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Inadequate
People thought they were listened to and were involved in their care and how this was delivered. Some concerns were found around maintaining people’s privacy and dignity, however, this was not a wider issue. People and their relatives told us their privacy was respected by staff.
They wrote to us on 18 December 2013 and stated that all records apart from staff files were kept in the nurse’s office. We carried out this inspection to follow up on concerns identified during our inspection of 01 October 2013. We found that some steps had been taken to address the concerns which had been raised. However, we identified a number of ongoing concerns such as the security of the premises.
Age UK North West Kent
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. Relatives told us they were happy with the care their loved ones received and that the staff were kind. Staff knew people well and were knowledgeable about how people preferred to be supported. Staff understood people’s communication needs and spoke with us about how they observed people’s body language when they were unable to express themselves verbally. Information, such as the resident’s guide and statement of purpose were available in an easy to read format.
Staff had a thorough understanding of and were following safe infection control practice which helped to minimise people’s risk from infection. People’s own rooms were personalised to reflect their preferences. We found that people were not always safe due to poor security at the home.
Ashley Down Nursing Home
Staff had one to one supervision meetings to support their development. Mandatory training and updates had been undertaken since the last inspection. Some training requested by registered nurses for the benefit of their professional development and for the benefit of people living in the home had not been carried out.
Care plans were not consistently fit for purpose and lacked personal information on people’s likes, dislikes and what was important to them. This was a planned comprehensive inspection to follow up from the previous inspection report when we placed the service into special measures to monitor improvements made. Although improvements had been made to the training of nurses and staff, there were still areas that needed to improve. The manager did not have access to staff training records and registered nurses had not completed professional development training.
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The provider had taken action to rectify the concern and people were now able to sit in the lounge area with their privacy respected. Many bedrooms were not made personal and homely at the last inspection. This had much improved and people had their personal belongings and mementoes around them. Ashley Down Nursing Home is a large converted detached property providing nursing care and accommodation for up to 19 older people, some of whom may have dementia or physical disabilities. Archived services are ones which are no longer part of a provider's registration with CQC. You can find out more about archived services and how you can use the information on our page about searching for the history of care services.
There was a lack of oversight of the quality of service and there was no plan to drive improvements. The previous six inspections identified significant concerns. The provider did not take any responsibility or ownership or give any assurances that immediate action would be taken to address CQC’s concerns at this inspection. The provider and manager did not work cohesively to implement changes and they did not lead by example. People’s needs had been assessed and this had been used to consistently make sure enough staff were on duty to provide safe, effective and responsive care. Staff had time to spend supporting people in a meaningful way that respected individual needs.
The provider had notified CQC of important events as required. The improvements related to Regulation 16 of the Health and Social Care Act Regulations 2014 and Regulation 18 of the Care Quality Commission Regulations 2009. However many improvements had not been made and we found continuing breaches of regulations from the last inspection. These related to Regulation 9, 11, 12, 17 and 18 of the Health and Social Care Act Regulations 2014. The inspection was unannounced.Ashley Down Nursing Home is a ‘care home’. There were 13 people living at the service at the time of our inspection.
Referrals to appropriate health care professionals was now better evidenced. A consistent approach was not taken when monitoring the blood sugar of people with diabetes. An assessment tool used to monitor the risk of malnutrition was erroneously scored, showing a score that was not correct. Staff knew their responsibilities in keeping people safe from abuse. The provider and manager had worked with the local safeguarding teams when concerns had been raised. People’s privacy and dignity was not always respected at the last inspection.
One member of staff has not taken a day off in eight months because they were “concerned about what would happen if they did not come in”. Not enough changes had been made and the Care Quality Commission has now said it requires improvement in almost every area. Ratings are provided by Care Quality Commission and reflects the most recent report for this care home, which was published on 17 April 2018. The Care Quality Commission is required by law to monitor the operation of Deprivation of Liberty Safeguards .
Fire evacuation practice drills had not been carried out to ensure people and staff knew what to do in the event of a fire. Quality audits, to monitor the safety and good quality of the service were effective in identifying where improvements were needed and action was taken to quickly remedy areas of concern. 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.
Although improvements had been made to the quality and safety of the service provided, further action was needed through sustained management and leadership to ensure the progress continued. Monitoring and auditing systems were now used to better effect to inform the improvements required and the action to be taken. However, the systems were still in their infancy and needed to embed to evidence they were sufficient to ensure progress could be maintained. The evidence was not available to show that staff had received the training and updates required to carry out their role providing care and support to people.
At this inspection, the service continues to be rated requires improvement. Since two previous ‘inadequate’ ratings, this is the second consecutive time the service has been rated requires improvement. The risk of skin breakdown for people had been assessed, however, where people received care on an air mattress, documentation failed to record that the setting was regularly checked.
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