The inspection took place on 13 and 17 June 2018 and was unannounced. At the last inspection on 21, 26 and 27 September 2017 we asked the provider to take action to make improvements around person centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. The home was rated inadequate and placed in special measures. CQC took enforcement action. Following the last inspection, we met with the registered provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At this inspection we checked to see whether improvements had been made and found improvements had been made in all areas, although the registered provider was still not meeting two of the regulatory requirements.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Ashworth Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Ashworth Grange is registered to accommodate up to 64 people. The service provides care for people with residential needs as well as those living with dementia. The home is divided into four units over two floors connected by a lift. At the time of our inspection 45 people were using the service including one person who was currently in hospital. One unit for people living with dementia remained closed following our last inspection.
A registered manager was in place. 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.
Emergency procedures were not robust to protect people in the event of the need to evacuate the building. Two night staff members did not know the correct procedure to follow in the event of a fire and had not received fire drills in line with the registered provider’s policy. These staff were uncertain how many people were living in the home on the day of our inspection. This was a continuing concern from our last inspection and was a breach of regulation 12, safe care and treatment.
Most risk assessments were individual to people’s needs and minimised risk whilst promoting people’s independence, although some lacked detail. Behavioural support plans did not always contain sufficient detail to investigate the causes of behaviour that may challenge others and to support staff to prevent and manage behaviour effectively. Consistent records of behavioural incidents were not always kept.
We found the systems for managing people’s medicines had improved and issues from our last inspection had been addressed. Competency checks on the administration of medicines were up to date. People received their medicines safely.
Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse. Safe recruitment and selection processes were in place.
The required number of staff was provided to meet people’s assessed needs and provide a good level of interaction.
Incidents and accidents were analysed to prevent future risks to people and learning from incidents was evident.
Staff told us they felt very well supported and they received regular supervision, training and appraisal to meet their development needs. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home. The registered manager was planning to improve the recording of initial induction to the home environment for new staff.
People told us they enjoyed their meals and meals were planned around their tastes and preferences. People were supported to eat a balanced diet and action was taken where people’s nutritional intake had declined.
People were supported to maintain good health and had access to healthcare professionals and services. Community professionals told us the service had improved and was working in partnership with them to improve outcomes for people. The service was adapted to meet people’s individual needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. New electronic recording systems meant signatures had not been recorded on best interest decisions and the registered manager planned to address this straight away using paper signature records for important decisions and consent.
Positive relationships between staff and people who lived at Ashworth Grange were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.
People were involved in arranging their support and staff facilitated this on a daily basis. People were supported to be as independent as possible throughout their daily lives.
The management team promoted an open and inclusive culture whereby people were encouraged to express their diverse needs and preferences.
Most care records contained detailed information about how to support people, however some records were inconsistent. People engaged in social and leisure activities which were more person-centred.
Systems were in place to ensure complaints were encouraged, explored and responded to in good time and people told us staff were approachable.
Improvements had been made to the system of governance and audits within the service. There were some issues that had not been picked up by this system. This showed that whilst improvement had been made since the last inspection, some issues relating to governance remained.
People told us the service was well-led. The registered manager was visible in the home and knew people’s needs.
The registered provider had increased resources and senior management input to the home. This had proved effective in driving improvements to the quality and safety of the service provided.
Feedback from staff was positive about the registered manager. Everyone at the home knew their roles and welcomed feedback on how to improve the service. People who used the service and their representatives were asked for their views about the service and they were acted on.
We found continuing breaches in Regulation 12 and 17 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.