Archived: Ascot Villa Care Home For Autism & LD

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.

During this inspection we found that the provider had met one legal requirement in relation to recruiting staff safely. However the three other legal requirements we told the provider to meet during our last inspection had not been met. These related to areas of safety of people, how person centred the service was and how well it was governed and managed.

Ascot Villa 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. Ascot Villa is a care home without nursing that can accommodate up to six people with learning disabilities and autism. At the time of our inspection four people were living at Ascot Villa.

We undertook this focussed inspection to check on progress that had been made since our last inspection in August 2017. At that time the service required improvement in three key areas and had been rated as inadequate in the key areas of Safe and Well Led.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

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. Ascot Villa did not have a registered manager in post when we inspected. The provider made an acting manager available to us throughout our inspection.

People and relatives said they felt the service was safe. Staff understood general risks to people's health and safety. However risks that were specific to individuals were not always known about by staff. Recording of these risks was not always evident, and in other cases had not been kept up to date. 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 understood their responsibility to raise concerns regarding potential abuse.

Staff did not all have the training they needed to undertake their roles safely and appropriately. Staff understood the need to ask for consent and we saw that they asked people before providing any care. People's nutritional needs were being met, and the provider had started to introduce more choice into the menu. People had access to health professionals when their health needs changed, however we were not confident that all healthcare needs were well met.

Medicines management had improved since our last inspection but there remained some areas of concern relating to medicines that were in boxes and an ineffective auditing process. Some areas of infection control were poor and related to damaged furniture and fittings within the home. Food hygiene had improved.

People had not been involved in planning or reviewing their care. People received care which was not always responsive to their individual needs. Improvements were required to ensure people's care records contained up to date and accurate information about the care they received. People and their relatives told us they felt comfortable raising complaints with the manager and they said they felt they would be listened to.

The governance system had not been implemented at the time of our inspection, and 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.

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.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During this inspection we found that provider remained in breach of three regulations.

You can see what action we told the provider to take at the back of the full version of the report.

We last inspected this service on 08 March 2017. At our inspection we found the provider was requiring improvement in all of the five key questions. We also found that the provider was in breach of the law in Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection we asked the provider to send us an action plan detailing what actions they would take to improve the service, which was returned to us in a timely manner. We also issued a warning notice for breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This notice tells the provider what actions they must comply with and by when. The date we told the provider they had to be compliant with this regulation was 26 May 2017.

This inspection was a comprehensive inspection which looked at all five key questions. At this inspection we found some small improvements had been made in some areas but the provider had failed to secure adequate improvements to improve the safety and quality of service provided to people. The provider was now failing to meet the requirements of the law in other areas and the governance system operated by the provider had not improved sufficiently which meant the terms of the warning notice had not been met. Breaches in regulation found at the last inspection had also failed to be complied with and a further breach of Regulation 9, in relation to person centred care was also identified.

The previous registered manager had left the home in December 2016 and at the time of our inspection a replacement had not been found. As a temporary measure an acting manager was in post and the provider told us they visited the home weekly. 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.

Staff did not always understand the risks to people’s health and safety and these were not always recorded in their care records. There was sufficient staff to meet people’s needs, but there was a large turnover of staff which put people at risk of inconsistent or unsafe care. The provider did not operate a safe recruitment system which meant people were at risk of receiving care from staff who were not suitable to provide care to them. Staff understood their responsibility to raise concerns regarding potential abuse.

People were supported by staff who had some training. Staff we spoke to told us they had received some training but staff did not have all the skills and knowledge they required to meet people’s specific care needs. Staff understood the need to ask for consent and we saw they sought consent before providing any care. The manager had applied the principles on the Mental Capacity Act 2005 (MCA) in relation to applying for deprivation of liberty safeguards, but had not ensured decisions about people’s care were always made in their best interests. People’s nutritional needs were being met. People had access to other health professionals when their health needs changed.

People had choices about their care and staff listened to them and respected their choice on a daily basis, but decisions and choices about their future care and support needs were not discussed with people. People were treated with dignity and respect by staff. Staff encouraged people’s independence where possible.

People received care which was not fully responsive to their individual needs but people had some choices about the care they received. Some improvements were required to ensure people’s care records contained up to date and accurate information about the care they received. People and their relatives told us they felt comfortable raising complaints with the manager, although none had been received.

The governance system in place was not effective as it did not highlight the areas where we found concerns during our inspection. Although people told us they were happy with the care they received, we could not be assured this was sustainable as there was no oversight of the service by the provider and there was no registered manager at the service. The provider had not taken effective action to improve the quality of the service since our last visit. Staff did not feel fully supported in their role.

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, 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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Ascot Villa is a care home without nursing for up to six people who have learning disabilities. At the time of the visit five people were using the service. Prior to our visit we had received notification that the registered manager had left the home some months earlier and that the provider was in the process of appointing a new registered manager. There was an acting manager in post at the time of the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found breaches in some of the regulations. There were no processes in place to effectively monitor and assess risks within the service and to drive improvements. We identified that the notifications of events and occurrences had not been made as required. People were not consistently supported by staff who had been robustly recruited. Individual risks to people in the event of an emergency had not been assessed to enable staff to know how to safely support people. You can see what action we told the provider to take at the back of the full version of the report.

People were comfortable and relaxed within the home. Staff understood safeguarding but had not had training to support their understanding. Not all staff knew how to keep people safe when their conditions changed. Not all incidents had been recorded or actions taken to keep people safe from them recurring. We could not be sure that people would be kept safe in the event of a fire within the home. People were supported by sufficient numbers of staff but they had not always been recruited safely.

Staff had received supervision and induction but there was no method of staff receiving the training they needed to deliver care well. People had their consent sought and some people were protected by the deprivation of liberty safeguards. The manager had not considered the needs of some people who may have needed to have their liberty safeguarded.

People had adequate amounts to eat and drink but the nutritional value of the food that was eaten had not always been considered. People were not always supported to maintain their health and well-being by the regular attendance to health appointments.

Staff at the home were kind and caring. They helped people maintain their privacy but we saw some examples of where staff did not always treat people with dignity. The ability of the home to promote people’s independence was not robust. People’s information was kept confidentially.

Staff knew what people liked and disliked, but people’s choices were not always respected. People had access to activities in the community and staff supported them to take part in activities of their choice.

The provider had not always notified us of certain events they were required to, such as safeguarding. Accidents and incidents were not well recorded or looked at for trends or patterns to assist in identification if changes needed to be made or if additional support for people was necessary.

Ascot Villa is registered with the Care Quality Commission to provide accommodation and care for up to six people who are living with mental health conditions, autism and learning disabilities. The home has a registered manager who was present throughout the inspection. 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.

We carried out an unannounced comprehensive inspection of this service on 8 March 2016. The registered provider had not ensured that adequate systems to monitor the safety and quality of the service were in place. They were in breach of Regulation 17 of the Health and Social Care Act (2008) Regulations 2014, good governance. After the comprehensive inspection, we met with the provider and they wrote to us to say what they would do to meet the legal requirements and to consistently provide a well led service. At this inspection we found that improvements had been made and that the home was no longer in breach of this regulation. Further improvements were still needed to ensure that compliance with the regulations would be maintained.

We carried out this unannounced inspection on 22 August 2016. We undertook the inspection to check if the provider had followed their plan and to confirm that they were now meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ascot Villa Care Home on our website at www.cqc.org.uk

The manager had become registered with the CQC since our last inspection. They were present during our inspection. 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.

We carried out our last inspection of Ascot Villa in March 2015. At that time we asked the provider to take action to make improvements to ensure as far as possible that people were safe and confident that the service well led. The provider returned an action plan to us stating that the improvements would be made by the end of September 2015. We found that some but not all of the improvements had happened.

During our inspection we found that many areas had improved and that the registered manager was considered to be very good by everyone we spoke with. People who live at the home looked well cared for and had food and drink they enjoyed. The home was comfortable, warm and clean. People had been supported to personalise their own rooms.

Risks people might experience had been identified and were being managed well. There were sufficient numbers of staff on duty. Staff had been subject to a thorough recruitment regime before employment commenced. Staff received appropriate induction, training and support to help them in their roles. People told us they liked the staff who supported them. People received their medication safely. People were supported to manage their own medicines where possible.

If it was considered that people were being deprived of their liberty, the correct authorisations had been applied for. However the provider had a limited understanding of the Mental Capacity Act. A process of asking people for their views about their home had just been introduced. There was no evidence of quality monitoring systems to review the service.

People had detailed care records in place which recorded how they should be cared for and the support they may require. The service had a complaints procedure and the registered manager was considered to be very approachable. There were a range of health professionals involved in supporting and reviewing people’s care. Other health professionals spoke highly of the management and staff.

We spoke with three people who used the service. Because of their complex needs not all the people who used the service were able to tell us their opinion of the care they received.

We observed and spoke with people about the care and support they had received to meet their different needs. We looked at a sample of care records and various management records. These records were used to review, monitor and record the quality of care and support that people received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

All the people who used the service told us that they felt safe living at Ascot Villa. They also told us the staff were kind and friendly towards them and provided the care and support they needed.

All the staff we spoke with were confident that people who used the service were safe at Ascot Villa. Staff also told us they would be happy to have a relative of theirs live at the home.

The majority of staff were newly appointed in post. The recruitment procedure carried out was not sufficiently robust to ensure that staff were suitable to work with vulnerable people.

There was no consistent system in place to make sure that improvements were made and that people were kept safe as a result. Improvement was needed in areas such as the management of accidents and ensuring that equipment was safe to be used.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoL's) which applies to care homes. We found that the manager had not considered whether an application under DoL's needed to be made as people were unable to leave without staff accessing door codes for them.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's safety.

Is the service effective?

People's health and care needs were assessed and we saw that people had signed their newly written care plan. However care plans were not always reflective of each individuals current care needs or were not fully completed. Care plans did not provide staff with the information they needed to consistently meet people's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing each person with an effective plan of care.

Is the service caring?

People we spoke with told us that staff treated them kindly and that their needs were met. We saw that staff interactions were supportive and respectful. Staff assisted people sensitively, whilst at the same time they promoted their independence as much as possible.

We found that people were able to make choices about their food and drink and how they spent the day.

Is the service responsive?

During this inspection the manager addressed some of our concerns and responded to our requests for information. This demonstrated that they were responsive to the areas of concern we raised during our inspection.

We saw that professional advice had been given about people's needs. This was not always suitably followed up. Staff were not always able to inform us how they had responded to situations which had occurred or taken place.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a responsive service.

Is the service well led?

The service had many new staff in place including senior members of staff. People who used the service felt well supported by the staff and the manager.

The provider did not have sufficient quality assurance systems in place. Those we saw did not provide evidence that shortfalls were always fully addressed.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing a service that effectively assesses and monitors the quality of service provision.

People were supported to prepare their own meals or to contribute to their preparation and encouraged to eat a healthy diet. Particular dietary needs were identified and addressed.

We found that although staff understood and had received some recent training in safeguarding people from the risk of abuse they were not supported by up to date policies and procedures. They were unsure how to respond to a safeguarding matter in the absence of the manager.

The design and layout of the premises were suitable for people who used it but systems for maintaining the safety of the building and the reliable operation of installations were not always effective. This issued had been raised with the provider on previous inspection visits.

People told us that they did not have any concerns about the staff that provided their care and support. Recruitment procedures were in place to check people's suitability to work in the service but there was no system to check that staff employed remained entitled to work in the UK. This meant that staff could be working illegally.

We visited the service again on 5 February 2013 to check and we found improvement. Legal requirements relating to the premises and necessary to keep people safe were complied with. There were effective systems in place for regular safety checks and to report, record, prioritise and action repairs and renewal of the premises and environment.

When we last inspected the service on 14 August 2012 we found that although people's care records were in good order people were not sufficiently protected against the risks of unsafe care arising from lack of proper information about the safe management of the service.

We visited the service again on 5 February 2013 to check and we found improvement. We saw that records were accurate and fit for purpose, kept securely and could be located promptly when we asked to see them.