Archived: Ashcroft Nursing Home - Chesterfield

Ashcroft Nursing Home - Chesterfield is a residential care home providing personal and nursing care to up to 42 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 17 people using the service.

The care home accommodates people in one adapted building across two floors. There are communal living and dining areas on each floor.

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

The provider had taken action to improve the systems and processes in place to monitor and assess the safety and quality of the service. These changes required embedding to ensure they were effective and consistently applied.

Staffing rotas evidenced there were enough staff deployed to provide people with the care and support they required. Regular agency staff were used to ensure continuity of care for people whilst on-going recruitment was in place.

Medicine was administered by trained nurses. Staff received regular checks on and direct observation of their practice to ensure medicines were administered safely.

Staff training was relevant and up to date. The staff training matrix evidenced that improvements in compliance had been made following our previous inspection.

There was a positive person-centred approach to the delivery of people's care. This was demonstrated by the staff’s understanding of the people they were supporting.

Since our previous inspection, people’s care plans and risk assessments had been reviewed and regularly updated.

People using the service had regular opportunities to suggest improvements to the service through residents’ meetings and in person.

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 and update

The last rating for this service was inadequate (published 10 March 2021) The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 11 January 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to concerns received about the care and treatment of people using the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern

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. This included checking the provider was meeting COVID-19 vaccination 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 Inadequate to Requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashcroft Nursing Home - Chesterfield 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.

Ashcroft Nursing Home Chesterfield is a care home registered to provide personal and nursing care to up to 42 people. There were 32 people living there at the time of this inspection. The home is set over two floors, there are communal living and dining areas on each floor.

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

The provider had failed to ensure government guidelines for working safely in care homes during the COVID-19 pandemic were implemented and adhered to. Staff were not always provided with clear guidance to support people who presented with behaviours that challenged. The governance systems used by the provider had not always identified areas requiring action or improvement. Relatives we spoke with told us they were confident their relation was supported by kind and caring staff.

The provider did not demonstrate there were always safe staffing levels, or that all staff had completed training before starting their role. Both of these issues were identified at the previous inspection we undertook last year, and the required improvements had not been made. We were not assured that the provider was making sure infection outbreaks could be effectively prevented or managed or that social distancing was promoted by the layout of the premises. The provider was not routinely monitoring people for the early signs of COVID-19.

At the last inspection a breach in regulations was identified in relation to the need for consent. This was addressed in the Effective domain of the last report. As this inspection is only reviewing the Safe and Well-led domains we were unable to review this breach.

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 June 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

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 received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashcroft Nursing Home Chesterfield 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 monitor the service.

We have identified breaches in relation to safety, staffing, safeguarding and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Follow up

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

People’s experience of using this service:

The service met the characteristics of requires improvement.

There were not always enough staff to meet people’s needs promptly and safely. Infection control systems were not always embedded to protect people from harm. Some risks to people’s wellbeing were not effectively managed to ensure they were safe and their dignity was met. Staff did not always have the time to spend with people to engage in activities or speak with them when they were distressed. Staff training was not always sufficient to ensure they had could support people effectively. The governance of the home was not effective in making the improvements required in a timely manner. People were not always supported to have maximum choice and control of their lives nor supported in the least restrictive way possible; the policies and systems in the service were not followed to review this practice. The environment required some maintenance and signage to ensure people’s independence.

People’s nutritional needs were met and there were good systems in place to monitor their weight and skin integrity. There were relationships in place with local healthcare providers to ensure people’s health needs were met. Medicines were managed to reduce the risks associated with them and were administered as prescribed. Families felt well informed of people’s wellbeing and welcomed to visit at any time.

When people required end of life care, there were measures in place to understand their wishes. People felt able to raise concerns about their care and be confident they would be dealt with promptly.

The registered manager was approachable and there were systems in place which encouraged people to give their feedback. Safe recruitment procedures were followed.

More information is in the full report.

Rating at last inspection: The service was last inspected on 6 February 2018 and was rated good.

Why we inspected: This inspection was brought forward due to concerns raised from reviews of the home completed by other professionals.

Enforcement: We found three breaches in regulatory standards and you can see what action we told the provider to take at back of full version of the report.

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.

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

The home had a registered manager in post. 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 home is run.

People were supported to have maximum choice and control their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. Staff received support for their role and training to develop their level of understanding about the care they provide.

People and their relatives felt relaxed at the home. All the staff were passionate about providing a home that met people’s needs. Relatives told us that their family member received care which was compassionate, kind and respectful.

People were protected from harm and staff knew to raise any concerns. Any concerns raised had been investigated and lessons learnt how to avoid a reoccurrence. The control of infection had been managed and people were encouraged to personalise their own space. The home continued to make improvements to the environment both internally and in the garden.

There was sufficient staff to support people’s needs and they had been recruited using appropriate checks to ensure they were suitable to work with people. The meals provided a variety of choices to support people’s dietary needs. Medicines were managed safety and in line with peoples prescribed needs.

Stimulation was on offer which supports people’s interests or previous lifestyles. The care plans were detailed and included all aspects of peoples care. These had been reviewed and any changes reflected.

A range of information was available to relatives and visitors, these included a complaints procedure. Any complaints had been responded to formally. The home completed regular audits on a range of areas to ensure the quality of the care was maintained and improved. Feedback was obtained from people using the home and staff members, information from the surveys had been shared to reflect the comments and actions to consider the feedback.