Date of assessment 22 to 24 October 2025.The service provides homecare for people in their own homes. The assessment was carried out to review the rating of the service because the last inspection took place on the14 August 2019. Not all key questions were looked at during the assessment. The rating for the service has remained good. There were130 people using the service when we carried out the assessment of whom121 were receiving personal care. We found the provider delivered safe care, and support for people, that was provided by staff who were professional, competent, and well-trained. Staff were recruited by the provider appropriately, and people were supported and enabled to take acceptable risks in an encouraging, proactive way. This enhanced people’s quality of life and reduced their social isolation. Staff supported people by working well as a team, and provided joined up, integrated care. This included involving external healthcare professionals. People’s independence was enhanced by the provider giving them choices and promoting a holistic approach to care. This included people having control over when they received it. The service recorded people’s consent to care and treatment, and they were encouraged, and supported to maintain healthy diets. The provider monitored the support provided to encourage, and drive improved experiences, and outcomes for people. The service was well led, with good support for staff, effective governance, and monitoring systems.
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Ashbourne Healthcare Services received a 'Requires Improvement' rating across all five key questions following inspections in early 2016, with six regulatory breaches identified including failures in safeguarding notification, staff supervision, dignity and respect, person-centred care, complaints handling, and governance. Key concerns included staff lacking knowledge of safeguarding and the Mental Capacity Act, a person receiving unrecognised personal care without a care plan, and the provider's failure to report safeguarding incidents to the CQC and local authority.
Concerns (12)
criticalSafeguarding: “Staff did not demonstrate a clear understanding of how to protect people from abuse and the provider did not consistently inform appropriate organisations about safeguarding concerns.”
criticalSafeguarding: “one person was intimidated by a staff member who attempted to coerce them into falsifying a timesheet”
criticalPerson-centred care: “the person had not been recognised by the provider as a recipient of personal care, although they were receiving daily support to get dressed”
criticalIncident learning: “the provider's inability to recognise that a person was receiving personal care within their care package and the failure to identify and report potential and actual safeguarding concerns”
moderateMedication management: “some care plans instructed care workers to assist people with the application of prescribed topical creams and lotions but did not state the names of these medical items”
moderateSupervision / appraisal: “these were 'spot checks' conducted at people's homes rather than formal supervision sessions that enabled staff to highlight any issues of concern related to their work”
moderateConsent / capacity: “The care staff we spoke with were not aware of the MCA and how it impacted on protecting people's rights.”
moderateCare planning: “Assessments and care plans did not evidence that staff knew people's needs and wishes well. There was a lack of details about people's wishes, interests, cultural requirements”
moderateComplaints handling: “the provider did not appear to recognise the need to make a record of verbal complaints with information about how the complaint was resolved”
moderateGovernance: “The management team did not demonstrate a comprehensive knowledge of the responsibilities associated with providing a regulated service.”
moderateStaff training: “Both staff members presented a limited understanding of safeguarding and demonstrated no knowledge of the provider's whistleblowing policy.”
moderateCommunication with families: “The staff member told the person about two other people who used the service, including personal information about people's diagnosis, healthcare needs, family composition”
Strengths
· Robust recruitment practices including DBS checks, two written references, proof of identity and eligibility to work in the UK.
· Sufficient staffing levels with people supported by a small consistent group of familiar care workers.
· Positive feedback received regarding palliative care, with one care worker highly regarded for compassionate and thoughtful end-of-life support.
· Staff placed on supernumerary placements at a nursing care home during induction to develop skills under qualified nurse supervision.
· Provider took action to address issues when raised during inspection, including organising refresher training and updating medicines policy.
Ashbourne Healthcare Services received an overall Good rating at this March 2017 inspection, having successfully addressed six regulatory breaches identified at the previous inspection in 2016. All five key questions were rated Good, with notable improvements in safeguarding reporting, formal staff supervision, complaints recording, and person-centred care planning.
Strengths
· Staff received safeguarding training and understood whistleblowing policies; safeguarding alerts were appropriately submitted to local teams and CQC.
· Medicines support was safely managed with staff competency tested during spot-check monitoring visits to people's homes.
· Comprehensive staff recruitment procedures including DBS checks, two written references, proof of identity and eligibility to work in the UK.
· Staff now received four formal one-to-one supervision sessions, addressing a previous breach of regulation.
· Care and support plans updated to include life history, religious and cultural needs, lifestyle choices and individual preferences.
Ashbourne Healthcare Services received a Good rating across all five key questions at its August 2019 inspection, maintaining its previous Good rating from 2017. The service demonstrated person-centred care, robust safeguarding and recruitment processes, effective partnership working, and strong leadership with no failure themes identified.
Strengths
· People felt safe and trusted staff visiting them in their homes.
· Care plans were person-centred, comprehensive, and updated when changes to people's health occurred.
· Safe recruitment processes followed including DBS checks and minimum two references.
· Staff received mandatory training including safeguarding, health and safety, basic life support and fire safety.
· Strong quality assurance systems with audits and service improvement action plans.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Dignity, privacy and respect
Good
caring: Person-centred care planningGood
caring: End of life careGood
responsive: Complaints handlingGood
responsive: Care needs assessment and planningGood
well-led: Governance and quality monitoringGood
well-led: Leadership and managementGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people, continuous learning and improving care, working in partnershipGood