Ashley House - Langport

Ashley House- Langport is a residential care home providing personal care to up to 25 people. The service provides support to people aged 65 and over. At the time of our inspection there were 19 people using the service.

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

Since the last inspection there had been changes in the management team and the service had a new registered manager, operations manager and nominated individual. New systems and processes had been introduced to monitor the service; however the new processes were still not fully effective in identifying and addressing shortfalls in a timely way. These new systems also required embedding into practice and sustained to continue to drive improvements.

Some individual risks to people were not always thoroughly assessed and mitigated, and records relating to people's care were not always complete. Although staff in general knew how to support people safely, they did not always have appropriate training and detailed guidance to ensure people received safe care at all times. The registered manager was responsive to our feedback and took action to address the issues identified.

People were supported by a sufficient number of staff who were recruited safely. Staff told us the atmosphere and communication in the home had improved. Staff felt supported by the registered manager and told us they were approachable and felt 'things had improved' at Ashley House.

Throughout the inspection we observed staff interacting with people in a caring and considerate way. People we spoke with were complimentary about the care and support they received. Relatives spoke positively about the current management of the home and changes that are being made.

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 told us they felt safe. Staff spoken with understood how to protect people from poor care and abuse. Action to rectify the concerns identified at the last inspection in relation to the safety of the environment were being addressed.

Medicines were stored and administered safely, and protocols were in place for the administration of 'as required' medicines.

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 5 October 2022) with breaches of regulations identified. At this inspection we found the provider remained in breach of regulations and the service remains rated requires improvement. We took into consideration the limited length of time and changes in management team since the last inspection and the provider's response.

Why we inspected

We carried out an unannounced focused inspection of this service on 11 and 12 August 2022 which was prompted in part by a specific incident. This incident is still subject to an ongoing police investigation and further investigation by CQC as to whether any regulatory action should be taken.

The inspection on 11 and 12 August 2022 identified breaches of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve consent, safety, staffing and 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, Effective and Well-led which contain those requirements. 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 remained requires improvement. 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.

Enforcement

We have identified continued breaches in relation to staffing and good governance at this inspection.

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 llocal authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect

Ashley House- Langport is a residential care home providing personal care to up to 25 people. The service provides support to people aged 65 and over. At the time of our inspection there were 15 people using the service.

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

People lived in a home where the providers system was not always effective to identify and address concerns and shortfalls in the service. During the inspection we identified issues relating to people’s health and safety and fire safety. The provider had produced a service improvement plan which was completed prior to our inspection. However, some of the issues we identified were not detailed within this plan.

A number of audits took place to ensure the quality of the service was maintained. However, these were not always robust and had not always identified where improvements were needed. The lack of governance measures in place and poor management oversight meant people were at risk of receiving care which placed them at risk of harm.

People’s rights were not protected because staff had not always acted in accordance with the Mental Capacity Act 2005 (MCA). The system in place for the oversight of the Deprivation of Liberty Safeguards (DoLS) needed improvement so applications to renew legal authority for any restrictions in place, were made in a timely way.

Not all staff had received training to equip them to support people, to understand their individual needs and mitigate associated risks.

We were not assured that all incidents which could constitute a safeguarding alert or concern were being identified or investigated by the registered manager. We made a recommendation that the provider researches current best practice guidance and liaises with the local authority to ensure they are identifying, investigating and referring safeguarding concerns appropriately.

Medicines were managed safely. The provider's staff recruitment procedures helped to protect people from harm. Practices relating to infection control were safe.

We observed kind, compassionate and caring interactions between people and staff. People looked comfortable and relaxed with staff who supported them. People and relatives spoke positively about the care provided.

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 15 April 2020).

Why we inspected

The inspection was prompted in part by a specific incident, following which a person using the service died. This incident is subject to a police investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of safety. This inspection examined those risks. 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.

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.

Enforcement and Recommendations

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 risk management, consent, staffing and the management 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety, and require regular updates regarding this. 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.

We found the following examples of good practice.

There were systems in place to support relatives and friends to visit people in their own room. Temperature and general health checks as well as lateral flow tests were undertaken to help ensure visitors were free from COVID 19. This helped to ensure people were guarded against the risks of infection.

Staff and people living at the service were routinely being tested for COVID 19 in line with national guidance.

The service had erected a wooden gazebo which helped to provide an outdoor space for people to meet visitors during clement weather.

Staff had been supported to work safely by turning one bedroom into an office space. This allowed staff to socially distance.

There were weekly multi-professional meetings held via social networking with professionals. This helped to ensure staff had good access to timely specialist advice and support, particularly if they had concerns about people’s health and well-being.

This inspection took place on 19 February 2020 and was unannounced.

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

People living at the service, and their relatives, shared positive comments and experiences of the service with us. They told us the service was safe and staff were kind and caring. One person commented, “Staff are good”. Staff engaged with people with kindness and compassion.

Most environmental risks had been managed. The provider was aware that seven hot water taps in people’s rooms exceeded 44 degrees. Warning signs to advise people of the risk of hot water had been put up and individual risk assessments had been completed. We identified two outlets where people were at possible risk of scalding. Action was taken during the inspection to have thermostatic water valves fitted to ensure the water was at a safe temperature. We also discussed two radiators which were not protected to reduce the risk of burns to people. The provider had risk assessed these but made the decision to switch these radiators off.

Fire safety overall was well managed. Regular fire checks were carried out and people had an individual risk assessment for evacuation in the event of a fire, which was regularly reviewed. We raised with the management team about two routes of escape from the conservatory, one with worn paint on steps highlighting the steps and bushes overhanging the second. Action was taken to address these.

Recruitment folders at the home did not contain all the information required. We received assurances from the provider’s operations manager that they had comprehensive recruitment processes and checks were undertaken at the provider’s head office but had not been filed. People and staff felt there were enough staff to meet people's needs.

Medicines were safely managed. Where there were issues these had been identified through audits and actions were being taken. People were protected from abuse because staff understood their safeguarding responsibilities. The provider's audits had identified a few gaps in staff receiving safeguarding training which were being addressed.

The home was clean throughout. Staff had access to protective equipment to protect people from the risk of infections.

In September 2019, a new nominated individual began working for the provider. Their role includes Director of Operations; they have a team of four staff with their own quality assurance responsibilities. Arrangements were in place to monitor the quality and safety of the service. Regular audits were completed and where areas for improvement were identified action were taken. However not all of the concerns we found at the inspection had been identified by the provider’s audits.

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

Why we inspected

The inspection was prompted due to concerns over the provider's governance of their services and whether we could be assured people were receiving safe care. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. We found the service was being managed well, however, we identified a few areas which placed people at risk from unsafe care. We raised these concerns with the provider, and they took action to address the concerns.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The last rating for this service was Good (published May 2018).

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashley House- Langport on our website at www.cqc.org.uk.

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.

Ashley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashley House does not provide nursing care.

Ashley House is registered to provide personal care and accommodation to up to 25 older people. Accommodation is provided in a converted residential dwelling over two floors. At the time of our inspection, 17 people were using the service.

At our last inspection in February 2016, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

People told us they felt safe living in the home. A relative told us, “No worries here, when I go home I don’t have to worry I know [the person] is safe.”

Medicines were managed safely, securely stored, correctly recorded, and only administered by staff that were trained and assessed as competent to give medicines.

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse.

There was sufficient staff to safely meet the needs of people living in the home. People told us they thought there was plenty of staff. One person said, “At night if I ring the bell they come to me straight away.”

People received effective care from staff who understood their needs. Staff were able to tell us about people’s specific likes and dislikes. People told us they thought staff were well trained and understood them well.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food and menus were regularly discussed and recorded at resident meetings.

All staff attended induction training before they started to work in the home. All staff spoken with said they had plenty of opportunities for training.

People could enjoy a full programme of activities and staff had built up links with the local community to ensure people could stay in touch with organisations such as their place of worship the local school and toddler group. The home was also a member of the Langport Dementia Alliance Group and were planning further initiatives for the year which included a, “Monday meander" (a walk around the local area), a dementia café and singing for the mind.

People said they received care and support from caring and kind staff. Comments included, “The staff are all very caring, They listen to you it’s like a home from home.” And, “They are all very nice and care comes with a smile.”

People received care that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives.

People told us they could talk with staff and the registered manager if they wished to raise a concern. One relative said, “The manager is always available, her door is always open and if I want to raise any concerns she listens.”

People were supported at the end of their life to have a comfortable pain free death. Care plans showed people’s advance decisions were taken into consideration and acted upon.

There were formal and informal quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care.

Ashley House (Langport) is registered to provide care and accommodation for up to 25 people. The home specialises in the care of older people.

The last inspection of the home was carried out in November 2013. No concerns were identified with the care being provided to people at that inspection.

There is 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.

People living at Ashley House (Langport) told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “I told my daughter what I wanted and expected and she visited several places and said this home was ideal. I can’t argue with that, however I did have the choice if I was not happy to find somewhere else, so as I am still here I must be happy.” Another person said, “I am very happy here. It is the place I chose and I can choose what I do daily.”

Everybody told us they felt safe living in the home, one person said, “I have always felt safe right from day one.” Whilst another person said they felt very safe when being cared for by the staff. Everybody was relaxed with staff and there was a friendly, cheerful atmosphere in the home.

Before the inspection we received concerns that staffing levels at night were low in the home which may have an impact on the safety of people. The registered manager confirmed there was one waking and one sleeping member of staff at night. They explained they monitored people’s care needs and if an extra staff member was needed more regularly, they were able to have two waking staff at night. They also confirmed a senior member of staff was available on call at all times.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during the day. One person said, “They all seem to care for you as an individual and take the time to sit down and have a chat.” Another person said, “[The registered manager] is so nice she came and sat on my bed and we talked about how I felt and if there was anything she could do to help.” A staff member said they felt they had plenty of time to do their tasks and chat with people through the day. The manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, for example they were receiving training in dementia awareness and end of life care to help support the increasing number of people referred to the home with more complex needs. They understood people’s needs and were able to explain to us how they would care for each person on a daily basis. One staff member said, “We are a small home so we know people very well. We also have handovers when we discuss specific changes and needs. Then the care plans are very informative.”

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included the person’s written consent to care. Staff had comprehensive information and guidance in care plans to deliver consistent care the way people preferred.

The registered manager had a clear philosophy for the home. The statement of purpose said their aim was to, “Create a relaxed and happy atmosphere for people who value their privacy and independence yet appreciate the benefits of companionship.” We saw in care plans this philosophy was followed. One care plan said, “I like company and to be as independent as possible.” Staff also said their aim was to ensure people were relaxed, happy and could be as independent as possible. This was observed throughout the inspection.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns, and people who lived at the home said they would be comfortable to discuss any worries or concerns with the manager.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

The service had a complaints policy and procedure which was available for people and visitors to view on the noticeboard. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

Without exception, everyone we spoke with was very positive about the care and support they received. Comments included 'I've lived here for eight years and I honestly can't think of anything they could do better', 'I feel so very lucky to be here. It's perfect in every way' and 'the staff will do anything for you." One person told us 'It's just like being part of a family. Every single member of staff, it doesn't matter whether it is first thing in the morning or in the middle of the night, greets you with a smile and a kind word.'

People felt safe and staff spoken with were aware of issues of abuse and knew how to report any worries or concerns. They said they felt confident that any reports would be fully investigated to ensure that people were protected.

The home's health and safety procedures minimised risks to the people who lived at the home. We saw that people had been provided with equipment in line with their assessed needs.

People using the service were provided with opportunities to express a view on the quality of the service they received. Quality assurance procedures helped to reduce risks to people who lived at the home.

The people we spoke with were positive about the care and support they received. Comments included 'I am very satisfied with everything and I can't fault the staff' and 'I haven't been here long but it feels like a very happy and homely place. All the staff are so very kind.' The visitors we spoke with told us 'we can't fault anything. The care is excellent and the staff are angels.'

The home ensured that people received their prescribed medicines in a safe way.

Staff recruitment procedures minimised any risks to the people who used the service.

The people we spoke with told us that they would feel confident in discussing any concerns if they had any. They said 'I don't have any worries at all but if I did I would certainly tell the staff or manager' and 'I am very happy with everything. If I wasn't, I know that they would sort things out.'