Archived: Ashleigh House

Ashleigh House is a residential care home providing personal care for up to a maximum of 24 people. The service provides support to older people. At the time of our inspection there were 16 people using the service.

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

We carried out an unannounced comprehensive inspection of this service on 13 and 19 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when, to improve good governance of the service.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

The quality and safety of the service had deteriorated since our last inspection which showed the provider was unable to make and sustain improvements to benefit people. The lack of provider and management level oversight meant previously demonstrated standards and regulatory compliance had not been maintained. The provider's systems and processes designed to identify shortfalls, and to drive improvement were not effective and had not identified the concerns we found.

Whilst people told us they felt safe, risks associated with people's care, staffing, and the environment, (including fire safety) were not consistently identified, assessed, and well-managed. This placed people at potential risk of harm. The prevention and control of infection was not always managed safely and in line with government guidance. The management of medicines required improvement. Safeguarding procedures had not always been followed to protect people from avoidable harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Records were not always sufficiently clear to show if people had capacity or not. Information on how to manage specific decisions relating to people’s care was not clear.

Staff lacked knowledge in some areas demonstrating training was not always effective. People and relatives spoke highly of the regular staff who cared for them. Staff were caring in nature, but people’s privacy and dignity was not upheld consistently. People had access to health and social care professionals to help support their needs.

People's needs were assessed prior to moving into the home to help ensure these could be met. Care records did not always provide staff with the information they needed to deliver personalised, safe care, and some records contained conflicting, out of date information. Daily care records had not always been completed in sufficient detail to demonstrate people had received the care they needed to keep them safe and well. Whilst people had access to some social activities there were limited opportunities to take part in varied and meaningful activities. People said staff were caring and spoke positively of the support they received. There had been no recent complaints received by the service.

Staff felt supported in their roles and spoke positively of management. The manager acknowledged the areas of the service that required improvement and acknowledged they needed additional support to achieve this.

Rating at last inspection and update

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 identified breaches in relation to people's safety, and governance of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashleigh House is a residential care home providing personal care for up to 24 older people aged 65 and over. At the time of our visit, 15 people lived at the home and one of these was in hospital. Accommodation is provided over three floors in one adapted building.

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

There had been an increase since the last inspection of audit checks completed to monitor the quality and safety of the service to help drive improvement. However, these had not been consistently effective in identifying risk and areas needing improvement. Quality checks included feedback from people, their relatives, and staff, through quality questionnaires and meetings.

Health and safety checks were carried out to make sure equipment and the environment was safe although we identified some areas needing improvement which were addressed during our visit. Arrangements were in place to keep the home clean, but staff did not always follow good infection control practice.

People's needs were assessed before they moved into the home to make sure their needs could be met, and it was the right place for them to live. People told us they felt safe living at Ashleigh House and spoke positively about the staff that supported them. We found there were some inconsistencies in regards to risks associated with people’s care being identified, recorded and reviewed, to ensure people were kept safe.

Staff understood what they needed to do to keep people safe from the risk of abuse and we had been informed of potential safeguarding incidents in a timely manner. Staff had improved their understanding of the Mental Capacity Act but where people lacked capacity, this had been not always been identified within records. However, staff said they supported people with decision making to ensure they had choice and control of their lives and aimed to support people in the least restrictive way possible and in their best interests.

Health professionals were contacted where appropriate to support people’s healthcare needs. At our last inspection we identified improvements in the management of people’s prescribed topical creams were needed. At this inspection, these improvements had been made. People received their medicines from trained staff when they needed them.

Staff were recruited safely and there were enough staff to meet people’s needs. Staff completed on-going training and supervision to be effective in their roles.

Staff knew people well and people had access to some social activities to maintain their wellbeing. People said there was not enough social stimulation for them. A new activity organiser had been appointed and was developing activities in accordance with people’s preferences. This included building further links with the local community.

Staff were caring in their approach and understood how to respect people’s privacy, dignity and independence and people told us this was maintained. Care plans contained information to support staff in providing personalised care. Some people had contributed to end of life care plans which were being developed to help ensure people’s wishes were followed at this time.

At our last inspection it had not been clear people's nutritional and hydration needs were met. At this inspection, this had improved. People were offered a choice of meals and snacks on a daily basis and staff understood and supported people's dietary needs.

People and their relatives knew how to raise a complaint and felt at ease to raise any concerns with staff. Complaint records showed the registered manager had investigated those received and taken action to address them.

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

Rating at last inspection

The last rating for this service was ‘Requires Improvement’ (published 22 June 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashleigh house 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. The care home accommodates up to 24 older people in one adapted building. Accommodation is based on the ground floor as well as the first and second floors of the building.

There were 16 people living in the home on the first day of our visit and 14 people on the second day. Most of these were older people and some were living with dementia.

At our last inspection in November and December 2017 we rated the service as ‘requires improvement’ overall. We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 because risks related to people’s health and safety were not safely managed. There was a breach of Regulation 18 because the provider had not reported notifiable incidents to us without delay. There was also a breach of Regulation 17 because the provider did not ensure people were protected from risks to their health and safety, and systems and processes were not effective in monitoring and driving improvement. The key questions of Safe, Responsive and Well Led were all rated ‘Requires Improvement’. The provider sent us an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we checked whether the actions they had taken were effective. We found the provider was no longer in breach of two of the three regulations previously identified. Due to further improvement needed, there was a continued breach of Regulation 17 and the rating remained requires improvement.

Action was needed to improve person centred care, ensure care decisions related to restrictions in care were in people’s best interests, and to ensure audit processes were consistently effective.

There was a registered manager in post as the manager who had been in post at our previous inspection had registered with us on 4 May 2017. 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 atmosphere in the home was relaxed and people spoke positively of the staff who supported them. Staff were caring in their approach but some staff were more interactive with people than others. People said they felt their privacy and dignity was maintained. However, CCTV had been in use at the home which most people and visitors were unaware of which can compromise people’s privacy and dignity.

People did not always experience person centred care and information in care plans was limited in regards to people’s backgrounds and interests. This meant staff had limited information to assist them in providing care centred on the person’s individual needs. Some people told us they wanted more opportunities to go out of the home and to participate in activities that were of interest to them. People were able to maintain relationships and friendships with those important to them and visitors confirmed they were welcomed into the home. Where people had identified healthcare needs, some records did not support staff to help ensure they always addressed them effectively.

The provider carried out a series of recruitment checks to make sure staff were suitable to work at the home before they supported people at the home. People told us they felt safe living at Ashleigh House and said they could access staff when they needed and staff were caring and approachable. We saw enough staff were available to support people’s care needs.

Staff who administered medicines had completed the necessary training to do this safely. People told us they received their medicines as required but we found some practices associated with medicine management needed to be improved.

We had been notified of reportable accidents and incidents as required such as those related to safeguarding people from potential risks to their health and safety. However, this was with the exception of one incident where they had been a significant delay in reporting this to us.

Processes to manage risks related to people’s care had been implemented but people’s care plan records were not always sufficiently detailed to help ensure these were managed safely by staff. We could not be assured systems in place to manage risks were always followed due to records not being clear.

People were positive about the food provided and a daily choice was available. Staff knew about people’s nutritional needs and took advice from health professionals when required. Staff told us they arranged for people to see a doctor when they needed one and people’s healthcare records confirmed visits were undertaken.

Staff attended regular training so they had the knowledge and skills required to meet people’s needs. The registered manager held supervision meetings with staff to talk about their training and development needs and planned to commence annual appraisals to assess staff development and performance.

Staff had some understanding of the Mental Capacity Act and knew to ask for people’s consent before delivering care. However, records were not clear in determining if people had capacity or not when decisions about their care needed to be made. Whilst staff considered they worked in people’s best interests to support their needs, there were some restrictions placed on people which had not been sufficiently assessed, agreed or authorised. Deprivation of Liberty Safeguard applications were in progress for some people.

Staff had completed training in infection control and wore gloves and aprons when supporting people and carrying out their work to help prevent the spread of infection. Overall the home was clean but sometimes cleaning chemicals were not safely stored when is use.

The provider had implemented quality monitoring processes to assess the quality and safety of the service. The provider was regularly available at the home to support staff and carried out regular checks to make sure the home was running safely and effectively. Staff told us they felt supported by the registered manager and provider and were happy working at the home.

People told us they knew who to raise concerns with if they needed to. Where complaints had been received, these had been recorded, investigated and responded to and lessons had been learnt to help prevent them from happening again.

The inspection took place on 14 November 2016 and 20 December 2016. The visit was unannounced. Ashleigh House provides care and accommodation for up to 24 older people. At the time of our visit there were 17 people living in the home.

The home is required to have 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 and associated Regulations about how the service is run. There was a registered manager at the time of our previous inspection in September 2015, but they left the service in September 2016. There was a new manager in post that was not registered with us.

When we inspected the home in September 2015 people told us that some staff were not caring in their approach and people were not fully involved in decisions about their care. There were limited activities that met people’s needs and wishes. As a result, we rated the home as 'requires improvement'. At this inspection visit, we looked to see if the provider had taken action to address the issues we had identified. We found improvements had been made in relation to caring but they were ongoing in relation to responsive. In addition, this inspection found improvements were needed in regards to “safe” and “well led”.

At times there was no senior staff members available in the manager’s absence to ensure the ongoing safe and effective management of the home. This was because there was only one senior care staff member employed to cover shifts in the absence of the manager.

Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and fluid intake to help ensure their nutritional needs were met. However, records were not always clear to show instructions given by health professionals were followed.

Risks associated with people’s care and support needs were not always managed in a consistent way. This included risks associated with the use of specialist equipment, management of accidents and incidents and medicine management.

Accidents and incidents had not been reported to us consistently as required to ensure appropriate actions were taken to keep people safe. This included incidents of a safeguarding nature. Some policies and procedures had not been updated or made available to staff to ensure they were aware of their responsibilities.

Staff knew how to recognise potential abuse and understood their responsibilities to report this to the manager. However systems and processes to follow to refer abuse to the relevant external agencies, and ensure information was sufficiently recorded, were not clear for staff to follow in the absence of the manager.

Overall people received their medicines as prescribed but two medicines were identified to be used beyond the dates they should have been.

People told us they felt safe living at the home because they were treated well by staff. People said staff were respectful towards them and we saw caring interactions between staff and people. Staff members were mindful of protecting people’s privacy and dignity and people told us staff asked them before supporting them with personal care.

People said they had enough to eat and drink and there were meal choices provided each day.

The provider carried out a range of recruitment checks before staff started work to ensure staff employed were safe and suitable to work with people. There were sufficient numbers of staff employed to meet people’s basic care needs but some people had limited support in relation to pursuing their interests, hobbies and outside visits.

Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. Staff told they had supervision meetings with the manager to discuss any ongoing training needs. Further training was being sought in specialist areas such as dementia care.

Staff had received training in the Mental Capacity Act and had a basic understanding of the principles. The manager had submitted applications to the supervisory body (the local authority) where restrictions had been placed on people’s care amounting to a deprivation of their liberty.

Visitors were made to feel welcome at the home at any time to help people maintain relationships with people important to them. There was a relaxed atmosphere in the home for people but staff were busy throughout the day completing their duties.

Complaints received had been responded to, and people knew the staff to approach if they wished to make a complaint. However, the complaints procedure was not up-to-date to ensure people knew how to escalate their concerns further if they wished.

Each person had a care plan which contained information staff needed to meet people’s care needs. Most people said they were not involved in planning their care but the manager said processes were in place to involve people and ensure they received person centred care in accordance with their needs and preferences. People had access to some social activities to support their interests and work was ongoing to further improve these.

There were systems to monitor the quality of the service and drive improvement within the home. Satisfaction surveys had been completed by some people with mostly positive results.

People and staff told us the manager was approachable and staff were complementary of the support they received from the manager. The provider was available in the home on a regular basis and staff and the manager felt supported by the provider.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009.

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

In December 2013 we met with the provider to discuss what they planned to do to improve staffing arrangements and the service provided at Ashleigh House. We carried out our inspection on 14 February 2014 to check appropriate actions had been taken to train staff and make sure there were sufficient numbers of staff to respond to people's needs.

When we visited there were 11 people living in the home. We checked:

1) There were sufficient numbers of suitably trained staff to care for people.

2) People's care needs were being met and they had suitable care plans in place.

3) People lived in a safe and suitable environment.

4) Medicines were being managed appropriately.

5) The views of people and their representatives on the quality of the service were

being sought.

We spoke with six people, two visitors and five staff. We also met with the provider and manager to obtain further information about the service.

We found improvements had been made across areas where we had previously identified concerns. We found staffing arrangements were not always effective to support people's needs.

During our inspection on 22 July 2013 there were 11 people living in the home. We checked:

' There were sufficient numbers of suitably trained staff to care for people.

' People's care needs were being met and they had suitable care plans in place.

' People had access to sufficient hot water

' Medicines were being managed appropriately.

' The views of people and their representatives on the quality of the service were being sought.

We looked at the care and medicine records for six people to see how their care needs were being met. We also looked at how medicines were being stored and managed.

We found that improvements had been made across all areas where we had previously identified concerns.

We found there were some improvements needed in relation to staff training and monitoring the quality of service. This was due to plans in place having not been fully implemented.

To check compliance with a warning notice we had issued in relation to medicine management following our inspection on 4 March 2013.

To follow up on concerns we had identified during our inspection on 20 March 2013 in relation to people's care needs not being met.

To check actions were being taken in relation to concerns we had identified during our inspection on 20 March 2013 with the environment including the lack of hot water in some areas of the home.

There were 15 people living in the home at the time of our visits. We looked at three people's medicine administration records and three people's care records. We spoke with some people about their care and viewed bedrooms to check they were safe and had hot water.

We found there were some improvements in medicine management but there were still areas that had not been fully addressed. This meant the service was not compliant as they had not met the requirements of the warning notice.

There were continued concerns around the care of people. An agency nurse was supporting the service to make improvements. Further actions were required to ensure people's care needs were met effectively.

On the day of our visit there was a gas engineer at the home looking at the hot water problems. A lack of hot water remained a problem in some areas of the home.

On the day of our visit there were 16 people living in the home. Some of these people suffered with confusion and short term memory problems. To help us determine what it was like for people living in the home, we spend a period of time observing and speaking with people.

Those people who were able to speak with us had both positive and negative comments to make about the home. Comments included: 'I'm quite happy here'I've had a stroke and I'm limited to what I can do. The lady here is a diamond.' 'This place is a dump' everything is on the cheap here.'

We found that overall major improvements were needed to make sure people's needs were met safely and appropriately. We had already identified during a visit on 4 March 2013 that improvements were needed in relation to medicine management. A timescale of 29 March 2013 was given for improvements to be made. During this visit we found there had been some progress in carrying out the required improvements.

We found that improvements were needed to the environment to make sure people had sufficient hot water and were warm enough.

We had received a report about medicine management from a care home pharmacist from within the Coventry & Rugby Clinical Commissioning Group. This was following an unannounced visit they had undertaken on 14 February 2013. The report stated 'There is a high risk of significant patient harm associated with medication errors with the current methods used by Ashleigh House'.

When we visited we found people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicine management.

We saw that the care files of people living in the home had been reviewed so that they contained more personal information about people. Families had been approached to obtain people's background histories as well information on their hobbies and interests.

People had signed their plans of care to show that they agreed with the care planned. Where appropriate, people had been asked to consent to staff delivering care such as administering medication.

People were positive in their comments about the care they were receiving. They told us: 'I think it's very good. They look after me excellent.' 'They look after me well.'

We walked around the building and saw that improvements had been made to the areas we identified during our last visit. This included hot water temperatures operating at required levels and the removal of personal information from being on display in the dining room.

Each person had a care plan record but these contained minimal information about their daily living routines, interests and wishes. We did not see that there were any systems in place to determine people's capacity to give consent.

We saw records confirming that staff had completed the appropriate training to help deliver care to people safely. People that we spoke with about the staff told us: 'They are very kind and very nice.' 'Quite good on the whole. Some girls really help but others ignore you a bit.'

We observed there was a calm and relaxing atmosphere in the home. We asked people if social activities were provided. They told us: 'Not a lot, I am quite happy with sitting here I can see on the faces of some that they are not" (happy). 'Not that I know of, I can't imagine many of the people living here would be interested anyway.'

People told us they were satisfied with the food. They told us: 'On the whole it is quite good considering' Most days they give you a choice.' 'Very acceptable... I am always happy with it.'

We that saw some areas of the home had been recently refurbished but there were still some additional improvements needed.