Ash Hall Nursing Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

During our assessment of this key question, we found concerns around the provider’s adherence to the Mental Capacity Act 2005. Systems in place to promote consent and to ensure the Mental Capacity Act 2005 was adhered to were not always effective. Although the registered manager was in the process of updating people’s care plans, improvements were still required as people’s care plans did not always include enough information about their care needs, risks and preferences. The provider did not always work well as a team or with external agencies. Systems in place to support people to live healthier lives were not always effective. Systems in place to monitor people's health conditions and improve their outcomes were not always effective.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People gave mixed feedback about how much they were involved in their care planning. One person told us, “It would be nice if someone came to ask me if everything is alright and if it was someone who could do something about things. The carers only come in when I press the call button, but I would like someone to come in more often to reassure me.” One relative told us, “The [registered manager] is very nice. We phoned up and asked for a meeting and we have enquired about our [relative’s] care plan.” Another relative told us, “Staff have got to know [relative] really well and know what they are doing.”

While staff generally knew people well, care plans did not always include enough information to guide staff how to care for people and medical concerns were not always followed up in line with people’s care plans. One staff member told us, “One of our residents uses a device to maintain their health. We regularly check on it and make sure it is working correctly.” Another staff member told us, “One resident needs help with maintaining their skin. They often decline to be repositioned, but we try to encourage them as much as possible and at the moment there are no issues.” Another staff member told us, “I wish we knew more about people’s social histories. Preadmission assessments from external professionals are quite good but we need to liaise with people and their families to make sure care plans are person centred.” The registered manager told us they were in the process of updating people’s care plans following feedback from the local authority during quality assurance visits.

Although the registered manager was in the process of updating people’s care plans, improvements were still required as people’s care plans did not always include enough information about their care needs and risks and about their preferences. We found, where people had risks in relation to sleep, catheter care, diabetes, behaviours, incontinence, skin, nutrition and medicines, these were not always assessed or reviewed effectively. This meant people were at risk of not having their needs met. Care plans did not always include information about people’s preferences in relation to end-of-life care, communication or activities.

People were not always involved in planning and reviewing their care.

While staff knew people well, care plans did not always include enough information to guide staff how to care for people.

Although the registered manager was in the process of updating people’s care plans, improvements were still required as people’s care plans did not always include enough information about their care needs and risks and about their preferences.

People gave mixed feedback about how staff, teams and services worked together. One person told us, “I don’t think the lines of communication are good. If you tell 1 of the carers about an issue it doesn’t go anywhere. However, staff were brilliant when I had to be taken to hospital in an emergency, but the small things are also very important.”

Staff told us they worked together as a team and with external agencies. One staff member told us, “When somebody has a fall, we press the emergency buzzer and a nurse from our service attends, assesses and checks for injuries. We call for an ambulance if needed.” A member of the leadership team told us, “Our management team is very good, and we receive good support from the GP practice who do ward rounds for residents. We refer residents to other health services when needed and work well with the end-of-life service.” While staff told us they worked together as a team and with external agencies, we found they did not always involve other services effectively with people’s health needs when required.

While we received some positive feedback from professionals supporting people at Ash Hall Nursing Home about how the care home works with them, we found they did not always involve services, when required to effectively meet people’s health needs.

The provider did not always work well as a team or with external agencies. While staff knew how to refer people to external health agencies when required, care plans did not always contain enough information about people’s health needs and when staff should refer to external agencies. When we reviewed people’s records, we found people had not always been referred to the relevant health service or referrals did not always include all the information required in relation to their care needs. This meant people were at risk of not having their health needs met.

People gave mixed feedback about how they were supported to live healthier lives. One person told us, “There are beautiful grounds, but we are never taken out. I do miss the outdoors.” Another person told us, “I did ask once to plant bulbs under a tree here and they let me. A relative takes me out into the garden. Staff would do it if I asked.”

While the staff we spoke with expressed people were supported to live healthier lives, our assessment found people were not always referred to health agencies when needed.

Systems in place to support people to live healthier lives were not always effective.

People we spoke with expressed they did not always receive good care.

While the staff we spoke with generally expressed people were monitored where required and had good outcomes, our assessment found people were not always referred to health agencies when needed and care plans did not always include enough information to guide staff how to care for people. This meant people were at risk of not having their health needs met.

Systems in place to monitor people's health conditions and improve their outcomes were not always effective. Where 1 person had been treated for a skin tear, there was no record of where the skin tear was located. This meant themes and trends could not be effectively monitored. Another person’s behavioural incidents were recorded, however, this did not always lead to risk assessments being updated or the information collated being used to guide staff how to manage those behaviours. We found where 1 person’s health condition was monitored, their care plan guided staff to administer as and when medication and refer to the relevant health agency, however, this was not done. This meant systems in place to ensure people’s needs were met were not always effective.

While people did not express any concerns about consenting to their care and treatment, and we observed staff asking people for their consent, care plans did not always include information about advocacy support or had inconsistent information about people’s ability to consent to their care. Where people were required to be deprived of their liberty to keep them safe in their best interests, the provider had not always made applications to the relevant authority.

While staff told us they obtained consent from people when supporting them, care plans did not always include information about advocacy support or had inconsistent information about people’s ability to consent to their care. This meant people were at risk of receiving inconsistent care. While staff were generally knowledgeable about how and when to support people in their best interests, people were at risk of receiving inconsistent care due to care plans containing inconsistent and conflicting information about what specific decisions people could and could not make, and where required, best interest decisions were not always recorded.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Systems in place to promote consent and to ensure the Mental Capacity Act 2005 was adhered to were not always effective. Where a decision had been made to put in place restrictions to prevent a person from falling, the provider had not completed a mental capacity assessment or recorded a best interest decision. Where another person had variable mental capacity to make decisions, their care plan did not include consistent information about what specific decisions they could and could not make, and where required, best interest decisions were not recorded. Least restrictive approaches had not always been considered as part of best interest decision making. Where people required to be deprived of their liberty to keep them safe in their best interests, the provider had not always made applications to the relevant authority. This meant people were at risk of being unlawfully deprived of their liberty.