Archived: Ashbourne House - Bristol

Ashbourne House - Bristol (referred to throughout report as Ashbourne House) is a residential care home providing personal care to up to 17 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were seven people using the service.

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

We found breaches of regulation during our inspection. People were not always supported to have maximum choice and control of their lives and the principles of the Mental Capacity Act (MCA) were not being followed consistently. Best interest decisions and applications for Deprivation of Liberty were not made for everyone that needed them. The environment of the home was not safe in all areas, as not all windows had restrictors in place, personal evacuation plans had limited information and the fire risk assessment had not been reviewed since being completed in March 2016. Quality and safety monitoring systems were not effective in identifying and acting on shortfalls.

People were supported by staff who were kind and caring and who knew people and their individual needs well. People were treated with dignity and respect. There were care plans in place to guide staff in providing the right support for people. Risk assessments were carried out in areas such as nutrition and tissue viability so that measures could be identified to keep the person safe.

Improvements had been made to the decoration of the home since our last inspection. Staff worked well with other health and social care professionals to ensure people’s health and wellbeing. Staff received training and supervision to support them in their roles and to care for people effectively.

Rating at last inspection and update

The last rating for this service was good (published 10 November 2017)

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashbourne House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, the MCA and good governance.

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.

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

There was a registered manager in post. 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.

At our last inspection in June 2016 we rated the service overall as Requires Improvement. At that inspection we found a breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not appropriate procedures for the administration and recording of PRN (as required) medicines. We also found that although improvements had been made since the inspection of August 2015 and previous breaches had been met we had to be satisfied that these would be sustained over time.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. Staff had completed nationally recognised qualifications in health and social care and others were in the process of completing this.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them those living at the service felt ‘valued and happy’.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions a process of best interest decision making had been followed that was consistent with the principles of the Mental Capacity Act 2005 (MCA). The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff embraced new initiatives with the support of the registered manager and deputy. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.

The provider and registered manager had implemented a programme of ‘planned growth’ that was being well managed and they were committed to continuous improvement. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

Following the inspection the home was placed into 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. 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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Ashbourne House' on our website at www.cqc.org.uk

Following the inspection in August 2015 the provider wrote to us to say what they would do to meet the legal requirements. We undertook another comprehensive inspection on 1 June 2016 to check the provider was meeting the legal requirements for the regulations which they had breached. At this inspection the provider had made sufficient improvements to be removed from special measures.

Ashbourne House is a 17 bed residential home for older people that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 12 people living at the service.

There was a registered manager in post. 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.

There were not appropriate procedures for the administration and recording of PRN (as required) medicines.

Daily records did not always accurately reflect the care given to people.

The home was generally clean however improvement was required in the level of cleanliness and the inappropriate storage of cleaning materials within the laundry room.

People’s needs were regularly assessed and resulting care plans provided practical guidance to staff on how people were to be supported. Care plans were personalised and contained individual information and references to people’s daily lives.

There were enough staff to meet people’s needs. Staff demonstrated a detailed knowledge of people’s needs. They had received training to support people to be safe and respond to their care needs. Training did not however include specific training to support all care staff to recognise and meet the needs of people Staff were aware of the service’s safeguarding and whistle-blowing policy and procedures.

The provider had quality monitoring systems in place which were used to bring about improvements to the service.

Training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided to staff. DoLS aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Staff were knowledgeable about the protection of people’s rights. The service had ensured that best interest decisions were undertaken when people lacked the mental capacity to make decisions and give their consent.

There was a robust staff recruitment process in operation. The recruitment process was designed to employ staff that would have or be able to develop the skills to keep people safe and support their needs.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care. We received positive feedback from people's relatives and visitors to the service. Staff respected people's privacy and we saw staff working with people in a kind and compassionate way when responding to their needs .People were supported to undertake activities.

People had access to healthcare professionals when required, and records demonstrated the service had made referrals when there were concerns.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

The provider had made appropriate notifications to the Commission; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

We found one breach of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We re-examined the outstanding outcomes during an inspection on 17 November 2013. People we spoke with were happy living in the home. People told us 'they look after me very well' and 'we get a first class service'. We also found that action had been taken to address the identified shortfalls.

The care plans we saw provided basic details of people's needs and were not person centred.The information in people's risk assessments were generic and did not clearly define the risk to individuals and measures required to ensure their health and safety.

The provider had effective systems in place to deal with safeguarding incidents. Staff received safeguarding training which was updated annually. Safeguarding and complaints information was displayed in the home for the staff and people to refer to.

The provider's infection control procedures did not meet the recommended guidelines for the prevention and control of infection within the home.

Staff did not receive appropriate professional development supervisions and annual appraisals.

The provider did not have effective quality assurance systems in place to monitor the performance of the home.