Ash Hall 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

During our assessment of this key question, we found concerns around the safety of the environment, the management of people’s safety and risks, staffing and medicines management. Systems in place to promote learning opportunities were not always effective. Systems in place to ensure people received safe care were not always effective. Procedures in place to ensure people were protected from abuse were not always effective. Systems in place to manage people’s risks were not always effective. Systems in place to keep people safe from the risks of the premises were not always effective. Systems in place to ensure the staff team was safe and effective were not always effective. Systems in place to manage medicines safely were not always effective. We found, however, systems in place to minimise the risk of spreading infection were effective.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always involved in improving the service. One person told us, “We haven’t been to any meetings.” Another person told us, “I haven’t attended any resident meetings, but I think there might be relative meetings.” A relative told us, “We haven’t been to any meetings although I think we have filled in a questionnaire at some point.”

Staff told us there was a good learning culture at Ash Hall Nursing Home. One staff member told us, “I have supervision every 8 weeks in which I discuss training. When I needed dementia training, this was accommodated by management.” Another staff member told us, “We do learn from things and discuss them in team meetings.” Another staff member told us, “Handovers are where we talk about learning from incidents and in our confidential group chat.” While staff told us there was a good learning culture, we found systems in place were not always effective at identifying learning opportunities.

While staff told us there was a good learning culture, we found systems in place such as care plan audits, call bell audits and incident investigations were not always effective at identifying learning opportunities.

People gave mixed feedback about how safe they felt. One person told us, “I do not feel safe.” Another person told us, “I do not feel safe when staff support me with the hoist.” Another person told us, “Although I absolutely love living here, the toilet system (when staff support people to go to the toilet) needs some attention.” Another person told us, “I feel very safe. It’s very good care. Staff notice if you are unwell in any way.”

Staff told us people received safe care. One staff member told us, “People receive good care. When we help people with a hoist, we always do it in pairs. We help people to move to give them pressure relief and apply their creams if needed.” Another staff member told us, “I feel people are safe. We have some residents who require further assessment from services, but they receive safe care here.” While staff told us people received safe care, we found people were not always supported to take medication when required or access health services when needed.

Professionals supporting people at Ash Hall Nursing Home gave mixed feedback about how safe the care was. One professional working with the service told us although the person did not come to harm, the provider went against their advice in how they managed their pain. Another professional working with the service told us, “When we visited a resident, we were made to feel welcome by staff and the nurse who helped us knew everything about the person’s needs.”

Systems in place to ensure people received safe care were not always effective. We found, where one person required as and when medication to manage a health condition, this had not been given and the concerns had not been escalated to the relevant external health agency. This meant people were at risk of harm. One person who required support with their weight, had been declining food and drink, the reasons given for this had not been shared with the GP. This meant their mental health needs had not been considered as part of their ongoing assessment. When we reviewed call bell data, we found several instances where people waited a long time to be supported after they had pressed their call bell. This meant people were at risk of not having their immediate needs met. Daily handovers took place to ensure changes in people’s needs and risks were shared with the staff team.

Although people we spoke with had not felt the need to raise any specific safeguarding issues, people did not always feel safe or know who to report concerns to. One person told us, “I’ve reported [a concern] to my family. Not to anyone in here. They are not interested.”

Staff told us they followed the safeguarding policy and knew how to safeguard people. One staff member told us, “I have had my safeguarding training which is refreshed every year, and I would report issues straight away such as bruising and issues with supporting people to move to help their skin. I trust the manager to follow up any concerns.” Another staff member told us, “I can report safeguarding issues to my manager and the Care Quality Commission. I have reported a staff member in the past who was not following correct procedures. The manager dealt with this, and their practice improved.” Although staff felt confident in following safeguarding procedures, we found safeguarding processes had not always been followed correctly following investigations of incidents.

While we did not observe any incidents requiring a safeguarding response, we found safeguarding processes had not always been followed correctly following investigations of incidents.

Procedures in place to ensure people were protected from abuse were not always effective. While incidents were investigated and safeguarding concerns were referred to the appropriate authority, we found where one person had been assessed to lack capacity to consent to restrictions placed on them such as using a lap belt and bedrails, the provider had not made an application to the appropriate authority for a deprivation of liberty safeguard (DoLS). This meant the person was at risk of being unlawfully deprived of their liberty. When we informed the registered manager about this, an application was made straight away to the relevant authority. Not all DoLS applications had been made in a timely manner. The provider did not always analyse themes and trends from accidents and incidents such as falls. There was an up-to-date safeguarding policy in place which was in line with local procedures. Staff had completed their safeguarding training and knew how to identify and act on safeguarding concerns.

People gave mixed feedback about how their risks were managed. One person told us, “I use a [equipment to support with health] and staff are always coming in to check that it is working OK.” Another person told us, “The nurses couldn’t help me with [health need], it was uncomfortable, and they had to get a [health professional] to come in and do it. I wasn’t happy.” One relative told us, “My [relative] needs support to eat and drink. Staff do not give [relative] enough help to actually drink. Often there is a jug of water or juice but nothing to drink it from.”

Staff gave mixed feedback about how people’s risks were managed. One staff member told us people waited a long time to be changed when they had used their incontinence aids as staff were busy doing other things. Another staff member told us, “Crash mats, sensors or one to one support is in place where needed for people who are at high risk of falling. Staff are trained to use mobility equipment and work in pairs when using a hoist.” Another staff member told us, “We support people to turn every 2 hours where needed to help with their skin and we apply creams when needed. I report any skin concerns to the nurse and record what I have seen.” The registered manager told us, “We focus on preventing people from falling such as providing people with suitable rooms and mobility aids. Sometimes I do think people can wait too long [with support to change incontinence aids or go to the toilet] but we do try to offer timely support and have procedures in place to prevent people waiting too long.”

We observed staff supporting people safely. Where people had eating and drinking needs, food was served to the correct consistency and staff ensured people were supported to eat and drink safely. We observed where people required equipment to support with their mobility and falls risks such as hoists and sensor mats, these were in place. While we observed people being supported safely with their risks during our on-site visits, when we reviewed people’s records, we found procedures had not always been followed to ensure their risks were met safely and care plans did not always include information about people’s risks or guide staff how to meet those risks effectively.

Systems in place to manage people’s risks were not always effective. Although the registered manager was in the process of updating people’s care plans, not all care plans included people’s risks or included accurate information. Where 2 people had been assessed to have behaviour risks, their care plans did not include enough detail about those risks and did not guide staff how to manage them or escalate for further support. Where a referral had been made to an external health service for 1 of these people, there was no information in the person’s care plan about the progress or outcome of this or any recommendations to support them with their behaviours. Where staff were required to monitor and support 2 other people with complex health needs, their care plans did not include a specific risk assessment or guidance for staff regarding the type of concerns to look out for and when to escalate concerns. This meant people were at risk of harm. People had personal emergency evacuation plans in place.

Although people did not express any concerns about the care home environment, we found risks in relation to falling from heights, trips, electrical shocks and scalds which had not been identified during the provider’s checks of the environment.

Although staff did not express any concerns about the care home environment, we found risks in relation to falling from heights, trips, electrical shocks and scalds which had not been identified during the provider’s checks of the environment.

People were at the risk of harm as the provider did not always ensure the physical environment was safe. We found some windows in communal areas had not been secured or did not have restrictors compliant with health and safety regulations. This meant people were at risk of falling from heights. We found some rooms with environmental hazards were not secure. For example, a communal bathroom contained exposed wiring, a boiler room was left unlocked, and the key was left in the keyhole, a storage room which contained obstacles, was left unlocked. A sluice cupboard was left unlocked, and the locking mechanism was not secure. Although there was no evidence people had come to harm, they had been placed at risk of harm from the care home environment. We found the entrance to the building had been left unlocked on 2 of the 3 visits we made to the care home during our assessment. This meant people who had a deprivation of liberty safeguard (DoLS) in place to keep them safe could potentially leave the premises and come to harm. When we told the provider about these environmental hazards, they purchased and installed coded locks and covered the exposed wiring straight away; and arranged for health and safety compliant restrictors to be fitted to the unsecured windows identified during the assessment. Portable appliance testing (PAT) records were not available during our on-site assessment. Although we observed some items in the care home had been tested within the 12 months before our assessment, we could not be assured all applicable items had been tested. This placed service users and staff at risk of harm from unmaintained equipment.

Systems in place to keep people safe from the risks of the premises were not always effective. Environmental checks carried out by the provider had not identified all the risks in the care home environment identified in our assessment observations, and they had only been addressed following feedback from the inspection team. The radiators risk assessment had not been updated since our last inspection where we identified mitigations were required to keep people safe from the risk of scalds. However, the provider was carrying out regular temperature checks of the radiators to ensure people were safe. Other environmental risk assessments were in place such as fire safety, gas safety and water safety. These were up to date and where there were issues identified, these had been addressed or there was a plan in place to address them. Routine testing took place for fire alarms and evacuation procedures. The care home environment was clean and tidy.

People told us there were not enough suitably trained staff. One person told us, “They are always short staffed and use a lot of agency staff. The language barrier with agency staff can be a problem when you try to explain what you need.” Another person told us, “The day room is often short staffed.” One relative told us, “The home is short staffed. My [relative] needs to be a priority as they have [complex health issue] and needs urgent care when required. The quality of agency staff is poor.”

Staff gave mixed feedback about whether people received safe and effective care. One staff member told us, “Staff genuinely care but feel rushed at times. People's incontinence needs are not met as quickly as they should be. However, we do have an extra staff member on in the morning which helps.” Another staff member told us, “Although agency staff don't know the residents, which slows things down a little bit, management are stepping up and getting staff numbers right.” Another staff member told us, “Carers are diligent and report any changes. We always learn from each other. We discuss a lot of learning in team meetings. We have a lot of online training and there is a train the trainer at the home.” Another staff member told us, “I had a DBS (Disclosure and Barring Service) when I started. I had an induction and do refresher training.”

While we observed enough staff supporting people safely, staff did not always interact with them when delivering care. For example, some staff did not communicate with people while supporting them to eat and drink in their own rooms.

Systems in place to ensure the staff team was safe and effective were not always effective. The provider could not demonstrate all nursing staff had received the training required to carry out specific clinical tasks. For example, we identified 2 instances where clinical care tasks had been carried out by nurses however, the provider had no evidence the nurses had received the specific training required to complete them safely. We shared this information with the relevant authorities to ensure they could investigate. We found 2 further instances where the provider had no evidence the nurses had received the required training to identify and monitor signs of infection. When we told the provider about this, they ensured online training was completed and put a plan in place to bring forward face to face practical training. Although the provider told us they had recently increased staff to cover the breakfast period and would increase staff numbers to meet dependency, they did not use a specific dependency tool to calculate the number of staff they needed. This meant the provider could not reliably evidence how they made decisions about staff levels. Team meetings, one-to-one meetings and daily handovers were in place to support staff to provide safe care to people. Staff were safely recruited. New staff were subject to pre-employment checks such as reviewing their education and employment history, references from previous employers and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

People we spoke with did not raise any concerns about infection prevention and control (IPC) procedures. One person told us, “It (care home) is very clean.”

Staff told us they had effective infection prevention and control (IPC) processes in place. One staff member told us, “We have no issues with IPC and there is always enough PPE (personal protective equipment) available.” Another staff member told us, “Everywhere is clean, we wash our hands when we are required and dispose of PPE safely.” A member of the leadership team told us, “The deputy manager carries out domestic audits. When somebody vacates a room, we ensure they are deep cleaned, use the correct PPE and dispose of them appropriately.”

Domestic staff members were completing cleaning tasks during our on-site visits and the environment appeared clean and tidy. People’s rooms and communal areas were free from malodours.

Systems in place to minimise the risk of spreading infection were effective. Staff were provided with appropriate personal protective equipment and had received training to support with minimising the risk of infection. Legionella assessments were carried out in line with requirements and remedial action was taken where required. There was an infection prevention and control policy in place.

People gave mixed feedback about how staff supported them with taking their medicines. One person told us, “When I first came to the home, staff took a medication device away, but I needed it for my health condition. They brought it back eventually.” Another person told us, “Staff bring me my medication and put it in my hand. They bring me water and trust me to take them.”

Staff told us they had received medicines training and people received their medicines safely. One staff member told us, “I have had all my medication training. We contact the pharmacy when there are issues, and the [registered manager] escalates issues when needed.” Another staff member told us, “I am trained to carry out more complex medicines procedures and discuss them with the GP beforehand.” While staff told us people received their medicines safely, we found people were not always given their medicines in line with their care plans, medicines records did not always include sufficient information about people’s risks and medicines records were not always available to staff when required.

Systems in place to manage medicines safely were not always effective. Where one person required as and when medication to manage a health need, this had not been given and staff had not informed the relevant health agency in line with their care plan. Although there was no evidence the person had come to harm, they had been placed at risk of harm by not having their health needs met. As and when medicines protocols for 2 people were not available to staff during our first on-site visit. This meant people were at risk of not receiving their medicines when required. The as and when medicines protocols were later located by the provider following our visit and put back in people’s care plans. The covert medicines agreement for 1 person was not available to staff during our first on-site visit. This meant the person was at risk of not receiving their medicines safely. The covert medication agreement was later located by the provider following our visit and put back in the person’s care plan. Self-administration risk assessments were not included in people’s care plans where required. There was an up-to-date medicines policy in place.