Ashton Lane

Ashton Lane is a care home providing accommodation and personal care to people who require support with physical and sensory impairments, communication difficulties and moderate to severe learning impairments. Ashton Lane accommodates up to 6 people in one adapted building. At the time of our inspection, there were 5 people living in the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

The service gave people care and support in a safe and clean environment that had been adapted to meet their physical needs. The home environment was maintained to a high standard and included a new summer house. Staff supported people to take part in activities and pursue their interests. Staff enabled people to access specialist health and social care support in the community. The provider had failed to identify shortfalls in the accuracy of people's medicines records.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

The service had enough staff to meet people's needs. People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

There was a person-centred culture focused on maximising people’s quality of life. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People and those important to them were involved in planning their care. Staff valued and acted upon people’s choices and preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 21 November 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashton Lane is a residential care home for six people with learning disabilities and complex health needs. Ashton Lane is a two-story building with a communal lounge, sensory area, adapted bathroom and kitchen on the ground floor. Bedrooms are accessed by a lift to the first floor.

Ashton Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection in February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated good.

The service had two registered managers. At the time of our inspection one of the registered managers who is the assistant chief executive was in the process of deregistering to focus more on other projects at Stockdales. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service was remarkable. Since out last inspection the service had continued to make further improvements that had a positive impact on people's lives. Staff, relatives, and people living at the service all felt the care at the service was exceptional and people were enabled to have a good quality life. Staff cared for people in a very kind and compassionate way, they knew them well and people were happy and relaxed at all times. Relatives were very positive about the care provided at the service and complimentary about staff and management.

There were elements of outstanding practice in relation to managing behaviour that challenged. People who had a history of behaviour that challenged had a personalised positive behaviour support plan. This supported them to have as much control as possible over their lives, so they did not feel the need to behave in a challenging way. Staff noticed when people were showing signs of being upset and swiftly provided care and support.

Staff worked hard to establish people's preferences and went the extra mile to help them find more hobbies and interests. Arrangements for activities were varied and adapted according to people's individual needs. People had over the past year had become busier and more content.

There were flexible staffing levels to meet the daily needs of people living at the service. Staff supported people in line with their personalised care records to manage individual risks and care needs. The management team had a robust overview of the staff teams training, supervision and appraisal needs.

Social contact and companionship was encouraged, which helped to protect people from social isolation. Staff supported people to keep in touch with their families and friends, and to maintain community links. People regularly visited community facilities.

We reviewed three staff files and saw that satisfactory recruitment and selection procedures were in place.

Medicines management and administration processes were reviewed during the inspection and found to be safe.

Checks were made to ensure that the environment was a safe place for people to live. These included electric, gas, Legionella compliance and fire safety.

Staff were aware of the importance of respecting people's choices. They constantly consulted people and supported them to make choices. They worked within the requirements of the Mental Capacity Act 2005 (MCA). Where appropriate, applications had been made to the relevant authorising body to deprive people of their liberty.

Accidents and incidents were routinely recorded and analysed. There was an accident and incident reporting policy in place and staff routinely completed accident and incident documentation. The registered manager analysed monthly accident and incidents reports and established trends that were emerging as a measure of mitigating risk.

Staff spoke with enthusiasm about their roles and were clear about their responsibilities. There was an open and transparent culture. The registered manager was clear about their plans to continually improve the service.

Quality assurance processes were in place to drive continuous improvement. Significant events, such as accidents, incidents, safeguarding and complaints, were monitored by the registered manager and by the provider for developing trends.

Ashton Lane is a care home for six people with physical and learning disabilities. There is a parking area to the front of the building and an enclosed garden to the rear. The accommodation is over two stories with a lift to the first floor. All of the bedrooms are single. There is a communal kitchen, a dining room, a sitting area with conservatory and a shared bathroom on each floor.

The service had a registered manager. 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.

Family members told us that they felt their relatives living at the home were safe. Staff understood about safeguarding vulnerable people, had received safeguarding training and said they would report any concerns.

There were enough staff on duty to meet people’s support needs and to provide activities for them. People’s access to activities was excellent; we saw that they were supported to get out and about in the community and to pursue hobbies they enjoyed.

The home undertook risk assessments for all aspects of people’s care and support. Equipment used to support people was well maintained and regular health and safety checks of the premises were made.

People’s medicines were well managed by the service. Support staff administering medicines and undertaking other clinical tasks had been trained and assessed for competence.

Staff received the training they needed to support the people safely.

Support workers had a good working knowledge of the Mental Capacity Act (MCA) and how it affected the people using the service.

People were supported to eat a healthy diet. They were involved in choosing meals, shopping for food and in meal preparation. Staff tried to ensure that the dining experience was person-centred so that individuals were supported to have meals in the manner they preferred.

Relatives and other healthcare professionals involved with the service said that the support staff were caring. Support staff we spoke with knew people well as individuals. We observed staff interacting with people with warmth and humour and found there was a relaxed and friendly atmosphere at the home.

Staff promoted people’s independence by giving them choices. This included supporting them to choose activities and holidays.

People’s support plans were comprehensive and very much person-centred. Support plans contained details about how people liked to communicate and be supported in all aspects of their care.

We saw that care files were regularly reviewed and updated as people’s needs and preferences changed. People and their relatives had an annual meeting with support staff where their achievements for the year were celebrated and new goals and aspirations were discussed.

The language used to describe people in their support plans and in other written records was at all times warm and positive. We saw that support plans were ‘living documents’ which were used by staff to ensure the support they provided was individualised and met the person’s preferences.

People were provided with excellent opportunities to take part in activities which were person-centred. Their enjoyment of new activities was evaluated to ensure they were only supported to do things they liked.

The system of audit and monitoring at the service was impressive. Staff at all levels, from support workers to the chief executive officer (CEO), were accountable for people’s safety and well-being. The service had also developed a collaborative approach to reviewing and updating its policies and procedures.

The service had an open culture. People, their relatives, staff and other healthcare professionals involved with the service were asked for feedback on their experience. People also had residents’ meetings and the opportunity to meet regularly with the CEO.

Support staff worked as a team to improve the service for the people. Support workers from all the provider locations met regularly with the CEO to share good practice and discuss ideas for improvement.

The home had developed effective partnerships with other local organisations and businesses in order to increase people’s opportunities to access activities and the community.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was safe and clean. Processes for the prevention and control of infection were in place. For health, safety and security reasons, visitors were asked to sign in and out. There were enough staff on duty to meet the needs of the people living at the home at the time of our visit.

Discussion with staff and examination of records confirmed a programme of training was in place for all members of staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. Staff had all received training about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) so they understood when an application should be made and how to submit one.

Is the service effective?

People's health, social and care needs were assessed with them and they were involved in writing and reviewing their care plans. Specialist needs had been identified in care plans, for example, ways to communicate. Care plans were reviewed every six months and when people's needs changed.

The people we spoke with told us they were happy with the care their relative received and said their needs were met. They spoke positively about the staff. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

A relative of a person who used the service said 'Without them (the home), my relative's life would be very insular and lonely'.

Is the service caring?

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

In June 2014, the local authority had renewed the home's Dignity in Care award. Dignity in Care is a national initiative designed to put dignity and respect at the heart of care services to enable a positive experience of care. Achieving the award is evidence the organisation is striving to provide the best possible health and social care services.

Is the service responsive?

The records we saw confirmed people's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives, for example, via Skype as well as open visiting and visits home. We saw areas of good practice, for example, a Carer Involvement policy was in place which meant the families and carers of the people who used the service were encouraged to be involved in service planning and delivery. The policy incorporated a carer support plan which could be implemented if necessary.

Is the service well-led?

We saw documentary evidence which showed the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, people who used the service had the opportunity to express their opinions through meetings and questionnaires.

During the inspection, we looked at a summary of quality survey results based on responses received from 22 people using the service, 31 parents or carers and four professionals involved in people's care. People responded very positively in areas such as complaints handling, staff friendliness and how well people were kept involved in care reviews.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People who use the service received care in a way that met their needs and preferences.

We found there were arrangements in place to manage medicines safely. People were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.

On our visit we observed that all the people who use the service were involved in activities and each had a personalized plan reflecting their individual needs and wishes.

We examined three people's records within the home and these were all very comprehensive, including life histories, care plans, risk assessments, personal evacuation plans, behaviour charts, nutrition and weight charts. All records that we looked at were up to date and had been reviewed regularly. There was very clear documentation around mental capacity, best interests meetings and Deprivation of Liberty authorizations.

We saw evidence of regular residents meetings at which discussions around day to day living and activities were held. We contacted two relatives of people who use the service. One told us that they were regularly consulted and included in decisions around care and that people were always given choices around their care. Another said that the management were 'very effective and efficient', the staff 'very dedicated' and had 'concern for the individual'.