Ashlynn Grange

Ashlynn Grange is a ‘care home’ providing personal and nursing care to up to 156 people. On the first day of our inspection there were 82 people living at, and using, the service. The service provides support to adults, some of whom have dementia, in 4 separate buildings, these are called ‘communities’. Each community is on ground floor level and has its own adapted facilities. At the time of our inspection 3 communities were in use.

People’s experience of using this service and what we found

Safeguarding processes were not always robust to help keep people safe, and lessons were not always learnt when things went wrong. Risks to people’s safety were not consistently assessed and considered, and people were at risk of pressure sores and worsening skin health due to ineffective monitoring of pressure relieving equipment. Checks for medical devices were not always being completed in line with the provider’s procedures and manufacturer’s directions. Medicines were not always managed safely.

In the months prior to the inspection, the provider had received support from the local authority to make improvements at the service. We found many actions had been taken, and improvements to service provision was apparent in many areas. However, governance, systems and audit processes still required review, development, and time to embed, which was recognised by the provider’s senior leadership team. The senior leadership team told us they were committed to making and sustaining ongoing improvements and were responsive to our feedback during the inspection process.

We have made a recommendation for the provider to review accessible information signage within the environment.

People told us they felt safe at the service. The environment was clean, and infection control processes were in place. There was enough staff to support people safely, and the provider undertook safe recruitment procedures.

People, and their relatives, gave mixed feedback for their involvement in the care planning process. However, responsive end of life care planning took place, and relatives told us staff did regularly involve them in this process. Activities for people had not always been consistently available and planned. However, a new activities team had been appointed at the service during the inspection time frame.

People, and their relatives, gave us mixed feedback of their experience and knowledge of how to raise a concern or complaint. The provider’s representatives had plans to improve communication information and systems.

People’s needs were assessed prior to them moving into the service. Staff received the required support and training to enable them to meet people’s needs. Trained chefs were employed at the service and staff supported people to receive a balanced diet. People told us they received healthcare reviews and support when it was needed, however, some people’s relatives felt this area could be further improved upon.

Most staff treated people with respect and dignity. People told us they received good care and support from staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safe care and treatment; safeguarding; person-centred care and good governance. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashlynn Grange on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment, and good governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We have made one recommendation for the provider to review the accessible information available for people.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashlynn Grange provides, accommodation, nursing and personal care for up to 156 adults; some of whom have dementia. It is also registered to provide the regulated activity; treatment, disease, disorder and injury.

People’s experience of using this service and what we found

Staff enjoyed working at the service and felt the they received good support. There were enough staff to support people in the way they wanted. The provider had followed good recruitment procedures to make sure new staff were suitable to work at the service.

Suitable infection prevention and control measures and practices were in place to keep people safe. This prevented the spread of the coronavirus and other infections. Staff had received appropriate training. Staff had access to enough stocks of personal protective equipment (PPE).

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 6 July 2018).

Why we inspected

We undertook this targeted inspection due to an outbreaks of coronavirus and to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing levels and that peoples care was not being provided appropriately.

We assessed whether the service followed safe infection control procedures during the current COVID-19 pandemic and if people received person-centred care. The overall rating for the service has not changed following this targeted inspection.

CQC have introduced targeted inspections to follow up on specific issues. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Ashlynn Grange provides, accommodation, nursing and personal care for up to 156 adults; some of whom have dementia. It is also registered to provide the regulated activity; treatment, disease, disorder and injury. At the time of this inspection there were 78 people living in four areas of the service (called communities), each of which have separate adapted facilities. The communities of Yeoman and Woolsack were housed together in one unit and the communities of Harvester and Hayward were housed in two separate units.

At the last inspection in 10 and 16 August 2017, the service was rated 'Requires Improvement'. At this inspection, we found the service had made the necessary improvements under the questions is the service caring, and responsive; and was now rated as 'Good'. Improvements were still needed for the question of, is the service safe?

Ashlynn Grange 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.

There was no registered manager in post at the time of this inspection. During this inspection the general manager had applied with the CQC to become the registered manager and were awaiting their fit and proper person interview. 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.

People were supported by staff who were knowledgeable about safeguarding and its reporting processes. Risk assessments were in place as guidance for staff to support and monitor people’s assessed risks. Technology was used to assist the majority of people to receive safe, care and support.

People’s confidential records were not always held securely. This put people’s personal information at risk.

Systems were in place to promote and maintain good infection prevention and control. Staff had been recruited safely prior to working at the service. A sufficient number of staff were deployed in a way which met people's needs in a timely manner in two out of the four communities (units). We have made recommendations about the provider making sure that the right skills mix of staff are available on shift to support people safely.

Actions were taken to learn any lessons when things did not always go as planned. However, records documenting the incident and any actions taken were not always in situ.

Medicines were administered as prescribed and they were managed safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received an effective service that met their assessed needs by staff who had been trained to have the skills they required. People were supported with their eating and drinking to promote their well-being. We have recommended that the provider looks at current guidance to make sure that people with short term memory loss are supported with both visual and verbal prompts to enable them to make food and drink choices.

Staff supported people to access healthcare services when this was required. The manager and staff team worked with other organisations to help ensure that people's care was coordinated and person centred.

People received a caring service as their needs were met in a kind, and considerate way. People’s privacy was promoted and maintained by staff and the majority of people’s dignity was supported by staff assisting them. People were involved in their care and staff promoted people’s independence as far as practicable. Staff knew the people they cared for well.

Activities were in place to support people’s interests and well-being. However, there was a lack of organised trips outside of the service for people to enjoy. This limited people’s ability to live a meaningful a life as possible. Compliments were received about the service and complaints investigated, responded to and resolved where possible to the complainants’ satisfaction. Staff worked well with other external health professionals to make sure that peoples end-of-life care was well managed and this helped ensure people could have a dignified death.

People received that was well-led as the manager led by example and encouraged an open and honest culture within their staff team. Quality assurance, audit and governance systems were in place to drive forward any improvements required. The manager and their staff team worked together with other organisations to ensure people’s well-being.

Further information is in the detailed findings below.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This was the first inspection carried out at this service under this provider since it was registered with the CQC in November 2016.

Staff assisted people in a way that supported their safety and people were looked after by staff in a kind and caring manner. Staff encouraged people to make their own choices. However, people’s privacy and dignity was not always promoted and maintained by staff.

Staff were knowledgeable of how to report incidents of harm and poor care. Accidents and incidents were identified and recorded. Actions were taken to, as far as possible; reduce the risk of recurrence where incidents had occurred. Staff were trained to provide effective and safe care. However, staff did not always move people in a safe way that would reduce the risk of injury and in accordance with their training.

People were supported to take their medicines as prescribed and medicines were managed by staff whose competency had been assessed. However, accurate records of people’s medicine administration were not always kept by staff members. Where there had been any errors in the administration of people’s medicines, these had been identified and were being dealt with appropriately. The provider’s quality governance manager had been tasked with undertaking a thorough audit of medicines management as a result of concerns identified by their own quality monitoring systems. This showed us that the safety of people’s medicines’ administration was effectively audited.

People and their relatives / advocates were involved in the setting up and agreement of their/their family members care plans. People’s care arrangements took account of people’s wishes including their likes and dislikes and any assistance they required.

Risks to people who lived at the service such as poor skin integrity or dehydration were identified and plans were put into place by staff to minimise and monitor these risks. During the inspection additional information about people’s specific health conditions and the management of these, including any equipment required, were added into people’s care records.

People were looked after by enough, suitably qualified staff to support them safely with their individual needs. Staff enjoyed their work and were supported and managed to look after people. Staff understood their roles and responsibilities and were supported to maintain their skills by way of supervision. Pre-employment checks were completed on new staff members before they were deemed to be suitable to look after people living at the service.

The service was flexible and responsive to people’s needs. People maintained contact with their relatives and friends and they were encouraged to visit the service and were made welcome by staff.

Activities took place at the service; however, some people felt that the number of activities taking place could be increased to improve social interactions.

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.

People were supported to eat and drink sufficient amounts of food and fluids. Choices of meals were not always given to people, with some memory loss, in a visual manner to aid with their choices and as per the providers ‘dining experience’ audit action plan. This meant that people were not always given the support they needed to make a choice.

Staff monitored people’s health and well-being needs and acted upon issues identified. They also assisted people to access a range of external health care services when needed and their individual health needs were met.

There was a process in place so that people’s concerns and complaints could be listened to and acted upon and where possible resolved to the complainants’ satisfaction. However, where actions had been taken to try to resolve people’s concerns, not all people that raised complaints verbally were made formally aware of any actions taken as a result of their complaint.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. Due to areas of improvement found by the management team, the provider’s clinical governance manager was working within the service to make the necessary improvements. People who lived at the service, their relatives and staff were encouraged to share their views and feedback about the quality of the care and support provided and actions were taken as a result to drive forward any improvements required.