Archived: Ashstone House

Updated 19 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 28 and 29 September 2017 and was unannounced. The inspection was conducted by one inspector. Before our inspection we reviewed information we held about the service, including previous inspection reports and notifications. A notification is information about important events which the service is required to tell us about by law.

We reviewed the Provider Information Return (PIR) and used this information when planning and undertaking the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

Before the inspection we asked for feedback from four healthcare professionals but did not receive any responses. During the inspection we spoke with five people, five staff members, the cook, the cleaner, the activities person, the deputy manager and the registered manager. Not all people were able to express their views clearly due to their limited verbal communication so we observed interactions between staff and people.

We looked at a variety of documents including five peoples support plans, risk assessments, activity plans, daily records of care and support, incident reports, three staff recruitment files, training records, medicine administration records, and quality assurance information.

Updated 19 December 2017

This inspection took place on the 28 and 29 September 2017 and was unannounced. Ashstone House provides accommodation and support for up to 12 people who may have a learning disability. At the time of the inspection seven people were living at the service. All people had access to communal lounge areas, a dining area, kitchen, shared bathrooms and a large well maintained garden.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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 registered manager was present throughout the inspection.

The previous inspection on 6 and 7 June 2016 found eight breaches of our regulations, an overall rating of requires improvement was given at that inspection.

At the last inspection the provider had not ensured people were protected from abuse. Numerous incidents had gone unreported and people left at risk of repeating incidents. People were at risk of receiving their medicine inappropriately because staff did not have up to date and clear information to refer to. Emergency evacuation plans had not been reviewed and some were not in place where needed. Sufficient staff were not deployed to meet the needs of people when required. Recruitment processes to protect people was not robust. The provider had failed to comply with the requirements of the Mental Capacity Act 2005. Staff had not received regular supervision and the provider was unable to provide us with clear information of training staff had received. The culture of the service did not always promote people’s dignity, freedom and choice. Staff did not have clear guidelines about people's current needs or how to support them in the best possible way. Although people had access to activities away from the service, this was dependent on the availability of staff and drivers on shift. Records were incomplete, conflicting and had not been kept up to date. The provider had not ensured suitable systems identified, monitored and addressed shortfalls requiring improvement. The provider had taken some action to resolve the issues raised at the previous inspection but other concerns remained and we found new areas of concern.

When risk had been identified robust assessments had not been implemented to reduce the likelihood of incidents repeating. Staff did not always have sufficient guidance to respond to risk well.

Although there were enough staff to meet people’s immediate needs within the service staff said taking people out could be restricted because of the availability of drivers and the location of the service. The provider did not follow a robust recruitment process which did not protect people using the service.

Some areas of the home suffered from wear and tear and were in need of a deep clean.

A person’s guidance around how their meals should be prepared and what food they should avoid due to problems with eating were not clear. Staff were not sure what food should be avoided and the person had been given food items previously identified as being a risk.

Some capacity assessments and a best interest process had not been followed when people lacked capacity to make simple decisions.

Some essential training had not been completed by all staff. Staff had not received training in how to respond to incidents of choking although a person had been identified as being at risk of this.

The provider’s auditing systems had not identified the shortfall in how risk had been managed. Shortfalls in recruitment processes had not been identified.

There were safe processes for storing, administering and returning medicines.

Since the last inspection more robust processes for monitoring safeguarding concerns had been implemented. Safety checks had been made regularly on equipment and the environment.

Staff confirmed they had supervision and the management were always available for support. New staff completed an environmental induction and mandatory training.

People were supported to eat and drink and had choice around their meals.

Regular monitoring and review of people’s health took place so action could be taken if further professional healthcare input was required.

Staff spoke and wrote about people in a respectful and dignified way. People and staff had a good rapport and people seemed relaxed in their home. People's bedrooms were decorated in a personal way.

Care plans were meaningful and contained specific detail so staff could understand people better. People chose to participate in a variety of recreational activities.

Complaints were recorded and responded to effectively. There were systems in place outlining timescales of the complaints process and details of what actions the complainant should expect throughout the investigation process.

The registered manager and provider conducted regular internal audits to ensure the service provided safe care and treatment for people. People’s feedback was sought so improvements to the service could be made.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.