Ashfield Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. We found a breach of regulation relating to the environment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with were unable to explain how the learning culture effected their experience in the care home. However, all people told us who the registered manager was, and they were confident in both theirs and staffs’ ability to keep them safe.

Staff told us they did not always have supervision sessions to review what was working well, and what could be improved at the service. A member of the management team told us they were aware supervisions had fallen behind and they were actively arranging these. Staff told us they reported incidents and were confident the management team acted on concerns; however, they weren’t always informed of outcomes of incidents they had reported.

There was a process in place to review incidents. The management team undertook a monthly review and analysis of accidents and incidents. For example, falls were looked at in detail and any trends were documented and action taken if needed. Staff meetings had taken place, any actions staff needed to take following incidents were documented within meeting minutes. The management team told us they would strengthen the process to ensure all staff had regular supervisions to allow them to have the opportunity to reflect on what was working well and what could be improved at the service.

People told us staff supported them to seek help and support from healthcare professionals. A person we spoke with told us staff supported them to attend hospital appointments. Another person told us staff arranged for specialist nurses to come and see them if their health condition changed.

The clinical lead demonstrated good knowledge of which health and social care professionals supported which people, they told us how they disseminated information to the wider staff team to ensure people received safe clinical care aligned with their needs. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. For example, we found a person had completed a course of treatment, but staff assessed this treatment to be ineffective, staff referred and followed up with the person’s named doctor to ensure they received further treatment. Staff’s actions ensured timely intervention which protected the person from the risk of harm.

Partners gave no specific feedback about this area. However, we found records in place showed the service implemented guidance into care plans.

Records in place reflected people’s needs and wishes to keep them safe. Clear records of external professional visits and assessments were in place. Electronic records meant any changes could be made easily with staff having immediate access to updated records. This meant staff had accurate information to support people safely. Some people living at the home became anxious because of advanced dementia and records in place detailed specialist advice from the dementia outreach team had been sought. Other people required external health and social care support; documentation showed that timely referrals had been made. For example, we saw a referral had been made to the specialist diabetic nursing team for guidance and support.

People told us staff mostly made them feel safe. One person said, “I would tell [registered manager], they would sort it.” Another person told us, “It’s good here I feel safe”. However, one person we spoke with told us sometimes they didn’t feel safe with how staff supported them to mobilise. This was fed back to the provider who arranged for all staff to recomplete practical moving and handling, this training was complete during our assessment. This protected the people from the risk of potential abuse through poor moving and handling techniques

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff told us they completed safeguarding training and were able to give us examples of incidents they recognised as safeguarding concerns. Staff were aware of who to report safeguarding concerns to both internally and externally.

We saw people and staff have positive relationships, and we saw no evidence that people were at risk or fearful of staff.

Safeguarding processes in place needed strengthening to ensure all staff followed the providers own processes to protect people from the risk of abuse. During the assessment a safeguarding concern was reported to the CQC. The provider was responsive to the allegation and reviewed the concerns and found no evidence to support the allegations. Some records relating to financial records had not been completed in line with the providers own process, records were also stored in differing places which meant the management team could not initially locate them. The provider reviewed their processes and increased their monitoring of financial safeguarding records and processes to ensure people were protected from the risk of abuse. Allegations of abuse were reported to both the local authority and CQC if needed.

People told us most staff understood their needs well and offered support to keep them safe. One person said, “The staff look after me very well.” However, a relative told us they felt they were not always included in discussions about the needs of their relative who lived with dementia.

Staff told us they felt they were able to support people safely. Staff and the management team knew people and their families well. Staff told us, “I have all the information I need to care for people, I love seeing our residents looked after properly.” The management team explained how they ensured a safe transition onto the electronic care planning system, where they felt some aspects of the electronic system such as a mental capacity assessment were not sufficiently detailed, they had paper records in place. All staff knew where to find these records.

We saw people were supported safely. Many people living at the home lived with advanced dementia and therefore could become distressed. We found all staff were quick to respond to people and offer support which reduced any anxieties. This meant people were kept safe as their distress did not escalate.

People’s needs were documented in their care plans, so staff had clear guidance on a people’s individual needs. Risks were assessed, and risk reduction measures detailed. For example, skin integrity and malnutrition risk assessments were in place. People also had positive behaviour support plans in place. These plans detailed techniques for staff to reduced periods of distress. People had personal emergency evacuation plans in place. This meant staff and emergency services had accurate information in the event of an emergency. The clinical lead had introduced an antibiotics log to monitor the effectiveness of antibiotics. This ensured if people required further treatment it was identified without delay. This protected people from the risk of harm.

People and their families told us they felt the environment was poor and needed work. A relative we spoke with said, “I am very unhappy with the state of my relatives’ room, I have asked for changes, but nothing has happened.” Another person told us, “They sort out some things, but then other things get left, it’s a shame as the staff are lovely.” Another person we spoke with said, they had a broken light in their room, but this had not been fixed.

Staff knew how to monitor the safety of the environment, and where to report any maintenance concerns too. However, staff recognised the environment needed further work. Staff we spoke with said, “It’s the environment we need help with, the care is second to none here” and another staff member said, “There has been work done but it is difficult to maintain, sometimes something is fixed and the next day it’s broken again.” The maintenance team explained they monitored things such as water temperatures. However, we found maintenance records in regards to fire safety was not always maintained. We fed back our concerns in regards to the environment back to the provider who sent in a detailed action plan detailing time frames for completion.

The environment was not always safe. We found several broken beds which were in use by people at the time of the assessment. We also found some people had faulty furniture in their bedrooms which posed a risk to them and others. For example, we found a broken wardrobe in one person’s room. We fed this back to the registered manager who moved the person to an alternative bedroom with their consent. We found that following our last assessment some areas had been addressed. For example, there were new chairs in the lounge area. However, we found many bedrooms to be sparsely furnished which restricted where people could spend their time. We also found bedding in people’s room to be threadbare and would not keep them warm during the winter months. We fed this back to the management team who changed the bedding during the assessment. The provider was responsive to our feedback and sent us an action plan addressing all of our observations.

Areas of the home and some equipment in the home had not been maintained which meant they were not safe. Whilst it is recognised some people at the home lived with health conditions which meant some people damaged their environment, not enough action had been taken in some areas to ensure the environment and equipment remained safe. For example, one occupied bedroom had been highlighted as needing action, but no action had been taken to improve the person’s living environment. We found governance process in place had either not identified issues or where issues had been identified no action had been taken. For example, a member of the management team told us they completed a walk round daily, however these had not been effective in identifying issues relating to the environment. Processes relating to fire safety needed further development to ensure checks were effective in identifying issues. Designated staff completed regular checks on water to ensure they did not exceed recommended temperatures.

We received very limited feedback about staffing levels from people living at Ashfield. People told us sometimes they waited longer than others for support but told us there was always a staff member around. People told us staff were kind and caring.

Staff spoke highly of the training provided to them. Staff told us they received a thorough induction and felt supported by the management team at Ashfield. None of the staff we spoke with raised any concerns with staffing numbers and they told us there were enough staff on duty to allow them the carry out their duties safely. The management team told us the provider was flexible in their approach to staffing levels and they increased staffing levels as when needed.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building, to provide timely support to people. Some people living at the service had medical conditions which resulted in periods of distress, we observed a person to become distressed, staff immediately responded to support them. This not only decreased the persons distress, but their dignity was also maintained.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people. The service employed some nurses. These nurses were registered with the regulatory body (The nursing and midwifery council). The management team completed regular checks to ensure their nursing registration was maintained.

Many people living at Ashfield Nursing Home were unable to share their experience about the infection prevention and control measures in place due to living with a cognitive impairment. People and their relatives who were able to speak with us, gave us mixed feedback about the cleanliness of their environment. Some people told us they thought the home was clean and tidy. One person said, “I am happy with how clean it is; the staff work very hard to keep it clean.” However, a relative we spoke with said, “It’s not clean, and I’m really unhappy with it.”

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. Staff told us they had completed training in infection control, and we found staff applied their training when supporting people. This protected people from the spread of infection. Staff recognised some areas of the home needed further attention. For example, many carpets in the home had been replaced due to staining, however a small number remained, a member of the management team told us the remaining carpets were due to be replaced.

Some areas of the home were clean and tidy whereas others were not. Some bedrooms had a strong malodour. This was fed back to the management team who told us they were in the processes of replacing all existing carpets. We found some carpets to be stained, one was stained with faeces. This was reported to the deputy manager who responded immediately to our concerns. Communal areas were generally clean and tidy. Chairs in the lounge had been replaced following our previous inspection, the new chairs were of material which could be effectively cleaned. We saw that staff had access to personal protective equipment throughout the home. This allowed them to support people in a hygienic way. We saw any dirt or spillages in the home were quickly resolved. The kitchen was managed in a hygienic way to ensure people did not get food bourne infections. The most recent check from the food standards agency, had rated the service 5 stars on the 3 November 2023.

There were processes and policies in place to ensure the environment was kept clean and hygienic. However, these were not always effective in highlighting areas for improvement. For example, stained bedding and carpets had not been identified on the management walk round. We were told a member of the management team completed a walk round every morning, however we found stained bedding in each of our visits to the service. This meant this walk round was not effective in identifying issues. However, other processes such as an audit of the kitchen had identified areas for improvement, we found actions had been completed. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak. The provider was responsive to our findings, they sent an action plan detailing the action they planned to take to improve the service.

People gave us brief feedback about medicines. A person we spoke with said, “I always get my tablets when I need them.” None of the people we spoke with raised any concerns in regards to the management of their medicines.

Staff told us that they completed training to safely provide support to people with their medicines. Staff were able to describe safe systems for medicine management. Staff knew who to report medicine concerns too. The clinical lead described good working relationships with the GP’s that serve the home. Staff told us only those trained to administer medicines did so.

People had medicine administration records in place which detailed how they like to take their medicines and what support they needed. This meant staff had accurate information to support people safely. We found topical medicines to have opening dates documented which meant staff knew they were safe to use. Controlled drugs were stored according to guidance. Staff completed regular checks for controlled drugs. Controlled drugs are subject to government restrictions due to the risk of harm and/or addiction. Completing regular stock checks of these medicines, provides assurances of management of these high-risk medicines.