We carried out a review of the data available to us about Ashton House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashton House, you can give feedback on this service.
Ashton House accommodates up to 100 people across two separate units, each of which have separate adapted facilities. One of the units, Hazelwood, specialised in providing care to people who lived with dementia. The main house supported people who lived with a wide range of health problems, such as strokes, heart problems, Parkinson’s disease and general frailty. At the time of the inspection there were 75 people living at the home. It is a large, detached home with accommodation across three floors.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
• People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “This is a good place to live, I feel safe,” and “The staff are very kind.”
• The service had made improvements since our last inspection. This meant people’s outcomes had improved. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. For example, the current systems for checking that air flow mattresses were set accurately as per manufacturers’ instructions for prevention of pressure damage were not effective. We found six air flow mattresses set incorrectly.
• Risk assessments had been undertaken for prevention of pressure damage. Some risk assessments had identified that people needed two hourly repositioning whilst in bed. Records confirmed these were undertaken during the day but there was no record of those people being repositioned between 9pm and 7am. There was no explanation why this was not necessary.
• Daily notes and behavioural charts were not always detailed and lacked meaningful information that told staff of actions that may be required.
• These were areas that required further improvement.
We have made a recommendation about seeking expert advice about the administration and use of medicines given covertly (disguised in food/drink).
• There were sufficient staff to meet people’s individual needs who had passed robust recruitment procedures that ensured they were suitable for their role.
• There were systems in place to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, these incidents and accidents were recorded and lessons were learned.
• Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “Staff are really helpful and efficient, look after my relative really well,” and “The staff team are wonderful.”
• People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave very positive feedback about the food. Comments included, “The food is good,” “Very tasty, good quality,” and “Good food”
•Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.
•People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.
• People's care was now more person-centred. The care was designed to ensure people's independence was encouraged and maintained. Staff supported people with their mobility and encouraged them to remain active.
• People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.
• There were positive changes to the management team. Improved audits and checks were put in place to ensure the service was continuously striving to improve. Areas identified as needing improvement during the inspection process were immediately taken forward and action plans developed.
• There was a happy workplace culture and staff we spoke with provided positive feedback and told us they were proud of the service and enjoyed their work.
The service met the characteristics for a rating of ‘Good’ in four of the five key questions we inspected, with the well-led question remaining ‘Requires Improvement.’ Therefore, our overall rating for the service after this inspection has improved to "Good".
Rating at last inspection:
At the last inspection the service was rated Requires Improvement (report published 09 April 2018).
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will follow up on our recommendations at the next scheduled inspection.
At a focussed inspection on 28 July 2015 looking at how safe and effective the home was we found concerns relating to actions taken following accidents and incidents. Improvements had been made. There were now actions clearly recorded and taken following any accident or incident. However, we did find new concerns with medicines management, the assessment of risks to people, inconsistencies in care plans and people with specific health needs not having clear guidance in place.
Ashton House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Ashton House accommodates up to 100 people across two separate units, each of which have separate adapted facilities. One of the units, Hazelwood, specialises in providing care to people living with dementia. The main house has a wider range of older people living in it. At the time of the inspection there were 74 people living at the home. It is a large, detached home with accommodation across three floors. Most people have a single bedroom. There are two double bedrooms.
At the last inspection the service was rated good.
The home currently has a senior registered manager supported by two unit registered managers. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. One of the unit registered managers had recently left employment.
People were not always kept safe at the home. Improvements were required when some people had specific health and care needs. Risks had not always been assessed or identified to enable people to retain their independence and receive care in line with their needs. Medicines had not always been managed safely because there were occasions where more than one staff had worked from the same medicine trolley. One person who required medicines administered in food or drink did not have it done safely. People were protected from potential abuse because staff were able to recognise signs and knew how to report it.
People and their relatives were involved in writing their care plans. Some care plans contained inconsistent information and lacked guidance for staff to follow. Systems were not always in place to ensure people had a dignified death.
There was a programme of activities in place to provide a range of opportunities. People were encouraged to suggest activities and trips which would respect their hobbies and interests. People and their relatives knew how to complain and action was taken. However, lessons learnt from complaints had not always been recorded.
The provider and registered manager tried to promote high quality care. The registered managers and provider had systems to monitor the quality of the service and made some improvements in accordance with people’s changing needs. The systems in place had not identified some concerns found during the inspection. There was a positive approach to improving the service once they had been highlighted. People were positive about the management of the service. Staff felt supported. The provider had not always completed statutory notifications in line with legislation to inform external agencies of significant events.
People were supported to have choice and control of their lives. When people lacked capacity the statutory principles of the Mental Capacity Act 2005 had not always been followed following feedback from an external audit. People and their relatives were positive about the food and meal times were treated as a social opportunity. Staff had the skills and knowledge required to effectively support people. People and their relatives told us their healthcare needs were met and staff supported them to see other health and social care professionals.
People and their relatives told us, and we observed staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. When people had specific needs or differences they had been considered by staff. People, or their representatives, were involved in decisions about the care and support received. There were enough staff to meet people’s care and health needs.
We found one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We carried out an unannounced comprehensive inspection of at Ashton House on 14 April 2015. Following that inspection we received information of concerns that people were not always receiving the care they needed which could place people at risk of harm. As a result we undertook a focused inspection to look at those areas of concerns. We looked at the key questions, is the service safe and effective. This report only covers our findings in relation to those areas. You can read the report from our last comprehensive inspection in April 2015, by selecting the 'all reports' link for Ashton House on our website at www.cqc.org.uk.
The inspection took place on the 28 July 2015 and was unannounced.
Ashton House is a large detached property, consisting of a main house and purpose built wing. Ashton House is registered to provide nursing care for up to 91 older people and people living with dementia. Accommodation is provided over three floors, with passenger lifts providing access between floors. On the day of our inspection 75 people were using the service.
The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We had received an application for the manager of the service to become the registered manager, which was currently being processed.
On the day of the inspection the provider was being supported by external agencies staff who provided guidance and support in care and nursing practices, this was due to a number of concerns that were currently being looked into by the local authority.
Concerns had been raised that there were not enough experienced and permanent nursing staff at the home. The provider and manager told us of the issues and difficulties they had and the plans they had in place to ensure the home was run by competent nurses who would be employed permanently. In the interim the provider was using regular agency staff.
Staff did not always take appropriate action following accidents and incidents to ensure people’s safety although they were recorded in the accident and incident book, we found the recording of incident and accidents was not always consistent and therefore it was not always clear what action was being taken. Some had limited information to be followed up which could have an impact of people’s safety.
The experiences of people were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. One person told us “I like it here, I feel safe and the staff are nice”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.
Staff supported people to eat and they were given the time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. One person told us “The chef is very good we have lovely meals”. Staff were patient and polite and supported people to maintain their dignity and were respectful of their right to privacy.
The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed.
People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.
Staff had received essential training and there were opportunities for additional training specific to the needs of people living at the home. Staff had received one to one supervision meetings with their manager.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.
Following this focused inspection, we have revised the rating of safe from ‘Good’ to Requires Improvement. However, the overall rating of ‘Good’ remains.
The inspection took place on the 14 April 2015 and was unannounced.
Ashton House is a large detached property, consisting of a main house and purpose built wing. Ashton House is registered to provide care and nursing for up to 91 older people and older people living with dementia. Accommodation is provided over three floors, with passenger lifts providing access between floors. On the day of our inspection 84 people were using the service.
The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The previous registered manager had recently left. We have received an application to register the acting manager.
This is the first inspection under the new provider of Ashton House who registered in October 2014.
People told us they felt safe at the home. There were enough skilled and experienced staff to ensure people were safe and cared for.
The experiences of people were positive. Staff were kind and compassionate and the care they received was good. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.
Staff told us how they worked together to support people and make sure people received the care they needed. Staff interactions were positive with staff speaking to people in respectful manners, asking them about what they wanted to do and giving choices
Care staff supported people to eat and they were given the time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to leisure and social activities in line with their individual interests and hobbies. These included trips to local cafes and the seaside and entertainers who visited the home. We spoke with the provider who was working with staff on improving individual and group activities for people.
People’s needs were assessed and personalised, care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.
People were cared for by staff who knew them well and positive, caring relationships had been developed. People were supported to express their views and arrangements were made to meet people’s individual requirements. People were treated with respect and their privacy and dignity was promoted.
People who were living with dementia were supported to express their views and decisions. This included offering choices and having staff who understood their preferences, likes and dislikes.
Medicines were managed safely and people received their medicines when they needed them. Any risks associated with medicines were assessed and managed in people’s best interests.
The manager considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.
The manager made sure there were enough staff on duty at all times to meet people’s needs. Appropriate checks were carried out before new staff started working at the service.
Staff felt fully supported by management to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example staff were offered to undertake a qualification in health and social care as part of on going support and development. Nursing staff were supported with training in specific nursing interventions such as wound care management and use of specialist equipment to help people maintain their independence.
People and relatives we spoke with were aware how to make a complaint and all felt they would have no problem raising any issues. The provided responded to complaints in a timely manner with details of any action taken.
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