Archived: Ashstone House

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.

The Care Quality Commission requires a registered manager be 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. The registered manager had been de-registered from the service in April 2016. The provider had appointed a manager to manage the service; they had taken up post on 09 May 2016. They had submitted an application to register with the Care Quality Commission (CQC) at the time of our inspection. The new manager was present throughout the inspection.

People were not protected from abuse. Safeguarding incidents had not been reported following the provider’s own policy or to meet the safeguarding legal requirements of the local authority.

There were enough staff to meet people’s immediate needs but staff numbers were not always sufficient to be flexible to the needs of people leaving the service to pursue outside interests.

Safety checks had not identified the risks of a fire door being propped open or the lapsed fire alarm checks. Emergency evacuation plans had not been reviewed for six years and some were not in place where needed. The provider had not done everything reasonably practical to reduce the risk of harm to people.

People were put at risk of receiving their medicine inappropriately because staff did not have up to date and clear information to refer to.

The provider had failed to comply with the requirements of the Mental Capacity Act 2005. The provider had not notified the Commission when standard Deprivation of Liberty Safeguards (DoLS) authorisations had been made; this is a requirement of the Commission’s registration regulations.

Although formal supervision of staff had lapsed staff said they felt supported and able to approach the new manager if they needed help and guidance. The new manager had identified this is an area which needed to improve.

Training records were insufficient to demonstrate the provider was providing staff with the necessary training to support people with their individual needs. However, staff could demonstrate they had the necessary skills and knowledge to support people safely. Staff benefited from a thorough induction process to prepare them for their role.

Although people knew how to complain and raise concerns the complaints procedure was not displayed and could not be located within the service.

Some documentation was out of date and had not been reviewed for a long period of time. This meant people were at risk of receiving inappropriate care and support. This was recognised by the new manager who had started to make improvements to some of the documentation.

Although maintenance planning processes were in place, the pace of repair did not always keep up with the rate of wear. Shortfalls in the maintenance of the service did not promote a well maintained environment.

The culture of the service was not wholly person centred and some of the language and behaviour staff displayed did not promote dignity and respect towards people.

Staff were positive about the direction of the service and the appointment of the new manager.

Safeguarding incidents had not been identified or reported following the agreed processes. Areas of practice which placed people at risk had not been acted on to improve.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

Staff demonstrated caring attitudes and were patient and respectful when communicating with people.

We found a number of 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.

From looking at care records, speaking with staff and people living at Ashstone House we could see that people's consent was sought. Where consent was not given, then care was not completed but this was recorded. People's care and welfare was given a high priority and care records were completed well and with good amounts of detail. Each care records was individual. Medication was stored and administered within guidelines and the policy relating to medication was up to date and comprehensive. Staff were supported in their job role and had training which was sufficient to provide them with knowledge to complete their work. Staff were positive about the manager and felt that the manager supported them well.

People said they thought there were enough staff to meet their needs. We saw that staff knew how to support people and understood what was important to each person. People were treated with respect and were given the opportunity to control their own lives and make decisions about things. We saw that staff listened to people and respected their views.

The provider made regular checks of the service to ensure that people were safe and getting the care they needed. People were asked for their views of their care at regular intervals and were involved in the running of the service.