We spoke to 9 residents, 3 members of staff, and the Care Home Manager. We observed the care and interaction between ten residents and staff in 3 lounge areas. In addition, we viewed all communal areas and a few residents’ rooms. The Care Quality Commission (CQC) carried out an unannounced visit to Ashgreen House on the 7 th and 15th March 2018. The home was rated as ‘good’ overall, and across all individual areas.
In November 2017, we conducted an Enter and View visit to Ashgreen House Residential and Nursing Home and provided the following recommendations:
• Display the activity programme in each wing for all residents to see
• A newsletter to notify resident’s and their visitors of upcoming events throughout the year
Summary of findings
Ashgreen House Residential and Nursing Home needs urgent improvement in several areas:
Clutter in communal areas, unattended maintenance equipment, personal belongings on the inside of the nurse’ station door restricting visibility of residents through the window when the door is closed, and easily assessible broken equipment provide evidence of weak health and safety practices, poor management of refurbishment activity, and lack of thorough risk assessments, increasing risk to resident’s safety. We strongly recommend an immediate full safety audit, to rectify issues that put resident’s health and safety at risk.
Strain in staff relationships indicate a somewhat hostile working environment. Whilst the Care Home Manager is aware and has made steps to resolve this, we are concerned this may impact resident’s experience of care, and one resident reports a mixed, not entirely positive, experience of care. We suggest that work already underway to improve staff dynamics is expedited.
The home documents care plans digitally, however, we are concerned that this is not working for all members of staff, increasing the workload for other members of staff, limiting time to care for residents.
Resident views on meals offered at the home are mixed. We were told the menu rarely changes, suggesting it does not always meet resident’s needs, and one resident has made a formal complaint to the CQC. We urge the home to implement a more diverse menu, with frequent rotation of options, to meet resident’s needs.
Many of the issues identified during our visit have previously been raised by staff internally but have not been resolved, contributing a lack of trust between some staff and management.
Recommendation 1: Adopt a vigilant approach to health and safety practices Many of our concerns are in relation to the risk of inappropriately placed and easily accessible items/equipment that could cause injury to residents or hinder/delay escape in the event of a building evacuation e.g. the unsupervised stepladder at the reception desk, the broken chair in the bathroom, and the clutter outside the laundry room. We strongly recommend an immediate full safety audit, to rectify obvious problems, and subsequent regular checks on communal areas to remove anything that could put resident’s safety at risk. Safety includes staff ability to see and hear residents. With this, the Care Home Manager should ensure that staff keep their personal belongings in the staff room, coats do not obscure internal office windows, and that music is never played at such high volume that calls for help from residents would go unheard.
Recommendation 2: Review processes to protect confidentiality Finding unsupervised confidential files in the reception area suggests a lack of understanding of:
• Duty of confidentiality
• Residents legal right to privacy
• The Human Rights Act
We recommend management review policies, procedures and systems in place to ensure confidentiality rules are followed and residents legal right to privacy is respected.
Recommendation 3: Improve the general hygiene and maintenance of the home In some parts of the home, there are areas of general hygiene and maintenance that require attention. We recommend more frequent, and more thorough, cleaning, particularly in communal bathrooms and toilets.
Recommendation 4: Review care plan documentation The current system of electronically documenting care plans does not work for all members of staff, creating an additional administration burden, and reducing the time available to care for residents. We recommend the home considers how to resolve this.
Recommendation 5: Include more culturally diverse menu options for residents One resident’s dissatisfaction with the food provided (and subsequent complaint to the CQC) may be a unique situation, however, it highlights an urgent need to implement a more diverse menu that extends to residents. This may help to increase a sense of belonging and inclusivity for all residents, complimenting the home’s diversity training.
Recommendation 6: Increase the provision of personalised bedroom doors All external facing doors of bedrooms should be personalised to help residents recognise their own bedroom and enable staff to maintain awareness of residents who are at risk of falls.
Recommendation 7: Continue to improve staff dynamics Whilst we are impressed that management demonstrate awareness of the need for improved staff relationships, we strongly suggest this is addressed as a matter of urgency and does not have a negative impact on resident’s quality and experience of care.