We carried out a review of the data available to us about Ashgreen House Residential and Nursing Home 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 Ashgreen House Residential and Nursing Home, you can give feedback on this service.
People’s experience of using this service and what we found
People and their relatives were complimentary about the service and told us the service had improved and was meeting their individual needs. People were protected from the risk of avoidable harm. People were supported by enough members of staff on each unit to ensure their needs were safely met. Accident and incidents were reported, recorded and analysed with lessons learnt shared with staff to prevent reoccurrences.
Medicines were managed safely, and people were receiving their medicines as prescribed by doctors. The home was clean, and staff followed appropriate infection prevention and control practices to minimise the spread of infections. People told us they felt safe living at the home and had no concerns regarding abuse or neglect. The service followed appropriate recruitment practices and ensured staff were properly checked before they began working at the home.
The service was well-led by the new management team who had good oversight of the service. Care and support was planned and delivered to meet people’s diverse needs and records were accurately maintained. An effective system was used to monitor the quality and safety of the service and to drive improvements.
People’s, their relatives’ and staff’s views were sought to improve on the quality of the service provided. The service worked in partnership with key organisations and health and social care professionals to deliver a joined-up service. Staff knew of their individual roles and responsibilities, they told us they felt supported in their role and were happy working at the service.
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 19 March 2021) and there were breaches of regulation.
Why we inspected
This was a planned inspection based on the previous rating. 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.
We carried out an unannounced focused inspection of this service on 26 and 27 January 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 staffing and good governance.
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 Ashgreen House Residential and Nursing Home 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.
Ashgreen House Residential and Nursing Home is a care home providing personal and nursing care to older adults. The home accommodates up to 52 people across four floors and in five units, each of which has separately adapted facilities. One of the units specialises in providing care and support to people living with dementia. At the time of this inspection, 39 people were using the service.
People’s experience of using this service and what we found
People were not always protected from the risk of avoidable harm. Risk management plans were not always in place or did not provide staff with the information they needed to ensure people received safe care and support. There was not always enough staff, deployed across all units, to ensure people’s needs were safely met. Where accidents and incidents had occurred, lessons were not always learnt to prevent reoccurrence.
We have made a recommendation about the management of medicines.
Care and support was not always planned and delivered to meet people’s diverse needs. Records were not always, accurate, complete and consistent.
There were systems and processes in place to assess and monitor the quality of the service, however these systems did not identify the shortfalls we found. The culture at the service was not always positive and staff morale was low.
The provider had sought people and their relative’s views to improve on the quality of the service; however appropriate forums were not always in place to gather staff views and act on them.
People were protected from the risk of abuse. People and their relatives were complimentary about the service; particularly in relation to how the provider had managed in response to the COVID-19 pandemic.
We were assured by the provider’s infection prevention and control measures and staff followed government guidance, to prevent and minimise the spread of infection.
The service worked in partnership with health and social care professionals to provide joined up care.
Rating at last inspection
The last rating for this service was good (published 9 June 2018).
Why we inspected
We received concerns in relation to staffing, medicines management, organisational culture and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full 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 Ashgreen House Residential and Nursing Home 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 risk management, staffing, lessons learnt from accidents and incidents and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Ashgreen House Residential and Nursing Home 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 provides care for up to 52 older people requiring residential or nursing care. The service is provided over four floors and within five units. At the time of this inspection the home was providing care and support to 46 people.
There was no registered manager in post. The registered manager had resigned from their post prior to this inspection. 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. A new home manager had been appointed and had started work at the time of this inspection. The deputy manager was in charge of the day-to-day management of the home and was being supported by a registered manager from the provider’s other home and a regional manager.
There were sufficient numbers of staff available to support people’s; however staff felt additional staff were required on some units to promote safety. The provider had safe recruitment practices in place and had vetted staff before they were employed to work in social care. People were protected from the risk of abuse because staff were aware of their responsibility to safeguard them.
Risk to people had been assessed, identified and had appropriate management plans to prevent or reduce the risk occurring. The provider had procedures in place to protect people in the event of an emergency and had carried out regular health and safety checks including the maintenance of equipment to ensure they were safe for use. People were given their medicines as prescribed by healthcare professionals and there were safe systems in place for acquiring, storing, administering and disposing of medicines. Staff had received medicines training and their competencies had been assessed to ensure they had the knowledge and skills to manage medicines safely. People were protected from the risk of infection because staff had followed the provider’s infection control protocols. Accidents and incidents were recorded, managed and monitored regularly to prevent future occurrences.
Before people started using the service, their needs were assessed to ensure they would be met. Staff received an induction when they started work at the home and were supported in their roles through training in areas the provider considered mandatory. Staff were also supported with regular supervision and an annual appraisal of their performance. People were supported to eat and drink sufficient amounts for their well-being and people’s preferences were taken into consideration and respected. People had access to healthcare services to ensure they received safe care and treatment. Where required staff had made prompt referrals to health and social care professionals to ensure appropriate support was in place for people.
Staff understood the requirement of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted in accordance to this legislation. People were supported in an environment that was suitable and met their needs.
People were treated with kindness and compassion and had built relationships with staff. People and their relatives were involved in making decisions concerning the care and support they received. People’s privacy and dignity was respected and their independence promoted so they would maintain their life skills. Staff understood the need to promote equality and diversity and supported people without any discrimination. People were provided with information about the service.
People were offered a range of activities to participate in; however more could be done to engage people in activities that interest them. Each person had a care plan in place which provided guidance for staff on how to care for them. People’s care plans were reviewed regularly to ensure that their needs were met. People were supported to maintain relationships with their family and friends. People and their relatives knew how to make a complaint and were confident their complaints would be handled appropriately. Where required, people received appropriate support at the end of their life.
All staff did not speak positively about the home’s culture; however the provider was taking action to improve staff relationships and maintain a healthy work environment. . There were appropriate arrangements in place for monitoring the quality and safety of the service provided. The provider took into account the views of people and their relatives and where required took action to improve the quality of the service. The provider worked well with other organisations such as the local authority to plan and deliver an effective care and support.
Ashgreen House provides accommodation and support for up to 52 elderly people who have nursing, residential, or rehabilitation care needs. The home is situated in the Royal Borough of Greenwich, south London. At the time of this inspection the home was providing care and support to 40 people.
At our last inspection on 25 and 26 November 2014 we found that some equipment within the home was not functioning properly which posed a potential risk to people’s safety and welfare. Systems for the management of medicines were not safe and did not protect people using the service. Accurate records had not always been maintained relating to peoples care needs, staff training and recruitment.
At this inspection, 1 and 7 December 2015, we found that action had been taken by the provider to make sure equipment within the home was functioning, serviced and maintained, systems for the management of medicines were safe, and records were maintained relating to peoples care needs, staff training and recruitment.
The home did not have 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 service is run. The previous registered manager left the home in August 2015. The current home manager started work at the home on 12 October 2015. They had applied to the CQC to become the registered manager for the home.
People using the service said they felt safe and that staff treated them well. Medicines were managed safely and records showed that people were receiving their medicines as prescribed by health care professionals. Appropriate recruitment checks took place before staff started work. There were enough staff on duty at the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure in place and staff said they would use it if they needed to.
Staff had completed an induction when they started work and they were up to date with the provider’s mandatory training. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and acted according to this legislation. There were appropriate arrangements in place to ensure that people were receiving food and fluids in line with their care plans. People had access to a GP and other health care professionals when they needed it.
People’s privacy was respected, and staff spoke to them in a respectful and dignified manner. People and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. There were a range of activities available for people to enjoy, and they received appropriate end of life care.
Staff said they enjoyed working at the home and good support from the manager. There were appropriate arrangements in place for monitoring the quality of the service that people received. The provider conducted unannounced night time checks at the home to make sure people where receiving appropriate care and support. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.
This inspection took place on 25 and 26 November 2014 and was unannounced. At the last inspection on 11 July 2013 we found the provider met all the regulations we inspected.
Ashgreen House accommodates up to 52 people who have elderly nursing, residential, or intermediate care needs (people needing short term nursing or residential care to meet their needs). The accommodation is on three floors and there are four units: two for residential care, one for nursing care and one for intermediate care.
There was a registered manager 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 and associated Regulations about how the service is run.
We found some concerns about the maintenance of equipment, particularly as one unit had very few working call bells. The manager took steps to address this during the inspection. We also had concerns that medicines were not stored securely or safely at all times. This put people at risk of unsafe care.
CQC is required to monitor the operation of the Deprivation of Liberty Safeguards. At the time of our inspection no one was subject to the Deprivation of Liberty Safeguards. (These are to protect people’s rights when their liberty may be restricted for their safety.) Some staff had not received training on the Mental Capacity Act 2005 or were not aware of the Code of Practice. This meant they may not be aware of their responsibilities under the act. Staff training in other important areas such as first aid and infection control was not always refreshed, meaning there was a risk staff did not have the current skills to deliver safe effective care.
Some records related to people’s care and support needs were not always up to date. This put people at risk of inappropriate care. Some records related to the management of the service were not easily located. While audits were carried out to monitor the quality of the service they had not always identified the concerns we found.
People felt safe using the service. Staff were knowledgeable in recognising signs of abuse and the associated reporting procedures. Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Plans were in place to reduce the risks identified and to identify people’s support needs.
Staff engaged with people in a caring manner and respected people’s privacy, dignity and independence. They understood and responded to people’s diverse individual needs and were familiar with people’s histories and preferences. We heard mixed views about staffing levels with some people feeling there were not always enough staff available and some who felt the service was staffed sufficiently. We found steps were being taken to address problems with the absence of the regular activities organiser.
People told us they thought the service was well run and organised. There was a complaints procedure in place and the manager had a weekly surgery that people could attend if they had any issues about the service.
At this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
At our inspection on 11 July 2013 we found the provider had taken action to meet these essential standards.
We did not speak to people using the service as part of this inspection because of the nature of the compliance actions we were following up.
A residents survey was completed in 2012 which showed, for example, that most respondents were happy with the care they received and that they and their family and friends had been involved in their care plan. They said their care and medical needs were attended to.
We found people using the service were treated with dignity and respect. They were protected from the risk of abuse and were cared for by staff who were suitably qualified and skilled to meet their needs. However, care was not always planned, delivered, or recorded in a way that ensured people's needs were met. Nor was care always reviewed fully after an incident such as a fall. We also found a fire safety mechanism in the home was not working.
People and their relatives appreciated the quality of the premises and facilities on offer. One relative commented that 'it's like a real home'. Overall, they were satisfied with the food and drink Ashgreen House provided, although one relative was concerned that people could be encouraged more to drink enough fluids.
People using the service were able to comment on the running of Ashgreen House and to raise any concerns through an elected residents' representative, who took part in the home's senior team meetings. There were also regular residents and relatives meetings held at the home.