Background to this inspection
Updated
15 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 12 and 15 March 2018 and was unannounced. The inspection team comprised of two inspectors and one specialist advisor. The specialist advisor had specialist skills relating to learning disability and autism.
On this occasion, we had not asked the provider to send us a provider information return (PIR). A PIR is a form that asks the provider to give some key information about the service. This includes what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt was relevant.
We checked the information we held about the service and the provider. This included notifications that the provider had sent to us about incidents at the service and information we had received from the public. We also received feedback from the local authority who commission the care. We used this information to formulate our inspection plan.
We observed staff interacting with people within the home but people did not want to talk with us. We spoke with two relatives and one health professional. We spoke with five members of staff, the acting manager, the manager who was applying to be the registered manager and the provider.
We looked at the care records of four people and pathway tracked three people. Pathway tracking is a way of seeing if services and care are delivered well. We looked at the recruitment records of four staff, and asked to see other information such as complaints records, and information relating to accidents and food. We also asked to look at records that related to the management of the service.
After the inspection, the provider sent us some of the information we had requested during the inspection. We received details of staff training. However, we did not receive information we had requested in relation to audits.
Updated
15 February 2019
We undertook this unannounced inspection of Ascot Villa Care Home on 12 and 15 March 2018. At our previous inspection undertaken on 9 and 10 November 2017 the provider was found to be in breach of Regulations 9, 12, 17. At the inspection on 9 and 10 November 2017 the provider had not met the conditions of a Warning Notice in relation to Good Governance that we had served on them previously. Following the inspection on 9 and 10 November we asked the provider to complete an action plan to show us what they would do, and by when, to improve the quality and safety of service people received to at least good. This action plan was received by us within the requested time frame. At this inspection, we found that the actions in the plan had not been completed and the provider had failed to make sufficient and timely improvements to the quality and safety of the service. This meant people continued to receive and inadequate service
During this inspection, we found that the provider remained in breach of Regulations, 9, 12 and 17 and further breaches in Regulations 11, 16 and 18 have been identified. The Warning Notice remains unmet.
Ascot Villa 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. Ascot Villa accommodates up to six people in one building. At the time of our inspection there were four people living at Ascot Villa.
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. At the time of our inspection there was no Registered manager in post at Ascot Villa.
Systems to safeguard people were not adequate to keep people safe. Risk assessments had not been completed well or reviewed when needed. Staff had a limited understanding of the risks to people's health and safety. Risks that were specific to individuals were not always known about by staff. Not all staff understood their responsibility to raise concerns regarding potential abuse. Medicines were mostly managed well but when people needed ‘as required’ or homely medication, we could not be sure these were given to people safely.
There were sufficient staff to meet people's needs. The provider operated a safe recruitment system, which meant people were supported by suitable staff.
Staff did not all have the training they needed to undertake their roles safely or well. The processes of gaining meaningful consent to care were not robust as there was no effective process of ensuring decisions were made in the best interests of people. People’s communication needs were not being met. People had a choice of food given to them on the day but were not meaningfully involved in planning their menus. Ascot Villa did not work well with other organisations to ensure continuity of care. People had some access to health professionals when their health needs changed, however we were not confident that all healthcare needs were well met.
People’s communication needs were not met at Ascot Villa. People were not communicated with well, and their opinions and views were not sought in the most appropriate way to enable them to join in and make decisions as much as possible. People did not have their independence promoted and staff and management did not have an understanding of how to do this in line with guidance such as Registering the Right Support. This CQC policy states that care services should have been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People’s privacy and dignity were upheld and we saw that staff were caring and kind when they were with people. We saw staff respond to people in a timely way, responding kindly if they were in discomfort or distress.
The care at Ascot Villa was not personalised and staff focused on completing tasks with people. People were not actively involved in making decisions about their home and lives on a regular basis, and their preferences and were therefore not properly respected. There was no method of making sure that people contributed to their care plans or reviews. Communication with people was not in line with Accessible Information Standards and therefore Ascot Villa did not include them as much as possible in decisions about them. Some people may have experienced unnecessary isolation, as people’s opportunities to participate in activities were limited. Care records included some information that was personal to people, but important information was omitted and in some cases incorrect. Records were not always available for staff to refer to when needed.
There was no clear process for people or their relatives to use to make complaints. The home had a policy but it was not known about or used. Relatives told us they had spoken to staff in the past when there was a problem but they were not always listened to. There was evidence of how complaints had been dealt with in the past.
Governance and oversight of Ascot Villa had not improved since our last inspection. The governance system that had been outlined in the action plan had not been implemented at the time of our inspection. There had been no improvement of quality or actions taken by the provider to mitigate risks. There were very few audits of the service and those that did take place were not effective.
People were treated with dignity and respect, but they were not actively involved in making decisions about their day-to-day care. People had little choice or control in their lives and their care was not individual to them. They had limited involvement with the planning and review of their support, and people's opportunities to participate in activities were limited. Care records included some information that was personal to people, but important information was omitted. Records were not always available for staff to refer to when needed.
The provider did not manage the service to ensure that people received high quality care. The audits that were in place were ineffective and the overall culture was not empowering to the people who lived there. People and staff were not encouraged to contribute to the development of the service. A positive open culture was not seen to be promoted and we were not assured that the provider understood their responsibilities as a registered person. The provider was not up to date with current practices or national guidance and they told us that they employed staff to meet the regulation and operate the service.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
You can see what action we told the provider to take at the back of the full version of the 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.