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The provider had notified CQC of important events as required. The improvements related to Regulation 16 of the Health and Social Care Act Regulations 2014 and Regulation 18 of the Care Quality Commission Regulations 2009. However many improvements had not been made and we found continuing breaches of regulations from the last inspection. These related to Regulation 9, 11, 12, 17 and 18 of the Health and Social Care Act Regulations 2014. The inspection was unannounced.Ashley Down Nursing Home is a ‘care home’. There were 13 people living at the service at the time of our inspection.
The residency also accepts individuals with Alzheimer's and other forms of dementia and sensory impairment. The home is situated close to good amenities and the River Thames. A spacious and secure interior with bedrooms that have tradition... Willows Lodge Care Home Calcutta Road, Tilbury, RM18 7QJ ★★★☆ Willows Lodge Care Home is a large nursing home located in Tilbury, with a capacity of 62.
Reports under our old system of regulation
People had the opportunity to share their views about the care and service through monthly residents meetings and yearly satisfaction questionnaires. People told us they enjoyed their meals and they had enough to eat and drink. Food was freshly prepared and people were supported to eat when they needed to be. Staff knew about people’s dietary preferences and restrictions such as how one person could not tolerate certain foods and fluids and this need was met.
People and relatives told us they didn’t feel there was enough staff deployed to meet their needs. Staffing levels had not been increased despite a recorded increase in dependency levels. Relatives also told us they thought their relatives were safe and care was provided appropriately. Although the manager had been in post since August 2018, they had not applied to register with the Care Quality Commission. It is the provider’s legal responsibility to ensure a registered manager is in post.
Safe
This meant that people's safety was not protected and the provider was not learning from incidents. There were no meaningful activities taking place in the home. People told us that there was nothing to do and no one to talk to. There was a lack of stimulation and people were at risk of social isolation. People and their relatives told us they received care that was safe, effective, caring, responsive and well led. At this inspection, we found the provider had made improvements within the service, although further improvements were required and work was still in progress.
We have asked the provider to tell us what improvements they will make in relation to ensuring that there are sufficient numbers of suitably qualified, skilled and experienced staff. At this inspection, we found that sufficient improvement had not been made to the assessment used to determine the numbers of staff required to provide the level of care people needed. Staff did have the opportunity to meet with their line manager on a regular basis to discuss work related issues. At our last inspection, on 20 and 21 February 2018, the service was rated as ‘requires improvement’.
ASHLEY DOWN NURSING HOME
About the service Ashley Down Nursing Home is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. Some people were living with dementia and people required support to move around the service. The premises were secure and protected with an alarm system. People had personal emergency evacuation plans in place and staff were trained in fire awareness. Staff were trained and had the information they needed to protect people from the risk of harm and abuse. Risk assessments were centred on the needs of the individual and included clear measures to reduce identified risks and guidance for staff to follow.
People’s health needs were generally taken care of by the registered nurses working in the home and GP practices. Health referrals had been made, however not always suitably quickly and not always pursued and followed up. Where people required a special diet or consistency of food this was documented and appropriate advice and guidance had been sought. The provider had now displayed the ratings from the last inspection in July 2017 in a prominent place so that people and their visitors were able to see them. People and their relatives gave positive feedback about the kind and caring nature of the staff team. Staff knew people well and a friendly and more relaxed atmosphere was evident.
Services we don’t give a rating
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.
The manager said the home was looking to recruit an activities coordinator, but nothing had been put in place. At other times we offer an answer phone service so please leave a message and we'll call you back. There is chicken casserole and mash, or cheese omelette and chips today”.
Sufficient improvement had not been made to the recruitment processes. Robust checking had not always been employed when assessing the suitability of new staff to provide care and support to people living in the service. Where people had lost weight or their blood sugar level had not been monitored, documentation did not consistently reflect what action had been taken and why. A complaints policy was in place but the provider had failed to update and review the policy since the last inspection in January 2016 when it was identified the policy was not fit for purpose. The management of risk across the home was not consistent and risks to people's safety had not consistently been mitigated.
National Autistic Society - Respite Care 27 Overcliffe, Gravesend, DA11 0EH National Autistic Society - Respite Care is a small care residence situated in Gravesend, with two beds. The home caters for adults of all ages including people with learning disabilities. The Care Quality Commission has monitored the residency since March 2013. It offers long-term nursing, residential care for elderly residents, where their families can spend time with them in a relaxed and compassion... Dene Holm Deneholm Road, Northfleet, DA11 8JY ★★★☆ Dene Holm is a large purpose built residential unit situated in Northfleet, on the outskirts of Gravesend. The home provides support to older people and people with dementia.
Although an audit and monitoring system was in place it was not used effectively to identify concerns and act on them to drive improvements within the home. Staff had not been sufficiently deployed to ensure peoples’ social and welfare needs were met. People were often left sitting on their own in the lounge or in their bedroom with little stimulation. People were not engaged in meaningful activities that were based on their interests and to create a motivating environment.
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