported people's needs.
“People were safe and protected from avoidable harm. Legal requirements were met.” from the report
Kind and respectful staff
Staff knew people well, respected their choices and promoted independence. Inspectors observed caring and person-centred support.
“Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.” from the report
Personalised activities and care
People were supported to choose activities and maintain family contact. Care plans included people's histories, interests, communication needs and preferences.
“There was a wide range of activities organised and these included, flower arranging, visits from exotic pets, cooking sessions and arts and crafts.” from the report
Improvements since the last inspection
The home had improved its risk assessments, medicines management and care planning since the previous inspection. Its overall rating rose from Requires Improvement to Good.
“The service had made improvements since our last inspection. This meant people's outcomes had improved.” from the report
Mattress checks missed incorrect settings
seriousSix air-flow mattresses were set incorrectly. These settings are important in preventing pressure damage, and the home's checks had not identified the problem.
“We found six air flow mattresses set incorrectly.” from the report
Night-time repositioning records
seriousSome people were assessed as needing repositioning every two hours. Records showed this during the day but not between 9pm and 7am, with no explanation recorded.
“There was no rationale in care plans that stated repositioning was not necessary or a request from people not to be disturbed during the night.” from the report
Incomplete daily notes
needs fixingSome daily notes and behaviour charts did not explain what happened or how staff responded. This made it harder to understand the best way to support a person.
“Daily notes and behavioural charts were not always detailed and lacked meaningful information.” from the report
Covert medicines guidance
needs fixingFor some people receiving medicines disguised in food or drink, records did not clearly show that medicines had first been offered in the usual way. The report recommended expert advice.
“It was not clear from the documentation that staff offered medicines in a normal way first and used covert as a last resort.” from the report
- 01How are you now checking that every air-flow mattress is set correctly for the person using it?
- 02How do you record and monitor repositioning between 9pm and 7am for people who need two-hourly repositioning?
- 03What has changed to make daily notes and behaviour charts more detailed and useful?
- 04What expert advice have you obtained about medicines given covertly, and how do you record that ordinary administration was tried first?
- 05How do you check that improvements found through audits are completed and remain in place?
This was a planned inspection covering all five key questions; the overall rating improved from Requires Improvement at the previous inspection, while Well-led remained Requires Improvement. This explanation was written from the published report of 25 April 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, April 2018
Ashton House was rated Requires Improvement; inspectors found kind care and good support, but serious safety, care planning and management issues.
This was an unannounced inspection over three days in November 2017. Inspectors spoke with people living at the home, relatives, health professionals, managers and staff. They observed care and checked care records, medicines, staffing, training, complaints and quality checks.
The home was not always safe. Medicines were not always managed safely. Risks and specific health needs were not always clearly assessed or recorded. Some care plans gave conflicting information, including about mobility, monitoring and eating. There were also gaps in guidance for epilepsy, tube-fed nutrition and pressure ulcer care.
Inspectors found staff were kind, patient and respectful. People received good support with food, training, healthcare and activities. However, the systems used by managers did not identify all the problems, and some required notifications had not been sent to the CQC. The home was rated Requires Improvement overall, with Good ratings for Effective and Caring.
Kind and respectful staff
People and relatives described staff positively. Inspectors observed staff being kind, patient and respectful, and found that people's privacy and choices were generally supported.
“People's needs were met by staff who were kind and caring. Staff respected people's individuality and spoke to them with respect.” from the report
Good healthcare support
People could access GPs and other health professionals. Staff acted quickly when some people's health deteriorated and worked with outside professionals.
“People benefitted from good medical and community healthcare support and links the staff and provider had developed.” from the report
Enough staff and safer recruitment
Inspectors found enough staff to meet people's care and health needs. Recruitment checks were in place to assess whether new staff were suitable.
“There were enough staff to meet people's care and health needs.” from the report
Activities and social opportunities
The home offered group and one-to-one activities, trips and opportunities linked to people's interests. Staff recorded activities and hobbies to help plan suitable options.
“During the inspection there was a range of activities taking place.” from the report
Action after accidents
The home had improved its response to accidents and incidents since the previous focused inspection. Action plans showed how the risk of a repeat incident could be reduced.
“There were clear action plans following accidents and incidents which highlighted ways to prevent reoccurrence.” from the report
Medicines were not always safe
seriousTwo staff sometimes worked from the same medicine trolley, and one medicine given in food may not have been taken. Medicines given covertly had not been checked with a pharmacist for safe use in the food or drink.
“People did not always have their medicines managed safely.” from the report
Risks and health needs lacked guidance
seriousSome people did not have clear instructions for staff about distress, repositioning, epilepsy or tube-fed nutrition. Inspectors found a person had not been repositioned as required on 16 occasions over six days.
“People with specific health needs were placed at risk of declining health and infection spreading.” from the report
Care plans were inconsistent
needs fixingSome care plans were not updated when people's needs changed. Conflicting information could mean staff, including agency staff, gave care that did not match a person's needs.
“people's care plans had not always been updated when their care and health needs changed.” from the report
End of life information was not always shared
needs fixingManagers were not aware that two people had recently been assessed as needing palliative or end of life care. This created a risk that their wishes and comfort needs would not be followed.
“There was a risk people would not receive a dignified death in line with their wishes and preferences.” from the report
Quality checks missed problems
needs fixingThe home's audits did not identify several concerns found by inspectors, including unclear repositioning records, contradictory care plans and missing risk guidance.
“However, none of these systems had identified some concerns found during the inspection.” from the report
Some notifications were late or missing
needs fixingThe provider did not always notify the CQC about safeguarding matters in line with legal requirements. This reduced the ability of external organisations to monitor people's care and safety.
“Notifications had not always been sent in line with current legislation.” from the report
- 01How will you make sure medicines, including medicines given in food or drink, are administered safely every time?
- 02How are care plans checked and updated when a person's mobility, health, distress or eating needs change?
- 03What clear instructions are in place for epilepsy, pressure ulcer repositioning and tube-fed nutrition?
- 04How will you make sure end of life wishes and changes in health are communicated promptly to all staff, including agency nurses?
- 05What has changed in your quality checks since this inspection, and how do you check that these changes are working?
This was an unannounced inspection covering all five CQC questions and the overall quality of the home; the previous inspection had been a focused inspection of safety and effectiveness. This explanation was written from the published report of 10 April 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 Ashton House
4 rated inspections over 4 years: the service has held its Good rating throughout.
- April 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2015Goodstayed GoodSafe: Requires improvementEffective: Good
- June 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014
Registered with the Care Quality Commission on 8 September 2014.
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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28 live-in carers within about an hour of West Sussex
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Most charge £1,020 to £1,170 a week. 23 can care for a couple. 11 years' experience on average.
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