We carried out a review of the data available to us about Ashdown Nursing Home 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 Ashdown Nursing Home, you can give feedback on this service.
We found the following examples of good practice.
At the time of the inspection, the home was closed due to an outbreak of COVID-19. There was a policy for the admission of visitors (and contractors) to the home in readiness for when the home re-opened. Visitors would undertake a Lateral Flow Device (LFD) test, and if tested negative, would be given Personal Protection Equipment (PPE) to wear, to protect themselves and others from spreading infection. Visits would take place in a person’s bedroom or outside in the garden. Temperature checks would be undertaken before visitors were allowed into the home.
The provider had completed a COVID-19 risk assessment and this covered all potential risks and described actions to be taken during the outbreak, for example, the place where visiting took place would be sanitised after use. Full COVID-19 risk assessments had been completed in areas such as control of the spread of infection, high touch areas, equipment, communal areas, handwashing, staff living or working together, cleaning, mental health and wellbeing (people and staff), social distancing, staffing levels and workplace ventilation.
People and their relatives or friends were encouraged to keep in touch with others through video links and phone calls whilst the home was closed to visitors. Social distancing guidelines were adhered to and observed during the inspection and staff understood the need for this. Some people chose to stay in their rooms during the outbreak and some were in isolation. Two people struggled to stay in their rooms whilst in isolation, so they had been risk assessed; there were plans in place to manage this. One person was observed walking around the home and when they did this, they were gently guided back to their bedroom by staff.
There were no admissions currently due to the outbreak, however, there was an admissions policy. New admissions would have to isolate for 14 days and undertake a Polymerase Chain Reaction (PCR) test to confirm whether they had COVID-19.
Effective infection prevention and control practices had been implemented. Staff were trained in the donning and doffing of PPE and this was confirmed at inspection. PPE was disposed of in separate, foot-operated bins in people’s bedrooms. Staff had explained to people the need to wear PPE, and people understood and acknowledged this. One person had a hearing impairment, which staff were aware of when communicating with them. In addition to masks, gloves, and aprons, staff wore visors. PPE was used in line with government guidance.
Staff completed LFD testing before coming on shift and weekly PCR testing. Staff who tested positive were isolating at home. People undertook a PCR test every 28 days, although they were currently receiving weekly PCR tests due to the outbreak in the home, as advised by Public Health England. Anyone testing positive isolated in their room for 14 days from a positive result or from when symptoms developed. Notices on people’s bedroom doors confirmed the date they went into isolation and the date when their period of isolation would finish. The signage was a visual aid for staff to understand who was potentially infectious. No-one had refused to be tested.
At inspection the premises were observed to be clean and hygienic. Regular cleaning schedules were in place and a ‘fogging’ machine had been purchased. This was used to spray a fine mist around the home and helped prevent the risk of the spread of infection for at least 48 hours. Windows were safely opened to aid the circulation of fresh air around the home.
Staff took their breaks in a staff room and were encouraged to take their breaks individually to manage any infection risk. Staff had completed Infection Prevention and Control (IPC) training. Agency staff had been needed to fill any gaps in staffing levels. The same agency was used and these staff did not work at any other home. A contingency plan included actions to be taken in the event of an emergency.
Staff had access to mental health and wellbeing support from the provider. The registered manager felt supported by the provider. Weekly calls from the community matron and from the local medical practice were described as being ‘very supportive’ by the registered manager.
We had been informed that staff were working between this home and another nursing home nearby. One staff member did occasionally work at both homes in the past, but as soon as the other home had an outbreak, they stopped working at Ashdown Nursing Home. Government guidance on staff working between homes was being followed by the provider.
Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However, rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were thirty people living in the home. The home provides care and support for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There was a lounge and a dining area. There was a well- maintained garden and paved area as well as a summer house that people could use during the summer months.
There have been another two comprehensive inspection since January 2016. We carried out an announced comprehensive inspection on 6 and 8 January 2016. Breaches of legal requirements were found and the home received a rating of ‘Inadequate’ and was placed into ‘special measures’. The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example, cancel their registration. Services placed in special measures will be re-inspected again within six months. If sufficient improvements have been made, the service can come out of special measures and the overall rating can be revised. You can read the report from our previous inspection, by selecting the 'all reports' link for (Ashdown Nursing Home) on our website at www.cqc.org.uk.
We carried out another comprehensive inspection on 3 and 13 May 2016. It was evident that improvements had been made and the home received a rating of ‘Requires Improvement’ and as a result was no longer in ‘special measures’. However, the legal requirements in relation to safe care and treatment, the need for consent and dignity and respect had not been fully met. Areas for improvement were also identified in order to further improve some practices in relation to staffing levels, medicines, communication and interaction and providing choice.
At this inspection it was evident that improvements had been made and the providers had ensured that this had been sustained and embedded in practice. The providers were no longer in breach of the regulations, however, although the providers were no longer in breach, we noted that further improvement was needed to ensure that there was a consistent approach to assessing peoples’ capacity and making decisions on peoples’ behalves.
At the previous inspection on 3 and 13 May 2016 the home had been without a registered manager for seven months. 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 providers had been responsible for the day-to-day management of the home and peoples’ care. A new manager had been in post for one month. Following the inspection the manager left employment and one of the providers had become the registered manager. At this inspection it was evident that considerable efforts had been made to continually improve the service. A clinical lead nurse had been recruited to improve the nursing care people were receiving. In addition, a general manager was in post who had worked hard to improve the leadership and management of the home and had introduced mechanisms to ensure that the service was meeting peoples’ needs.
At this inspection people received care that was safe. There were sufficient numbers of suitably trained staff to meet peoples’ needs and people told us that when they required support, staff responded in a timely manner. People were assisted to move and position in a safe way. Staff had received training in safe moving and handling and their practice was observed and monitored by the management team as well as senior staff to assure peoples’ safety. People received their medicines on time from nursing staff as well as staff who had received the required training. Records showed that relevant healthcare practitioners had been involved in decisions that related to peoples’ care and their access to medicines. The home was clean and people were protected from the risk of infection.
People were treated with dignity and respect. Observations showed staff explaining their actions, treating people with kindness and compassion and being sensitive when supporting them with their personal care needs. Positive relationships had developed between people and staff and people and relatives told us that staff were kind and caring. A relative told us, “I can‘t see how they can do anything else, they’re fantastic. I have to trust these people, and I do”. People and relatives were involved in peoples’ care and able to share their thoughts and suggestions. Regular care plan reviews took place as did residents’ and relatives’ meetings where people and relatives were kept informed of peoples’ care and the running of the home. People were able to stay at the home until the end of their life. People and their relatives had been involved in planning how the person wished to be supported during this stage in their life.
The management team and staff ‘knew’ people and took time to find out about their life before they moved into the home. People were encouraged to participate in a wide range of activities, external entertainment and meaningful occupation that occupied their time. People received care that was personalised to their needs. Care plans documented peoples’ preferences and wishes as well as their healthcare needs. People and their relatives were involved in the development, review and implementation of peoples’ care.
The management team welcomed feedback and used various mechanisms to obtain this from people, relatives, staff and external professionals. Feedback was positive and any suggestions that had been made had been recognised and changes made as a result. This related to peoples’ choices of activities or the food that they were provided with. There was a positive culture and a warm, calm, friendly and welcoming atmosphere.
People told us that they liked the food. One person told us, “The food is very good, very good, better than at my last place”. Observation showed people could choose what they had to eat and drink and peoples' right to change their mind was respected by staff. Communication aids were used to adapt communication for both staff and people. For example, pictures of meals were shown to people to help them to choose food and guidance had been translated in staffs’ first language to promote understanding and aid their development.
The home was well-managed and people, relatives, staff and external professionals were complimentary about the leadership and management of the home. Rigorous quality assurance processes audited the care that was provided to ensure that it was meeting peoples’ needs and they experienced a service they had a right to expect. The management team worked with external healthcare professionals to ensure people were receiving good quality care, to promote learning amongst the staff team and the sharing of best practice guidance.
The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. Services placed in special measures will be re-inspected again within six months. If sufficient improvements have been made, the service can come out of special measures and the overall rating can be revised. You can read the report from our previous inspection, by selecting the 'all reports' link for (Ashdown Nursing Home) on our website at www.cqc.org.uk
We undertook this unannounced comprehensive inspection to look at all aspects of the home and to ensure that the required actions had been taken to address the concerns, and to see if the required improvements had been made. We found improvements had been made in the majority of areas. The overall rating for Ashdown Nursing Home has been revised to ‘Requires Improvement’, the home has also come out of ‘Special Measures’. However, the legal requirements in relation to safe care and treatment, need for consent and dignity and respect had not been fully met. Areas for improvement were identified in order to further improve some practices in relation to staffing levels, medicines, communication and interaction and providing choice.
Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were twenty-three people living in the home. The home is for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There was a lounge and a dining area. There was a garden that was in the process of being landscaped with a summer house that people could use during the summer months.
The service had not had a registered manager for seven months. 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 providers had been responsible for the day to day management of the home and people’s care. A new manager had been in post for one month and was undertaking the process of registration.
Observations of some care practices and feedback from some people and their relatives raised concerns over people’s safety when they were supported with moving and positioning. Risk assessments recognised the potential risk to people and provided guidance to staff in relation to how to support people in a safe manner. However, staff did not always adhere to this guidance and were observed undertaking unsafe moving and handling practices. One person told us “They often knock and bang my legs when they hoist me, but they can’t help it”. This was raised with the providers who took immediate action. Meetings were held with the members of staff concerned and they undertook refresher training.
The provider had taken some measures to ensure that people were asked for their consent and were not deprived of their liberty unlawfully. However, for people who required the use of bed rails and who needed to have their medicines administered covertly, measures hadn’t been taken to ensure that relevant people were consulted to give lawful consent for their use. This was addressed with the provider who was aware that this required further improvement, there were plans in place to improve this but these had yet to be implemented. This was an area of concern.
People, relatives and staff told us that the staffing levels were sufficient, and our observations confirmed this. However, we were unable to determine whether the current service provision, in relation to staffing levels, had been fully embedded and could be sustained over time, should the number of people living at the service increase.
Most staff communicated with people, explained their actions and demonstrated positive interactions. However, some staff provided little interaction or communication with people, particularly when people were being supported to eat and drink and to have their medicines. People were supported to have their medicines by registered nurses and had their medicines on time. However, there were concerns regarding people’s privacy and dignity when being supported with their medicines. This was an area of concern.
Guidelines were in place for people who required medicines on an ‘as and when required’ basis, however these lacked detail and there was a potential risk that this could lead to a lack of consistency in approach by staff. However despite these areas that required further improvement, the provider had made significant improvements to the standard of care people received.
Staff had received induction training and had access to on-going training to ensure their knowledge was current and that they had the relevant skills to meet people’s needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns.
Risk assessments had been undertaken and were regularly reviewed. They considered people’s physical, health and cognitive needs as well as hazards in the environment and provided guidance to staff. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments. Observations of people assessed as being at risk of falls showed them to be independently walking around the home. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice.
People were supported to maintain their nutrition and hydration and now had a positive dining experience. People felt that they had enough food and drink and observations confirmed that drinks and snacks were offered throughout the day. Most people were content with the food. One person told us “The foods not bad”. Another person told us “It’s quite good”. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements. Foods were fortified with double cream and full fat milk to increase their calorie intake. As a result people’s weights had increased.
People had access to relevant healthcare professionals to maintain good health. Records confirmed that external healthcare professionals had been consulted to ensure that they were being provided with safe and effective care. People’s clinical needs were assessed and met. People received good health care to maintain their health and well-being.
People were cared for by a majority of staff who knew them and who understood their needs and preferences. The provider had taken appropriate measures to ensure that people, who were at risk of social isolation, had access to interaction and engagement with staff and others. People had access to a wide range of activities and observations showed people partaking in these activities and showing enjoyment.
People were involved in their care and decisions that related to this. People and relatives were asked their preferences when people first moved into the home. They were provided with an opportunity to share their concerns and make comments about the care they received through care plan reviews and relative and resident meetings. Most relatives confirmed that they were involved in their loved ones care, felt welcomed when they visited the home and knew who to go to if they had any concerns. People also confirmed that they knew who to go to if they had any concerns. One person told us “I’d tell her over there (pointing to the provider) she’s like the teacher here and makes sure you’re alright”.
There was a homely, friendly, calm and relaxed atmosphere within the home. People were complimentary about the leadership and management of the home. One person told us “Things have definitely changed for the better”. Relatives confirmed this, one relative told us “They’ve got strong leadership now and I feel there’s reliability and safety which is consistent”. Staff felt supported by the providers and manager and spoke highly of them. One member of staff told us “The atmosphere has changed. Before, everybody had a long face, not now though, everybody is happy and it’s calmer”. Another member of staff told us “The manager and providers are very nice, they’re polite, they’re approachable and listen to us”.
There were now rigorous quality assurance processes in place that were carried out by the provider to ensure that the quality of care provided, as well as the environment itself, was meeting people’s needs.
We found breaches of 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.
The inspection took place on 6 and 8 January 2016 and was unannounced.
The provider had taken ownership of the home in September 2015, they explained to us that they had been left in a difficult predicament by the previous provider and recognised that the home and the care provided needed significant improvement. The registered manager had left in October 2015 and the home had been without a registered manager for three months. 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 provider had recruited a new manager as well as a deputy manager, who have since left employment.
The overall rating for Ashdown Nursing Home is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were twenty-nine people living in the home. The home is for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There were two lounges and a dining area. There were plans in place to extend the dining area to provide more space for people to use. There was a garden that was in the process of being landscaped with a summer house that people could use during the summer months.
There had been changes in the staff team, several members of staff had left the home, yet despite the use of agency staff there were insufficient levels and inappropriate deployment of staff during peak periods to meet people’s personalised and individual care needs. For example, due to there being inadequate staffing levels, one person, who preferred to be supported to get up and have their breakfast earlier in the morning, was supported to get up much later than they wished and was still eating their breakfast half an hour before their lunch was served. Staff confirmed this was the case, one member of staff told us “There are not enough staff. We are not finishing personal care and getting people up until about 12:00pm.”
Risk assessments had been undertaken, however there was not always sufficient guidance for staff and these were not always implemented or sufficiently monitored. Observations of care practices raised concerns over people’s safety when they were supported with moving and positioning and receiving pressure area care. People who were at risk of malnutrition had been assessed, however suitable measures had not been followed to ensure that appropriate actions were taken in regards to this. For example, care records for five out of the ten people that we looked at showed that since the provider had taken ownership of the home they had lost significant amounts of weight. This had not been recognised and they had not been referred to external healthcare professionals. People were not supported to maintain adequate nutrition and hydration. People had a poor dining experience and they were not supported appropriately to enable them to have sufficient amounts to eat and drink.
The level of staffing to meet people’s individual needs, the implementation and monitoring of risk assessments, weight loss for people who had been assessed as being at risk of malnutrition and the practice of staff in relation to moving and positioning were areas of concern.
Accidents and incidents had been recorded but there were insufficient mechanisms in place to monitor these to identify trends and aid prevention. Measures to minimise the risk of cross contamination had been taken however observations of poor practice in relation to infection control raised concerns. These are areas in need of improvement.
People were supported by staff who lacked the experience, skills and knowledge to support them according to their needs. Relatives were concerned over staff’s experience and skills and one member of staff told us “The staff don’t really know anything about dementia care.” There was insufficient supervision, support or training for staff to provide them with the skills necessary to meet people’s needs.
The provider had taken some measures to ensure that people were asked for their consent and were not deprived of their liberty unlawfully. However, for people who required the use of bed rails and who needed to have their medicines administered covertly, measures hadn’t been taken to ensure that relevant people were consulted to give lawful consent for their use.
The skills and knowledge of staff, as well as the lack of processes to gain people’s consent were areas of concern.
Observations showed that people were not treated respectfully. One person told us “I can tell when people don’t care.” People were not always appropriately supported to maintain their continence or their personal hygiene. Relatives were concerned that their loved ones were not receiving the support that they needed. One relative told us “My relative never gets supported to use the toilet, the staff are told that they have to use their pads. I came in the other day and my relative had a blanket over them, I pulled it back and their legs were soaking wet.”
People were at risk of social isolation, their personalised and individual needs were not met and there was a lack of stimulation for people. One person confirmed this and told us “It’s a bit boring, I don’t know what I’m doing today, I don’t get out.”
The lack of personalised care to meet people’s needs and ensure they were treated respectfully and their dignity maintained was an area of concern.
There was a lack of quality monitoring processes and as a result the provider had failed to identify when people’s care needs were not being met. For example, people who had been assessed as being at risk of malnutrition had their weights and food and fluid intake monitored. However, the provider had not ensured that the results of these were reviewed or analysed. They had failed to identify that some people had lost significant amounts of weight and therefore had not taken the necessary action to ensure people’s safety.
We found a number of breaches of 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.