Ashdown House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a breach of the legal regulations in relation to good governance. The provider failed to have effective systems in place to assess, monitor and improve the quality and safety of the service. Systems to assess and monitor medicines, risk management, infection prevention and control and the environment safety had not identified or effectively addressed the concerns found during the assessment. Not all staff felt they could speak openly and did not always feel their voices were heard. Staff had received training in equality and diversity, and we saw evidence of some workforce inequality being addressed by the registered manager. Professionals visiting the home spoke positively about the service, the staff, and said people had access to healthcare support if required. The leaders acknowledged the feedback given by the inspector and took some action during the assessment to address the concerns found.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were not able to confidently describe the direction and vision of the service. Not all staff spoke positively about the culture of the service. We did not evidence this had an impact on people’s care.

Staff had received training in equality and diversity, and we saw evidence of some workforce inequality being addressed by the registered manager. Further improvements were required in relation to the culture of the workforce and further work was required to address staff’s concerns. Culture had been addressed with staff in emails and during meetings by the registered manager and provider. Where actions and improvements had been identified by leaders, these were shared with staff via email.

Inspectors spoke with 12 staff members and the management team. Not all staff spoke positively about the support they received from the registered manager. The registered manager and staff told us the provider visited the service, but not often. However, the provider was available to speak to over the phone or email.

We were not assured leaders had the experience, capacity and capability to deliver the vision of the service and manage risks well. Prior to the assessment, the registered manager had been absent from the service for a period where senior staff had stepped in to run the service. The provider did not have the experience and capability to oversee the service in the managers absence. This was discussed with the provider and further improvements were required in this area to ensure appropriate support and guidance is in place for staff in the event of a leader’s absence. Business continuity plans were in place, for in the event of an emergency.

Not all staff felt they could speak openly with the registered manager and felt concerns were not dealt with in confidence. Staff did not always feel their voices were heard. One staff member said, “I am able to raise concerns with the manager but there is no visible change”. Staff told us they would feel confident to contact the provider via telephone or email if required.

Processes were in place to enable staff to speak up such as a whistleblowing policy, staff meetings and supervisions. However, feedback from staff meant we were not assured staff utilised these opportunities to raise concerns or ideas for improvement. The provider had a whistleblowing policy in place which staff had access to. When something went wrong, people using the service received an apology and were told about any actions being taken to prevent the same happening again.

We received mixed feedback from staff regarding workforce equality. Some staff told us they experienced favouritism within the service whilst other staff told us the registered manager had acted where concerns had been raised about inequality.

The provider had systems and processes in place to promote equality and diversity. Staff had received training in equality and diversity, and we saw evidence of some workforce inequality being addressed by the registered manager to remove bias from practices to ensure equality of opportunity and experience for the workforce within the place of work. Following concerns being raised about discrimination in the workforce, the registered manager sent out a survey to staff to address this.

Leaders had given staff roles and responsibilities within the service without ensuring staff had the skills, knowledge and confidence to carry out those duties. We spoke with the leaders of the service about the governance arrangements and how these had not been effective in identifying and addressing the shortfalls found during the assessment. The leaders acknowledged the feedback given by the inspector and took some action during the assessment to address the concerns found. The provider told the inspector of their plans to improve the service moving forward and told us they would achieve this by working closely with a newly appointed manager.

The provider failed to have effective systems in place to assess, monitor and improve the quality and safety of the service. Systems to assess and monitor medicines, risk management, infection prevention and control and the environment safety had not identified or effectively addressed the concerns found during the assessment.

People and their relatives told us they had access other professionals in the community. A relative said, “The district nurse, GP have been fully involved in my loved ones care they have all worked well together”. Relatives told us they were kept informed of any changes to their loved one’s care.

The registered manager told us of the good links he had made with another local registered care home to seek support and guidance. During the assessment, the registered manager contacted leaders at this care home to seek their support in auditing medicines.

Professionals visiting the home spoke positively about the service, the staff, and said people had access to healthcare support if required.

The service had a relationship with the local GP practice which involved a named person as a direct link with the surgery to enable good communication. Further consideration was required in relation to sharing information and learning with partners to collaborate for improvement and the use of networks to identify new or innovative ideas that can lead to better outcomes for people.

Most staff we spoke with told us they were not actively encouraged or involved in discussions around improvement. Staff told us where they had shared feedback, they were not assured this was listened to or acted on. Staff told us they received information on learning from incidents.

There was some evidence of the service using innovation to improve people’s quality of care. The service used a digital tool which enabled care staff to conduct monitoring of people’s vital observation, such as blood pressure, when a person appears unwell. The use of this digital technology enabled the service to receive support from an external healthcare professional when a person’s observation score indicates they are unwell. This meant people would receive timely support when unwell. Systems and processes to assess the quality of care and drive improvements were in place, however, these were not always effective. Where action plans were produced, these were not always followed to complete all actions within a time frame stated. Feedback from external professionals had not been effectively implemented. We were not assured the provider had learnt from previous inspections and enforcement actions as some of the concerns identified during this assessment had previously been identified by the Care Quality Commission. Further improvements were needed to ensure the provider was monitoring the service effectively. Processes were in place to share learning with staff when things went wrong.