Ashfield Nursing Home

On this page

• 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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people using the service were only able to give limited feedback, people looked relaxed in staff’s company and were being supported in a safe and kind manner. Relatives we spoke with, told us staff knew their relatives needs well and supported them safely.

Staff knew people’s needs well. Staff knew how to access care records and ensured they referred to healthcare professionals when needed. Staff had good knowledge of how to support people’s needs, and what action to take if the person’s needs appeared to have changed. For example, staff gave us an example of person whose mental health needs had changed since living at Ashfield, they told us what support and advice they obtained and implemented to ensure the person’s changing needs were met. Staff told us they were able to update care plans immediately when people’s needs changed.

An electronic care planning system was in place. An alert was placed on the system which highlighted any people who needed a review of their care and support needs. This meant people’s needs were reassessed regularly. We found some care plans clearly detailed what support people needed to However, oral healthcare plans needed further work to ensure staff always had the correct guidance to support people in line with their needs and wishes. We also found where oral health assessments were in place, staff did not always ensure these were followed. We found many people did not have access to oral hygiene products despite care plans recording support was needed. We also found other people did not have an oral healthcare plan in place despite care plans indicating they needed support with every aspect of their personal care needs.

People and their relatives told us staff contacted healthcare professionals when needed to ensure they got the care and support they needed, A person we spoke with said, “If I am poorly, staff get me the medical attention I need straight away.” People told us, staff ensured the right healthcare professional was contacted at the right time.

Staff had good knowledge of tools that the service used, and how they impacted the care given. For example, one staff member explained they completed training in RESTORE2, this tool is designed to recognise when a person may be unwell or at risk of becoming unwell. Staff told us they used this tool to assess the person, and they used this assessment to inform them of what action they needed to take to ensure people received timely care and support. The management team discussed a person who they supported who required specialist support with their diabetes. They told us they worked closely with the specialist nursing team to ensure the person received the right care and support.

Care plans followed national guidelines on how to support people most effectively. For example, positive behaviour support plans were in place for people who became distressed due to their health condition. We found plans in place were detailed and implemented best practice guidance. People’s nutrition and hydration needs were supported in line with current standards. Staff had identified people at risk of weight loss and were monitoring how much food they were consuming. Where needed, staff had supported people to source additional weight gaining supplements.

People and their relatives told us staff communicated well. A relative told us, they could speak to any member of staff about their loved one’s care and support.

Staff told us they worked with partners to ensure people received effective care and support. A member of the management team told us they worked closely with the pharmacy team to ensure people’s transition into Ashfield was smooth and to reduce any disruption to their prescribed medicines. Staff told us, they visited various settings such as hospitals, people’s own homes and other care homes to assess people’s needs prior to moving into Ashfield. Staff told us they met with people and where needed their families to complete care plans and assessments to ensure their needs and wishes were met. The management team told us, they knew the importance of communicating and working well with partners to ensure people received effective care and support.

We received no negative feedback from partners. We saw evidence where advice had been given by partners this had been implemented into care and support plans.

Processes in place demonstrated staff worked well with partners to ensure people received effective support. Care plans detailed specialist guidance had been implemented. For example, a care plan had been updated to evidence advice from stoma care nurses. The contact details of the specialist team were clearly detailed within the care plan, this meant staff had the right contact details if concerns arose. The electronic care planning system meant care plans could be updated without delay. We found any communication from partners was documented within care records.

People told us staff supported them to access health appointments as needed. People told us staff accompanied them to hospital and medical appointments.

Staff understood people’s needs and how to support them to access health and social care support if needed. The management team gave us several examples of referring to partners such as the dementia outreach team, speech and language therapists and dieticians. Staff told us they worked effectively with the pharmacy and GP to ensure people’s medicines were managed safely. Staff told us they had recently been visited by the pharmacy to ensure they had the right processes in place to ensure people received their medicines correctly to improve their health. The management team told us staff completed training in REACT TO RED and RESTORE2. REACT TO RED is training relating to the prevention of skin damage and RESTORE 2 supports in the early detection of sepsis. This meant staff were able to recognise and act people became unwell.

Records were kept of when health professionals reviewed people, and what advice they gave. For example, we reviewed a care plan where a person suffered with a long-standing wound, we saw evidence staff had requested specialist advice and support several times when they were concerned about an infection. We also reviewed records relating to weight loss. A person who had become unwell had their weight and nutritional monitoring increased to highlight any weight loss or malnutrition associated with their ill health. We found where needed healthcare professionals were contacted for advice.

People were supported with their healthcare needs to improve their physical health. However, people raised concerns about their environment and the impact this had on their overall well-being. For example, a relative we spoke with said, “I am not happy with the state of the home, I do worry that this has a negative effect on my [relative’s] mood, as they’re not used to living like this, I have asked for changes to their room but nothing so far.”

Staff were able to tell us how they helped people with their physical needs to improve their outcomes, they gave us several examples of how they supported people to maintain and improve their health. However, staff recognised the environment needed work to improve people’s experience. Staff told us, they were proud of the care and support offered at Ashfield but felt the environment needed lots of work to ensure it had a positive impact on people. Staff shared several ideas of how they would like to improve the environment. For example, a staff member told us they would like to improve the environment for people living with dementia to improve their outcomes. The registered manager was open and honest and told us they were aware the environment needed work and was committed to improving the environment for people.

Processes in place meant whilst staff and the management team had a good oversight of people’s care records, issues with the environment had not been acted on in timely manner, which resulted in people having a poor experience. This was a missed opportunity to improve people’s experience and outcomes. Care plan audits were in place and detailed areas for improvement.

People told us they felt respected, and staff always gained consent before providing support. We found people were supported in the least restrictive way.

Staff understood how to apply the principles of the MCA in practice and ensured consent to care was sought. Staff gave us an example of how they supported people to take their medicines covertly. Staff explained they followed best practice guidance and ensured any administration was in line with their best interests. Staff explained which people had a Deprivation of Liberty Safeguards (DoLS) authorisation in place, and what having a DoLS in place really meant for people.

People’s rights were respected, and The Mental Capacity Act 2005 (MCA) was followed for people who were deemed to lack capacity to make decisions about their care and treatment. 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. We found staff followed the MCA. Some people would be at risk if they did not have continuous supervision and control. Where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.