Background to this inspection
Updated
30 April 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak and to identify good practice we can share with other services.
Inspection team
Two inspectors visited the service on two separate occasions. An Expert by Experience supported this inspection by carrying out telephone calls to relatives for their feedback about the service. An Expert by Experience is a person who has personal experience of using or caring for someone who used this type of service.
Service and service type
Eight Ash Court 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Inspection activity started on 11th February 2022 and ended on 14th February 2022.
What we did before the inspection
We reviewed information about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.
During the inspection
We spoke with two people who used the service and nine relatives about their experience of the care provided. We spoke with nine members of staff including the registered manager and the deputy manager.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data. We spoke with other professionals who have regularly visited the service.
Updated
30 April 2022
About the service
Eight Ash Court Limited is a residential care home set across two bungalows. It provides accommodation and personal care for up to 12 people, including those living with a physical disability, learning disability and/or autistic people. At the time of the inspection there were 11 people living at Eight Ash Court.
People’s experience of using this service and what we found
Infection prevention and control (IPC) measures at the service required improvement, and up-to-date government guidance on the management of COVID-19 was not being adhered to in practice. This placed people at risk of infections. Risks to people’s safety were not assessed and mitigated effectively, and we identified shortfalls and gaps in medicine records. There were not always sufficient numbers of competent staff deployed to ensure the service was safe. Lessons had not been learned following the last inspection or input from other professionals.
The service was not well-managed, and quality assurance, monitoring and oversight systems were either poor or not in place. We found significant shortfalls identifying the provider had not met the objectives and requirements since our last inspection and was not compliant with the Warning Notices issued. We were concerned about indicators of a closed culture, including in relation to the reporting of safeguarding concerns.
It was not demonstrated people had consistently good outcomes, or they were always consulted and engaged with to ensure person-centred care.
People had very few meaningful activities on a day to day basis. Other professionals reported concerns the management team did not respond adequately or in a timely way.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We received some positive feedback from relatives that staff were kind and caring, however the care was not always attentive, and staff did not have time to spend with people.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about service supporting people with a learning disability and autistic people and providers must have regard to it.
The service could not show how they met the principles of Right support, right care, right culture,
Right Support:
¿ The service was made up of two detached bungalows which could accommodate six people in each one.
¿ People had their own rooms which had been personalised.
¿ Information in peoples care plans was out of date and therefore did not reflect their current needs.
¿ People were not always actively supported in maintain their own health and wellbeing. Health plans were either not in place or lacked detailed information.
Right Care:
¿ The service did not have enough appropriately skilled staff to meet people's needs.
¿ People were not always sufficiently protected from the risk of harm. Although staff had completed safeguarding training they had not always recognised or reported poor care.
¿ People did not always receive good quality care, because staff training had not been embedded in practice.
Right Culture:
¿ People were not always involved in planning their care. Care plans were not person centred.
¿ The registered manager did not have robust systems in place to monitor the quality of the service and people's care documentation did not reflect their current health or care needs.
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 inadequate (published 19 August 2021).
At this inspection enough improvement had either not been made or sustained and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to safeguarding, risk management, staffing levels and infection control. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
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.
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 overall rating for the service has remained inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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.
Enforcement
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 to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to the management of the service, staffing levels, identifying and reporting safeguarding, infection control, risk management and person centred care. The provider had also failed to notify the Commission of incidents as required by law, including abuse or allegations of abuse.
Follow up
The overall rating of this service is inadequate and the service remains in 'special measures' as one of the key questions remains inadequate.
This means we will keep the service under review. Since this inspection the provider has put a notification into the commission to cancel their registration. We will continue monitor the service until this process is complete.