Ashfield Nursing Home

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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. We found governance systems were ineffective which resulted in breach of regulation.

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.

The management and staff team showed a caring and committed attitude to people living at Ashfield. However, staff told us they felt the environment was poorly managed which sometimes made their roles more difficult. For example, staff told us, “I do report things that need sorting, but it’s not always completed, which makes things hard.” Staff also told us whilst communication was good, they felt meetings were only held when things went wrong which did not always boost morale. Staff told us that the management team were approachable and acted in people’s best interests.

Processes in place needed strengthening to ensure all staff felt heard. Whilst some staff told us they had supervisions to share ideas and raise concerns others did not. The supervision matrix showed 50% of employed staff had not had a supervision in line with the providers own policy, 18% of staff had not received any supervision since starting work at Ashfield. This meant that not all staff were given the opportunity to ask for further support or share ideas in a confidential environment. The provider took action to address situations where staff did not work in line with the culture and policies of Ashfield.

The management team were experienced and told us they wanted to improve the service. The registered manager recognised the environment needed work to improve people’s experience. The management team told us they had meetings with the provider, but these were not always recorded. The management team said, they would start to document meetings to ensure progress on actions were monitored. Staff told us the management team were approachable.

Whilst the management team were experienced, they did always ensure action was taken when needed. We found whilst audits had been completed action was not always taken to address issues in a timely manner. For example, management walk rounds were not completed effectively and did not always identify issues. We found broken beds during our first visit and were informed all other’s working as expected. We found many more broken beds on a third visit. This meant monitoring processes were not effective. A good governance audit had been completed with some areas highlighted for improvement.

Not all staff we spoke to were aware of the whistleblowing policy and how this would protect them if they needed to speak up. A staff member told us they did not know what we meant by the term ‘whistleblower’; they told us they did not know who they could report concerns to outside of the organisation. However, another staff member had good knowledge and were aware they would be protected in the event of speaking up. Staff told us the management team were approachable.

Processes in place needed strengthening to ensure the entire staff team, people and their relatives felt when they spoke up, they were listened too. Staff and people’s relatives all told us whilst the management team were approachable, when they raised issues with the environment, they did not always feel action was taken. This meant processes in place were not always effective. There was a whistleblowing policy in place however not all staff were aware of this policy.

Staff told us they valued in their roles. Many staff had worked at Ashfield for a number of years because they felt they valued, and that they made a difference to the lives of people living at Ashfield. There was a diverse staff work force all of whom told us they enjoyed working at Ashfield.

Processes in place meant not all staff were provided with the opportunity to engage with their line manager during supervisions. This meant there was a risk that not all staff had their voice heard. The management team and staff had completed Equality, diversity, and inclusion training. Staff had access to the policies and systems in place at Ashfield.

The management team were experienced. However, the management team had been splitting their time between another location which meant issues relating to the environment had not been acted upon in a timely manner. The management team were open and honest and told us they would ensure issues relating to the environment were rectified to protect people from the risk of harm. Staff felt confident in the management team's ability to address issues relating to care and support people received. The management team told us they had support from the provider. During the assessment the provider took action to address issues relating to safeguarding processes, they also increased their monitoring of the service.

Systems to audit the quality and safety of the service were not effective in identifying and addressing areas for improvement. Environmental audits were not effective in driving service improvement. Although environmental audits had been conducted, effective action had not been taken to address the issues found. For example, we found multiple beds to be faulty. There had been a lack of effective action taken to fix the faulty beds until the assessment team requested immediate action be taken. All of the faulty beds in place were in use by people living at the service. This placed people at an increased risk of harm. Some of the faulty beds were stuck in a low position, which meant staff could not raise beds to provide safe moving and handling care. This placed staff and people at an increased risk of harm. Where issues had been identified and fed-back, action was not always taken to ensure the safety and quality of the service. We found management walk rounds to be ineffective in highlighting issues. For example, the management walk round during the first day of assessment failed to identify concerns relating to oral healthcare. We received assurances this would improve but found identical issues on the next two visits. We fed this back to the provider who increased their monitoring of the service. The provider sent in a detailed action plan to address the issues we highlighted.

People told us they were supported to attend healthcare appointments. We received positive feedback from people and their relatives we spoke with regarding gaining access to healthcare services. People were supported to go out into the local community with staff. A person we spoke with said, “We go to the shops, and I get what I need, I like to go with [staff] we have a nice chat.” Whilst some people at Ashfield couldn’t tell us about their experience, staff shared photos of people enjoying social occasions.

Staff and managers gave us examples of working with other healthcare professionals to improve people’s outcomes. Staff discussed working with a specialist nursing team to ensure a person living with a long-term health condition received the right care and support. Staff recognised the importance of social opportunities. There was a new member of staff who had introduced a range of social activities, including baking, a veteran’s party and a coffee morning. They told us of their further plans including working with the local church.

Partners shared no concerns about partnership working at Ashfield. Records evidenced advice was sought and implemented.

Processes in place meant referrals were made to other professionals when needed. When professionals provided advice and guidance this was implemented into care records. For example, where people had attended hospital appointments information relating to appointments was clearly recorded. This meant staff had correct information to ensure people received the right care and support.

The management team told us they acted upon feedback to improve the service. However, we found that feedback was not always acted upon or shared with the wider staff team. We shared concerns with the management team about the environment and oral healthcare during our first visit. A member of the management team told us they would address this and told us they had arranged training for staff but found monitoring had not been increased and the training had not taken place. This was a missed opportunity to drive service improvement. The provider was receptive to our feedback and provided an action plan highlighting any issues and how they planned to address them.

We found there was not an effective system in place to drive service improvement. Audits in place did not always identify issues particularly issues relating to the environment. Lessons had not been learnt since our last inspection at the service where we found issues with the environment. Following the last inspection the management team told us they would strengthen systems and ensure the environment was maintained safely for people. We found areas of the home had not been maintained therefore lessons had not been learnt to improve the quality and safety of the environment.