Archived: Ashlee Lodge

Ashlee Lodge is a residential care home providing accommodation and personal care for up to five people. At the time of inspection, five people were living at the service. People living at Ashlee Lodge had learning disabilities and some associated physical and/or sensory disabilities. Some people had complex communication needs and required staff who knew them well to meet their needs.

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

Quality and governance systems had improved however they had not been fully established and embedded into everyday practice. The service was in the process of introducing a new electronic system for recording all records. This was a slow process so there were two systems operating at the same time. However, the registered manager was clear about the areas that still required reviewing and updating. Records in relation to some aspects of people’s mental capacity and demonstrating how people spent their day were not detailed. There were interim measures to support two people with activities outside of the home, but these were only one day a week.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. The home was clean and tidy throughout. Enhanced cleaning had been instigated as a result of the pandemic, staff had received additional training and the home had a visiting procedure that was thorough to ensure as far as possible people’s safety from the virus.

There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service. There were safe procedures to ensure people received their medicines as prescribed. Relatives and professionals spoke positively of the care provided by staff.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

¿ Two people displayed behaviours that made support in public difficult during the pandemic. There was a shortage of staff who could drive so this had a temporary restriction on the numbers and frequency of outings they could have. An interim arrangement had been made to try to address this and a new staff member had just been appointed. Staff spent time with people individually to assess their wishes in relation to decoration of communal areas and these were then voted on. The sensory room had been redecorated to ensure people had an additional area other than the lounge to spend quiet time away from others.

Right care:

¿ Care plans provided guidance to ensure staff could care for people in a way that suited their individual needs and wishes. Greater analysis of links between people’s health and behaviours had been introduced. Although still at an early stage, this had already helped staff to focus their support in meeting one person’s health needs appropriately which then resulted in a reduction in behaviours that challenged. We observed that staff were caring in their approach and people were very content in their surroundings.

Right culture:

¿ One person who used to spend a lot of time in their bedroom now chose to spend time in the lounge with others. Staff saw this as a sign that they were happy. Staff told us that the registered manager was approachable and easy to speak with and there were regular opportunities to share their views on the running of the home either in individual supervision or at staff meetings. A pictorial staff rota was displayed to show staff which staff were on duty each day and a pictorial menu board was being devised to enable people to have a greater say in food choices.

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 requires improvement (published 22 August 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe care and treatment and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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

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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. However, staff levels, on occasions, did not always support this. See below.

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

Staff rotas did not demonstrate there were always enough staff to meet people’s assessed needs. Whilst the service had referred potential safeguarding matters to the local authority, they had failed to send these to CQC. The quality assurance systems were not always effective and had not identified some of the shortfalls found at inspection. For example, in relation to some people’s health needs, complaint records, fire drills and staff recruitment.

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.

People’s medicines were managed safely. Staff attended regular training to update their knowledge and skills. They attended regular supervision meetings and told us they were very well supported by the registered manager. A staff member told us, “I’m definitely supported.”

People were supported to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People had enough to eat and drink and menus were varied and well balanced.

Staff were kind and caring in their approach. They had a good understanding of people as individuals, their needs and interests. Most people needed some support with communication and were not able to tell us their experiences; those who could told us they were happy, and we observed people were happy and relaxed with staff.

People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants and trips to places of interest. A relative told us “We are invited to parties twice a year, often barbeques and buffets. We all know each other, and it is lovely to meet up and chat.”

The environment was well maintained. A new shower had recently been fitted. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks on equipment were all up to date.

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 good, (published 7 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches of regulation in relation to staffing, reporting incidents and the governance of the service. The provider had failed to ensure there were always enough staff to meet people’s needs. The provider had failed to submit notifications and the provider had failed to ensure that systems to assess, monitor and improve the quality and safety of the service were sufficiently robust.

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 return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Ashlee Lodge is registered to provide care and support for up to five younger adults. People living at this service have a learning disability and may also have autism. The service does not provide nursing care. At the time of the inspection there were five people living at Ashlee lodge.

A registered manager was 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 2014 and associated Regulations about how the service is run. The registered manager was present throughout the inspection and was responsive to feedback and suggestions.

People’s needs were well met by staff who understood people’s needs, wishes and preferred routines. Staff had training and support to do their job effectively and safely.

People were protected because there were good recruitment practices whereby any potential new staff were fully checked to ensure they were suitable to work with vulnerable people. All staff received training in understanding about abuse and knew how and when they should report any concerns.

People were supported to take part in activities which were meaningful to them. This included trips out using a vehicle owned by the service, as well as activities within the house. The service was close to shops, cafes and the seafront so people could walk to local amenities.

People’s nutritional needs, likes and dislikes were taken into consideration when planning menus. People were offered a balanced diet to maintain good health. Mealtimes were relaxed and staff sat with people to make it a sociable event.

Care was well planned, with risk assessments in place to keep people safe and ensure care and support was being offered in the least restrictive way. Staff knew people well, understood their needs and what they enjoyed doing. This helped staff to provide a person centred approach and ensured individualised care.

People were supported to express their views in a variety of ways. Staff understood people’s ways of communicating and this helped to ensure people were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives, friends and relevant professionals were involved in best interest decision making. This ensured people’s rights were protected and the service consulted and worked with others to ensure the right care and support was being offered.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they live in a care home and do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. People's consent to care and treatment was sought. Where they were unable to provide informed consent the principles of the MCA and DoLS were followed, so people's legal rights were upheld.

There were sufficient staff with the right skills and support to enable them to provide safe, effective and responsive care and support to people. Staff received training in all areas of health and safety as well as more specialised areas around people’s needs and health conditions. Staffing levels were flexible to meet people’s changing needs and wishes.

Medicines were appropriately managed and monitored. Where minor errors had been made, these had been picked up quickly via audits. Staff received training to ensure their competencies were kept up to date in medicine management.

Well managed systems were in place to ensure the quality of care and support were continually reviewed and monitored. Where improvements were needed, prompt action was taken to drive up improvements.

Relatives of people living at the home were complimentary about the care and support they received. One had written, "There has been an incredible positive change in my daughter in her short time here," and "A home from home." Another stated that their relative was, "Always happy to go back there after a visit."

Professionals working in partnership with the home to provide support for the people living there had commented, "Our client has been very successful since living at Ashlee Lodge," and "The staff are always friendly and courteous." A visiting chiropodist stated, "I love coming here."

There were proper recruitment and training systems in place to ensure that people were kept safe and cared for by suitably qualified and experienced staff.

The premises were homely, safe and met the needs of people who used the service. People were enabled to be involved in making decisions about their care and treatment. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare.

There was an effective complaints system available but there had been no complaints received by the home since our last inspection.