The inspection took place on 4 September 2017 and was unannounced.

Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However, rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were thirty people living in the home. The home provides care and support for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There was a lounge and a dining area. There was a well- maintained garden and paved area as well as a summer house that people could use during the summer months.

There have been another two comprehensive inspection since January 2016. We carried out an announced comprehensive inspection on 6 and 8 January 2016. Breaches of legal requirements were found and the home received a rating of ‘Inadequate’ and was placed into ‘special measures’. The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example, cancel their registration. Services placed in special measures will be re-inspected again within six months. If sufficient improvements have been made, the service can come out of special measures and the overall rating can be revised. You can read the report from our previous inspection, by selecting the 'all reports' link for (Ashdown Nursing Home) on our website at www.cqc.org.uk.

We carried out another comprehensive inspection on 3 and 13 May 2016. It was evident that improvements had been made and the home received a rating of ‘Requires Improvement’ and as a result was no longer in ‘special measures’. However, the legal requirements in relation to safe care and treatment, the need for consent and dignity and respect had not been fully met. Areas for improvement were also identified in order to further improve some practices in relation to staffing levels, medicines, communication and interaction and providing choice.

At this inspection it was evident that improvements had been made and the providers had ensured that this had been sustained and embedded in practice. The providers were no longer in breach of the regulations, however, although the providers were no longer in breach, we noted that further improvement was needed to ensure that there was a consistent approach to assessing peoples’ capacity and making decisions on peoples’ behalves.

At the previous inspection on 3 and 13 May 2016 the home had been without a registered manager for seven months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The providers had been responsible for the day-to-day management of the home and peoples’ care. A new manager had been in post for one month. Following the inspection the manager left employment and one of the providers had become the registered manager. At this inspection it was evident that considerable efforts had been made to continually improve the service. A clinical lead nurse had been recruited to improve the nursing care people were receiving. In addition, a general manager was in post who had worked hard to improve the leadership and management of the home and had introduced mechanisms to ensure that the service was meeting peoples’ needs.

At this inspection people received care that was safe. There were sufficient numbers of suitably trained staff to meet peoples’ needs and people

We inspected Ashdown Nursing Home on 3 May 2016. Following the inspection we received some information of concern and as a result we returned for a second day of inspection on 13 May 2016. We previously carried out a comprehensive inspection at Ashdown Nursing Home on 6 and 8 January 2016. Breaches of legal requirements were found and we took enforcement action against the provider in relation to safe care and treatment, staffing, nutrition and hydration and dignity and respect. The overall rating of the home was ‘Inadequate’ and Ashdown Nursing Home was placed into ‘special measures’.

The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. Services placed in special measures will be re-inspected again within six months. If sufficient improvements have been made, the service can come out of special measures and the overall rating can be revised. You can read the report from our previous inspection, by selecting the 'all reports' link for (Ashdown Nursing Home) on our website at www.cqc.org.uk

We undertook this unannounced comprehensive inspection to look at all aspects of the home and to ensure that the required actions had been taken to address the concerns, and to see if the required improvements had been made. We found improvements had been made in the majority of areas. The overall rating for Ashdown Nursing Home has been revised to ‘Requires Improvement’, the home has also come out of ‘Special Measures’. However, the legal requirements in relation to safe care and treatment, need for consent and dignity and respect had not been fully met. Areas for improvement were identified in order to further improve some practices in relation to staffing levels, medicines, communication and interaction and providing choice.

Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were twenty-three people living in the home. The home is for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There was a lounge and a dining area. There was a garden that was in the process of being landscaped with a summer house that people could use during the summer months.

The service had not had a registered manager for seven months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The providers had been responsible for the day to day management of the home and people’s care. A new manager had been in post for one month and was undertaking the process of registration.

Observations of some care practices and feedback from some people and their relatives raised concerns over people’s safety when they were supported with moving and positioning. Risk assessments recognised the potential risk to people and provided guidance to staff in relation to how to support people in a safe manner. However, staff did not always adhere to this guidance and were observed undertaking unsafe moving and handling practices. One person told us “They often knock and bang my legs when they hoist me, but they can’t help it”. This was raised with the providers who took immediate action. Meetings were held with the members of staff concerned and they undertook refre

The inspection took place on 6 and 8 January 2016 and was unannounced.

The provider had taken ownership of the home in September 2015, they explained to us that they had been left in a difficult predicament by the previous provider and recognised that the home and the care provided needed significant improvement. The registered manager had left in October 2015 and the home had been without a registered manager for three months. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited a new manager as well as a deputy manager, who have since left employment.

The overall rating for Ashdown Nursing Home is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

Ashdown Nursing Home is located in Worthing. It is registered to accommodate a maximum of forty people, as some of the rooms were large enough for dual occupancy. However rooms had been converted and were single occupancy, therefore the provider was only able to accommodate a maximum of thirty-one people. At the time of our inspection there were twenty-nine people living in the home. The home is for people living with dementia, some of whom have complex health needs and who may require nursing support. The home itself is a large detached property spread over two floors. People had their own rooms and had access to shared, communal bathrooms. There were two lounges and a dining area. There were plans in place to extend the dining area to provide more space for people to use. There was a garden that was in the process of being landscaped with a summer house that people could use during the summer months.

There had been changes in the staff team, several members of staff had left the home, yet despite the use of agency staff there were insufficient levels and inappropriate deployment of staff during peak periods to meet people’s personalised and individual care needs. For example, due to there being inadequate staffing levels, one person, who preferred to be supported to get up and have their breakfast earlier in the morning, was supported to get up much later than they wished and was still eating their breakfast half an hour before their lunch was served. Staff confirmed this was the case, one member of staff told us “There are not enough staff. We are not finishing personal care and getting people up until about 12:00pm.”

Risk assessments had been undertaken, however there was not always sufficient guidance for staff and these were not always implemented or sufficiently monitored. Observations of care practices raised concerns over people’s safety when they were supported with moving and positioning and receiving pressure area care. People who were at risk of malnutrition had been assessed, however suitable measures had not been followed to ensure that appropriate actions were taken in regards to this. For example, care records for five out of the ten people that we looked at showed that since the provider had taken ownership of the home they had lost significant amounts of weight. This had not been recognised and they had not been referred to external healthcare professionals. People were not supported to maintain adequate nutrition and hydration. People had a poor dining experience and they were not supported appropriately to enable them to have sufficient amounts to eat and drink.

The level of staffing to meet people’s individual needs, the implementation and monitoring of risk assessments, weight loss for people who had been assessed as being at risk of malnutrition and the practice of staff in relation to moving and positioning were areas of concern.

Accidents and incidents had been recorded but there were insufficient mechanisms in place to monitor these to identify trends and aid prevention. Measures to minimise the risk of cross contamination had been taken however observations of poor practice in relation to infection control raised concerns. These are areas in need of improvement.

People were supported by staff who lacked the experience, skills and knowledge to support them according to their needs. Relatives were concerned over staff’s experience and skills and one member of staff told us “The staff don’t really know anything about dementia care.” There was insufficient supervision, support or training for staff to provide them with the skills necessary to meet people’s needs.

The provider had taken some measures to ensure that people were asked for their consent and were not deprived of their liberty unlawfully. However, for people who required the use of bed rails and who needed to have their medicines administered covertly, measures hadn’t been taken to ensure that relevant people were consulted to give lawful consent for their use.

The skills and knowledge of staff, as well as the lack of processes to gain people’s consent were areas of concern.

Observations showed that people were not treated respectfully. One person told us “I can tell when people don’t care.” People were not always appropriately supported to maintain their continence or their personal hygiene. Relatives were concerned that their loved ones were not receiving the support that they needed. One relative told us “My relative never gets supported to use the toilet, the staff are told that they have to use their pads. I came in the other day and my relative had a blanket over them, I pulled it back and their legs were soaking wet.”

People were at risk of social isolation, their personalised and individual needs were not met and there was a lack of stimulation for people. One person confirmed this and told us “It’s a bit boring, I don’t know what I’m doing today, I don’t get out.”

The lack of personalised care to meet people’s needs and ensure they were treated respectfully and their dignity maintained was an area of concern.

There was a lack of quality monitoring processes and as a result the provider had failed to identify when people’s care needs were not being met. For example, people who had been assessed as being at risk of malnutrition had their weights and food and fluid intake monitored. However, the provider had not ensured that the results of these were reviewed or analysed. They had failed to identify that some people had lost significant amounts of weight and therefore had not taken the necessary action to ensure people’s safety.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.