We carried out a review of the data available to us about Ashington Grange 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 Ashington Grange, you can give feedback on this service.
Ashington Grange is a residential care home providing personal and nursing care to up to 59 older people, some of whom are living with dementia. At the time of our inspection there were 44 people using the service. People’s bedrooms were arranged over two floors with communal lounges and dining areas on each floor.
People’s experience of using this service and what we found
People and their relatives spoke positively about the service they received. Comments included, “The home was brilliant through Covid-19; we had to test, sanitise, and so on. The staff, bless them, were working extra with staff off but there was no drop in the care, the care is always there” and “I’m really happy within the home, there is always good care. I go in regularly. It’s totally safe, there are never any issues. [Relative] was like a different person when she went to Ashington Grange. Happy, chatty. There are no issues on safety. There are never any issues with the care. The staff are lovely.”
All staff understood their responsibility to keep people safe from harm. Systems to assess, monitor and manage risk were in place. Care plans contained information and guidance for staff on how best to support the person to minimise and manage risks.
There were enough staff to safely provide care and support. Safe recruitment processes were in place and followed.
Medicines were safely managed, and people received their medicines as prescribed.
People, their relatives and staff all had an opportunity to feedback and be engaged with the running of the home. “Resident Champions” were in place and played an active part in the running of the home.
Staff spoke positively about the registered manager. They felt listened to and could share their views on the running of the home and what this should look like. They felt the registered manager was both approachable and visible around the service.
Systems were in place to monitor the safety and quality of the service. Audits were completed and fed into a ‘home action plan’ which identified what actions were required and when they were subsequently completed. Actions had been taken to address the shortfalls identified at the last inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 27 April 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
We carried out an unannounced focused inspection of this service on 17 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their infection, prevention and control, risk management and governance systems to monitor the quality and safety of the service.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashington Grange on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Ashington Grange is a care home providing nursing and personal care for up to 59 people, some of whom are living with a dementia. At the time of the inspection, there were 32 people living at the home.
People’s experience of using this service and what we found
Action had been taken in relation to the IPC issues identified at our previous inspection, which led to enforcement action. However, we found new shortfalls relating to infection control and the management of risk. Staff were not using the correct PPE required for a specific medical procedure associated with one person’s care, to ensure they were protected from the risk of infection. One person’s care plan and risk assessments had not been updated following several behavioural incidents to ensure staff were aware of the actions to take to manage and minimise the risk to others. These issues had not been identified by the provider’s governance system.
Safeguarding allegations were reported to the local authority. However, it was not always clear which incidents should be reported to the police by staff. We have made a recommendation about this.
Medicines were managed safely. There were sufficient staff deployed to meet people’s needs.
Information requested by CQC during the inspection was not always sent in a timely manner. We have made a recommendation about this.
There was a cheerful atmosphere at the home. Staff spoke positively about working at the home and the people they cared for.
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 requires improvement (published 29 December 2020)
Why we inspected
We carried out a focused inspection of this service on 26 November 2020. A breach of legal requirements was found in relation to safe care and treatment. We undertook this inspection to confirm if the provider was now meeting legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contained those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
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 inspection, by selecting the ‘all reports’ link for Ashington Grange on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so
We have identified two breaches of the regulations in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Ashington Grange is a care home providing nursing and personal care for up to 59 people; some of whom are living with dementia. At the time of the inspection there were 34 people living at the home.
People’s experience of using this service and what we found
People and staff were at an increased risk of infection because a safe and effective infection control system was not fully in place.
Staffing levels had been affected by current events at the home. Staff told us that whilst there had been issues with staffing on certain shifts, they had worked as a team to ensure people received appropriate care and support. Medicines were generally managed safely. We have made a recommendation relating to medicines storage.
The service had been through a difficult period. However, staff spoke positively about working at the home and the people they supported. One staff member told us, "The bond we have with the residents is amazing. I love coming here every day." We observed positive interactions between staff and people.
The provider had a system to assess and monitor infection control across its services. This had been updated and amended in response to the COVID-19 pandemic. However, this system had not been robustly implemented at the home to ensure an effective infection control system was in place. We have made a recommendation about this.
The registered manager and senior management were open and honest and told us that improvements had been made and lessons had been learned.
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 (8 December 2017)
Why we inspected
We undertook this targeted inspection to look at specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and infection control. A decision was made for us to inspect and examine those risks. When we inspected, we found there was a concern with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashington Grange on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified a breach in relation to safe care and treatment regarding infection control. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Ashington 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. The home is registered to provide support for up to 59 people over three area. The lower floor predominantly supported people with nursing care issues. The upper floor is divided into two units, one supporting males and one supporting females, who have a cognitive impairment or mental health issue. At the time of the inspection there were 51 people living at the home.
The home had a registered manager who had been registered since February 2015. 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 told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. The registered manager was able to describe lessons learned from previous safeguarding events. Maintenance of the premises had been undertaken and there was evidence of safety checks and risk assessments being carried out. People had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed.
Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. Some people and staff members told us there were times when more staff would be helpful, but overall there were enough staff at the home. We found minor issues with the recording of some medicines at the home, which were addressed immediately. We found the home to be maintained in a clean and tidy manner.
Staff had an understanding of issues related to equality and diversity and what it meant for people using the service. They told us they had access to a range of training and updating and records confirmed this. They confirmed they had access to regular supervision and an annual appraisal. The registered manager described how technology was being used to enhance care delivery.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found some the registered manager had system in place to review and resubmit DoLS applications. People were asked for their consent on a day to day basis. Where this was not possible there was evidence of best interest decisions being made.
People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements. Risks associated with diet and weight loss were monitored.
People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. We observed staff had positive interactions with people throughout the time of the inspection. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. Relatives told us they were regularly involved in care decisions.
People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.
Care plans were detailed and related appropriately to the individual needs of the person. A range of activities were offered for people to participate in. The service had two dedicated activities co-ordinators, who also had an understanding of how to engage people with a cognitive impairment. Formal complaints in the last 12 months had been addressed appropriately. The majority of people and relatives told us they had no reason to raise concerns.
The registered manager told us regular checks on people’s care and the environment of the home were undertaken. The area manager also visited the home to undertaken checks, speaking to both people who used the service and staff. Relatives, staff and visiting professionals had a positive view of the registered manager and the way she ran and developed the service. Staff felt well supported by the registered manager, who they said was approachable and responsive. Records were largely up to date and well maintained. The home was meeting legal requirement related to its registration through the display of its current quality rating and ensuring the CQC was notified of significant events.
We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashington Grange on our website at www.cqc.org.uk.
We found action had been taken to address the shortfalls identified at our last inspection and the provider was now working within the principles of the Mental Capacity Act 2005 (MCA).
People's capacity to make decisions had been assessed. Records of mental capacity assessments and best interests decisions were detailed. People's choices and decisions about their care and treatment were respected. All staff had received additional training in MCA, and how it was applied in practice was discussed regularly at both group and individual supervisions sessions.
This meant that the provider was now meeting Regulation 11.
We have changed the rating of the effective domain from 'requires improvement' to 'good'. This was because records showed the improvements had been sustained over a significant period of time. This has not affected the overall rating for the service which remains at 'good'.
Ashington Grange provides residential and nursing care for up to 59 people. At the time of the inspection 43 people were accommodated at the home, some of whom were living with dementia.
This inspection took place on 21 and 22 July 2015. The inspection was unannounced.
The provider, HC-One, had two services on one site, Ashington Grange which is a nursing home and Moorhouse Farm which is a residential home. We inspected both services at the same time. The same staff were used across both services and the same management structure was in place. Our findings for Moorhouse Farm are discussed in a separate report.
The last inspection we carried out at this service was in April 2014 when we found the provider was not meeting one of the regulations we inspected. This breach of regulation related to assessing and monitoring the quality of service provision. At this inspection we found improvements had been made to the systems in place to monitor the quality of the service and this breach in regulation had been met.
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.
People and their relatives told us they were safe in the home. Staff had undertaken training in how to respond to safeguarding issues and concerns and were able to describe to us the correct process to follow. We saw where concerns had been raised these had been shared promptly with the local authority safeguarding team.
Risks had been assessed and where possible action had been taken to reduce the likelihood of the risk occurring. Accidents and incidents were monitored to ensure staff response had been appropriate.
People, their relatives and staff told us there were enough staff to meet people’s needs. We saw staff were able to respond to people’s requests quickly. Recruitment processes were in place to ensure checks on candidates’ character were undertaken before staff began working in the home. Checks were in place to check nurses’ qualifications and registration were up to date.
Medicines were managed appropriately.
Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired. Staff had received a range of training in care and welfare subjects in addition to training specific to the needs of people they supported, such as dementia, end of life and mental capacity training. Nursing staff attended training relevant to their experience. Care workers and nurses received regular supervision sessions and a yearly appraisal.
The principles of Mental Capacity Act 2005 (MCA) were not always followed. Some people had capacity assessments completed which were not decision specific and had been carried out by only one nurse. Where decisions had been made on people’s behalf, documentation had not been completed to evidence that their capacity had been assessed or that the decision had been made in their ‘best interests’.
Do not attempt to resuscitate documentation within some people’s care records were out of date, meaning they were invalid.
Where restrictions were in place to keep people safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards.
People spoke highly of the food in the home. A choice of food was available at every meal and food was on offer throughout the day.
The home was spacious and considerations had been made to improve the environment for people living with dementia. Some areas of the home were tired looking or impersonal. A large scale refurbishment plan was in place and due to commence in the months after our inspection. The manager told us improvements would include better signage, bringing the home up to date and making it more homely. People and their relatives were to be consulted on the improvement plans and included in decision making about colour schemes and decoration.
All of the people we talked with, and their relatives spoke highly of the staff and how well they cared for them. Staff had good relationships with people, they responded with a gentle and kind manner when they were distressed.
During mealtimes staff were attentive, caring and considered people’s individual needs. People were encouraged to be independent by staff who recognised their needs and responded in a personalised way with practical solutions. Where people did need help from staff with their meals, this was provided in a dignified way. The manager told us considerations had been made to make mealtimes as enjoyable as possible, such as thinking about different ways to present the food. For example, by using traditional boxes and people eating ‘on their knee’ rather than at the table when having fish and chips.
Activities staff showed creativity in devising an activities schedule planned to meet the different interests of all of the people in the home. We saw busy and louder activities brought people together in the main lounge of the home, whilst staff engaged with people one to one or in smaller groups in other areas of the home, either playing games, chatting, or gardening outside. People were given the opportunity to travel to the nearby coast where they home had hired a beach hut for two days a week over the summer and a caravan for a week at the start and end of the summer for people to go out and enjoy their local area.
Staff told us they enjoyed working at the home and we saw they treated people with dignity and respect. Staff knocked on doors and waited to be invited inside before entering people’s bedrooms and addressed people politely.
Staff supported people to reach their goals. Staff had helped one person to manage their own care needs. Spending time talking through their medicines and equipment they used in preparation for them returning to their own home. Plans were in place to ensure that people were cared for as they wished as they approached the end of their lives.
People, relatives and health professionals told us that the home was responsive to people’s needs. Care records were detailed, specific and individual to the person receiving care. Assessments had been carried out to determine people’s needs and were regularly reviewed. Staff we spoke with were knowledgeable about people needs and how best to support them.
People and relatives’ feedback was encouraged through regular meetings and a yearly survey. Complaints had been investigated and responded to. The home had received nine compliments since January 2015.
Improvements had been made to systems in place to monitor the quality of the service since our last inspection. People, relatives and staff spoke highly of the new registered manager and told us about the improvements she had made to the home.
Staff we spoke with told us they felt valued. They explained how communication between the three units in the home had improved.
Audits and checks were carried out regularly to monitor the quality of the service. The manager assigned some of these checks to care staff and nurses so all staff were aware of the standards which were expected.
We found one breach of regulations. This related to the Need for Consent. You can see what action we told the provider to take at the back of the full version of the report.
Ashington Grange is a nursing home registered to accommodate up to 59 people. At the time of our inspection the service provided care for 39 people.
Our inspection team was made up of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Below is a summary of what we found. The summary is based upon observations during the inspection, speaking to people who used the service and the staff supporting people.
At the time of our inspection there was no registered manager in post. However a manager had been recruited to the home and had been in post for number of weeks. The manager was in the process of applying to register with the Care Quality Commission.
The manager was responsible for two services on the same site; Moorhouse Farm and Ashington Grange. When looking at the accidents, incidents and complaints recorded we saw that this information was not recorded separately and therefore it was difficult to distinguish which home the incidents or accidents had occurred in.
In addition we noted the records for complaints received in the past 12 months were not complete.
We saw that no documentation was available to show any investigations or actions had taken place and, in seven cases the original complaint letter was not available to view.
This meant there had been a breach of the relevant regulation (Regulation 10) and the action we have asked the provider to take can be found at the back of the main report.
During our inspection staff we spoke with had a good understanding of safeguarding vulnerable adults, could describe the training they had received to us and what they looked out for when working in the home. The manager had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These safeguards make sure that people, who lack capacity, are not deprived of their liberty unlawfully and are protected.
We saw medication kept in the home was stored appropriately and monitored on a regular basis.
During our inspection we spoke with a relative who was visiting and attending a care review. They told us they were regularly informed of any changes and were attending a meeting to check all the care arrangements in place were still applicable.
Staff told us they had received training in all mandatory areas such as infection control and moving and handling. The manager told us they were aware supervisions had fallen behind prior to them starting in post. However, we noted 70% had been completed in the three months since they joined and they confirmed the remaining supervisions were planned to be completed by the end of the following month.
We noted that staff had positive relationships with people living at Ashington Grange. We saw that people were given choice and staff helped to involve them in day to day decisions. Staff told us how they tried to maintain people’s privacy and dignity. They told us they knocked on people’s doors and made sure that curtains and blinds were drawn when people were receiving personal care. One person we spoke to said, “I can’t grumble about the care, they are always on hand if you need them.”
We saw relationships between staff and people were good and there was a relaxed atmosphere. People's privacy, dignity and independence were respected.
We saw staff delivered care in a calm and pleasant manner. We found they were aware of people's needs. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.
The home was clean. We saw there were effective systems in place to reduce the risk and spread of infection.
People received care in a calm and unhurried manner. There were enough qualified, skilled and experienced staff to meet people's needs.
People were asked their views about the service. Systems were in place to monitor the quality of the service.
We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us that staff spoke to them respectfully and they were consulted about their care preferences. We saw good interactions between staff and people during our visit.
Individual records were detailed and provided clear information about the care and support provided.
The provider had in place appropriate systems to manage medicines safely and this protected the people living in the home.
The provider used questionnaires to seek the views of people about the service. Information collected was used to help plan changes and improvements.
Quality monitoring systems were in place and these took account of people's views about the service.