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Our last inspection report of this service was published on 20 February 2017 and related to an inspection that had taken place on 22 and 24 November 2016. At the inspection in November 2016 we found six breaches of the Health and Social Care Act Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission Regulations 2009, CQC had not been notified of important events that had taken place in the service. Ashley Down Nursing Home is registered to provide accommodation for older people who require nursing or personal care. The home could provide care and support for up to 19 people. There were 15 people living at the home at the time of this inspection.
Large gaps in documentation reflected that people could go up to seven hours without support to meet their continence needs. Staff told us they received essential training that equipped them with the skills to meet people’s individual care needs. The provider had failed to identify that training had not been provided on the safe and effective management of diabetes, epilepsy and pressure care.
Inadequate
“We have lots of different activities in the afternoons, exercises, ball and balloon games, dominoes, darts, singing and things”. “We mostly sit and chat together in the mornings and watch TV, and sometimes we run out of things to say”. We also talked with the five staff members who were on duty in the morning; and briefly met other staff who came on duty during the afternoon. The security of the home had been improved as well as the surrounding perimeter of the garden.
People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashley Down Nursing Home provides accommodation and support for up to 19 older people. There were 11 people using the service at the time of our inspection. People had varying needs including diabetes and Parkinson's disease and some people were living with dementia. Some people required the use of a hoist to help them to move from their bed to a chair and vice versa and others required two staff to assist them to move around.
Age UK North West Kent
We inspected Ashley Down Nursing Home on the 22 and 24 November 2016 and the inspection was unannounced. The accommodation is provided in an older style detached house in a residential street. There is a communal lounge, dining room, kitchen, communal bathrooms and bedrooms with en-suite bathrooms. Outside there is a good size garden that people have access to.
We talked with people who used the service or their relatives, one person said 'staff treat me with respect, I get on very well with staff' another said 'I like my room and the staff are lovely'. At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. We found seven breaches of the Health and Social Care Act Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Ashley Down Nursing Home
All staff were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation. “We are having a garden party with a barbeque on Saturday – that will be a good time”. If you wish to see the evidence supporting our summary please read the full report. We will minimize, reuse and reuse all materials wherever possible. Our toner and ink cartridges are recycled using the manufacturer\'s recycling services. If you got here via a search engine like Google, then the page did exist on this site at some point, so you're on the right track.
They confirmed that they had a choice of food for all meals. We found that records were not accessible and that we could not check to see if the registered person was managing the delivery of the regulated activity safely. There were ‘residents meetings’ held which all people were encouraged to attend.People had been consulted about recent redecoration works and chosen colours.
They wrote to us on 18 December 2013 and stated that all records apart from staff files were kept in the nurse's office. However, during our inspection of 22 April 2014 we found that a number of records could not be located promptly as the provider unavailable. Staff had a safeguarding procedure to access the information they needed to protect people and raise concerns. A copy of the local authority procedure with their full guidance for reporting concerns was kept in the home, however, it was an old copy with the wrong information available. The provider had not displayed the ratings of the previous inspection in a prominent place as required by the regulations. New staff had not had the appropriate checks made of their suitability to care for and support the people living in the home.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated Inadequate or Requires Improvement for the last six inspections. The premises were not always safe and essential checks, such as gas safety, had not been completed in a timely way. There had been significant concerns with the fire system when fire doors were not closing in an emergency.
Record keeping had improved, staff recorded the time they spent with people and what they did so their care could be monitored. Accidents and incidents were recorded well and monitored by the manager to prevent further incidents. More detailed plans were now in place to assist people to evacuate the building or keep them safe in an emergency. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
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.
This means they are providing inadequate care for the residents who are frail, unwell and very elderly people. Ashley Down in Clarence Place was one of 14 homes named among the worst care providers in England by OlderLivingMatters4.net. Because of the strain on staff, those employed had not received all the necessary training and did not have any time to spend with residents, inspectors found. – the service is performing well and meeting our expectations. People living in the home said that staff asked them for their choices about day to day events, such as if they wanted a bath or a shower, and if they wanted it in the morning or evening. They also asked them if they wanted to stay in their own rooms, or go to the lounge or elsewhere.
– the service is performing badly and we've taken enforcement action against the provider of the service. There was an open and positive culture at the service which focussed on people. Staff told us, “The manager and senior nurse are approachable; we can talk to them any time and discuss any concerns”. People and their relatives told us they were satisfied with the care, the staff had a good knowledge of their needs and met these in a way that suited them. Another person told us, “The staff know me well and understand me well”. Two relatives said, “The staff know my mum well and what she likes, they know how to get the best of her” and, “The staff are well trained”.
January 2020
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.
They were confident any concerns they had would be acted on quickly. "What is even more shocking is that many homes have had a succession of poor, sometimes ‘inadequate’, reports. A view of Ashley Down Nursing Home in Gravesend“More than 400 homes are sitting on an ‘inadequate’ notice.
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