Archived: Ashmeadows

Updated 5 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors, including a medicines inspector.

Service and service type

Ashmeadows is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ashmeadows is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and three relatives about their experience of the care provided. We also spoke with six members of staff including the operations manager, the home manager, the cook and three care assistants.

We reviewed a range of records. This included six people's care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at a variety of records relating to the management of the service, including policies and procedures. We met with partners and spoke with the provider about our enforcement action.

Updated 5 January 2023

About the service

Ashmeadows is a residential care home providing accommodation for up to 17 people, who require personal care, in one adapted building. There were shared communal areas on the ground floor, with bedrooms located on the ground, first and second floor. At the time of our inspection there were 9 people using the service.

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

There were not enough staff deployed to meet people’s needs safely. This meant people in the communal areas were left without staff support for long periods of time. Risks associated with infection prevention and control were not effectively managed. Staff were seen not wearing Personal Protective Equipment (PPE) appropriately. Risks to people’s safety were not adequately assessed, monitored or managed. Medicines were not managed safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were not provided with relevant training to ensure they had the right skills and knowledge to support people safely. Care records did not contain an accurate overview of people’s care and support needs and were not person centred.

Shortfalls identified at the previous inspection had not been adequately addressed. Where there were systems and processes to monitor and improve the quality of the service, these were ineffective as they had not identified issues found at this inspection. There was no effective system for analysing, investigating and learning from incidents. People’s confidential information was not always stored securely. Effective systems had not been established for gathering views from people and their relatives.

Staff were recruited safely. People and their relatives felt the service was safe. Staff were knowledgeable about people’s dietary requirements and people spoke positively about the choices they were given with food and drink. People were appropriately referred to healthcare services, when their needs or personal circumstances changed. Staff told us they enjoyed their roles and spoke positively about the improvement in the culture of the service since the home manager had been appointed.

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 06 January 2022) and there were 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 we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, staff training and managerial oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

During this inspection, we also checked whether the provider had followed their action plan to confirm whether they now met legal 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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashmeadows 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 and will take further action if needed.

We have identified breaches in relation to managing risks to people, medicine management, the management of infection control, consent, staffing and oversight of the home.

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

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.