CQC takes action to protect people at Norfolk care home

The Care Quality Commission (CQC) dropped the rating for Ashill Lodge Care Home in Norfolk from requires improvement to inadequate, and placed it into special measures to protect people, following an inspection that took place from May to July.

Ashill Lodge Care Home, run by Ashill Lodge Care Limited, is a residential care home providing accommodation and personal care to up to 35 older people, some of whom are living with dementia.

This inspection was prompted in part due to concerns raised by healthcare professionals about staff training and responsiveness to people's needs as well as whistleblowing concerns about the service, and to check on the progress of improvements they were told to make following previous warning notices issued by CQC in previous inspection around medication.

As well as the home's overall rating dropping from requires improvement to inadequate overall, so have the home's ratings for being safe, responsive and well-led. The rating for how caring the service was, has dropped from good to requires improvement. CQC has again rated the home requires improvement for being effective.

CQC also imposed conditions on their registration, to ask CQC before admitting residents to the home.

The service has been placed into special measures which means it will be kept under close review to make sure people are safe whilst improvements are made.

Stuart Dunn, CQC deputy director of operations in the east of England, said:

"It was concerning that standards of care being provided to people living at Ashill Lodge Care Home continued to fall below an acceptable level. Instead of using the findings from our previous inspection to make improvements, we found further decline which is why we took action around them admitting new residents and placed them into special measures to protect people.

"Staff didn't always support people to eat and drink safely. For example, people who'd been given special diets to prevent choking, weren't being fed foods with the right consistency to avoid this from happening. We saw other people who needed to sit upright to avoid choking, being left lying down in their beds to eat meals. Although leaders had provided recent training on this to staff, they couldn't explain to CQC how they monitored people's dietary needs. This is unacceptable, particularly for residents with dementia who need additional support.

"Leaders didn't assess restrictive practices, which prevented people who are mobile from walking freely around the home. We have raised this to the service, and they have carried out an investigation.

"Staff didn't manage medicines safely. For example, one person missed their medicine for nine days and staff hadn't followed the process to escalate to the GP immediately. Staff didn't always document when topical creams had been applied meaning they couldn't be assured that this had been carried out.

"The home wasn't safe or well-maintained, with several dangerous hazards that posed significant risks to residents, especially those living with dementia. These included exposed wiring on electric bed handsets, and loose wires from sensor mats creating tripping hazards. While the service addressed these concerns after they were raised, it is unacceptable that they were allowed to persist for any length of time.

"We have told leaders where we expect to see immediate and significant improvement and have imposed conditions on the provider's registration to protect people. In the meantime, we'll continue to monitor them closely to make sure people are safe while this happens and won't hesitate to take further action if this doesn't happen."

Inspectors also found:

• Staff weren't offered specific training needed to meet individuals needs within the service, this includes Diabetes, Dysphagia and Stoma training
• The service was unable to provide evidence of how they monitor call bell response times. Call bell response times weren't monitored, and people expressed frustration at the delays in getting assistance
• Safe recruitment practices weren't always followed, there were gaps in employment checks and inadequate risk assessments carried out
• Several areas of the home were visibly dirty and stained. Equipment used to transfer people was unclean despite being recorded as checked and cleaned
• Staffing levels weren't adequate, especially at nighttime to ensure people consistently receive adequate and safe care.