Archived: Eight Ash Court Limited

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.

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 12 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 were poor, 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 sufficient numbers of competent staff deployed at all times to ensure the service was safe, particularly at night. Lessons had not been learned following recommendations made at the last inspection, or from the input of other professionals.

The service was not well-managed, and quality assurance, monitoring and oversight systems were either poor or not in place. 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. 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 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.

Based on our review of safe and well-led. The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care did not maximise people’s choice, control and independence.

• People were not supported to participate in meaningful activities personalised to their interests.

• Staff lacked training in how to support autistic people and people with a learning disability. Despite this being identified at the previous inspection, improvements on providing staff training had not been made.

Right care:

• The care people received was not always person-centred and did not always promote people’s dignity, privacy and human rights.

• Effective systems were not in place to identify, report and take effective action to safeguard people from abuse.

• People were not always supported in a clean and hygiene environment, which ensured their dignity.

Right culture:

• The service was not ensuring Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• There was a lack of leadership oversight and knowledge to support autistic people and people with learning disabilities to promote a positive culture.

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 requires improvement (published 25 October 2019).

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 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 changed from requires improvement to 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 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, and risk management at this inspection. The provider had also failed to notify the Commission of incidents as required by law, including abuse or allegations of abuse.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Eight Ash Court Limited is a residential care home providing personal care for 12 people who have a learning disability. Some people also had a physical disability.

The service consists of two bungalows, each providing domestic style accommodation for up to six people. There was no identifying signage outside the premises or on the service’s mini buses to identify it as a care home. This was in keeping with the design 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 as part of the community and achieve the best possible outcomes.

The principles of Registering the Right Support also reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. This required further development. People had been living in the service for a long time and staff knew them and their families very well. However, the positive feedback the service received from relatives had led to the provider not exploring new initiatives in learning disabilities and/or autism, and seeing how it could be used to consistently support good outcomes for people and promote a better quality of life.

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

The service didn’t always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, people were not always supported to participate in meaningful activities and decisions made in people’s best interests had not been fully assessed and documented.

The system to identify and mitigate potential risks were not robust enough to ensure people were always safe. We have made a recommendation for improvement in this area. Appropriate reports to safeguarding professionals had not been made by staff and staff were not able to tell us about how safeguarding concerns should be reported, without prompting. There is currently an investigation being undertaken relating to this and we have recommended the service improve in ensuring safeguarding processes are embedded into practice.

Relatives told us people were supported in a safe, clean environment. However, improvements were needed to ensure infection control processes were always sufficient to ensure people were safe. We have made a recommendation to improve in this area.

Improvements were needed to ensure all management and staff were receiving training to keep their knowledge and skills updated to support them in carrying out their role effectively.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; there were policies and systems in the service supported good practice but this had not always been followed.

People’s privacy and dignity was not always respected. We have made a recommendation that the service improve in this area.

People’s care needs were assessed and planned for. However, they were not always kept up to date to ensure people received a consistent service. We have made recommendations that the service improve in the systems to support people with their oral care and ensure people’s end of life decisions are sought and documented.

The provider’s systems for assessing and monitoring the service were not robust enough to promptly identify shortfalls and address them. We have recommended that the service use the provider’s resources effectively to improve in this area.

Despite the shortfalls we had identified in the service, people and their relatives told us they were happy with the care being provided. One relative said they had recommended the service to others.

The systems for managing medicines was safe. There were enough staff to provide care and support when needed. The processes for recruiting staff was safe.

People were supported to access health care professionals when needed. People’s dietary needs were assessed and met.

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 1 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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

There is a Registered Manager at this location. 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.

In some people’s records, we found that accidents and incidents had not been consistently recorded. When accidents occurred, the provider did not use this as a learning point to develop practice. There were only a few minor incidents that had not been recorded. The manager confirmed they would address this to make sure people received the care and support they needed and were not harmed.

The registered manager told us that they would review this area of the service immediately and take action.

Staff were appropriately trained and skilled and provided care in a safe environment. A thorough induction was provided and staff understood their roles and responsibilities.

People lived in an environment that met their needs and people enjoyed the food provided. The premises were properly maintained with a clean, bright and inviting environment. Rooms were personalised and individually decorated.

Staff knew how to safeguard vulnerable adults and they were able to describe potential risks to people.

We saw that people had developed caring and positive relationships and they were sensitive to individual choices. Relatives told us that when they visited the home there was a calm and friendly atmosphere.

The registered provider was working within the principles of the Mental Capacity Act and was following the requirements of the Deprivation of Liberty Safeguards.

Staff treated people with dignity and respect and helped to maintain people's independence by encouraging people to care for themselves as much as possible.

People had their requests responded to promptly, and people told us there were enough staff to meet their care needs. Peoples medicines were managed safely and staff understood their responsibilities.

People who used the service, family members, and visitors were made aware of how to make a compliment, complaint, or comment and there was an effective complaints policy and procedure in place.

The service regularly used community services and facilities and had links with the local community. People, their family members, and staff were regularly consulted about the quality of the service they received.

The registered manager conducted regular audits and improvements were carried out when these had been identified. The manager explained that they were reviewing ways in which the service could review the quality of the service, by putting continuous improvement at the heart of this process.

Staff members understood the principles of the Mental Capacity Act 2005 (MCA) and were able to describe their responsibilities to seek the consent of the people they supported. When people were thought to lack mental capacity the provider had taken the appropriate action to make sure their care did not restrict their movement and rights under the MCA. Decisions about the care people received were made by the people who had the legal right to do so.

Health care professionals were involved in peoples care when necessary and encouraged to provide feedback about the service.

Families were encouraged to become more involved in the service by providing feedback on the service by completing an annual questionnaire.

People and their relatives told us that the service was well led and spoke positively about the registered manager. Staff spoke positively about the culture and the management of the service. There were systems in place to monitor and review the quality of the service.

We saw that the provider had information to support people if they were admitted to hospital, for example communication passports. We spoke with another provider who told us, 'They are on the ball. If there is a problem they seek advice.'

We reviewed the medication administration records for four people. There were clear and detailed guidelines available for staff. We spoke with three members of staff all of whom said that they felt supported. One member of staff told us, 'I had one day of medication training and I had competency assessments done too.' This meant that staff were able to safely administer regular and as required medicines.

We saw evidence of completed induction forms. One member of staff said, 'They showed me everything you need to do to support the people living here. It was really useful.' We looked at the staff files for three members of staff and saw evidence of a range of training certificates for both mandatory training and additional training.

There was a process in place for recording and learning from accidents and incidents. We saw that people who used the service and their relatives were asked for their views and these were acted upon. One relative told us, 'They have information about complaints on display. I would just ring them and I am sure they would be responsive.'

We saw there were good arrangements to protect people from abuse. People told us they felt safe. There were appropriate recruitment arrangements. Staff had training and supervision to be able to provide safe care.

There were suitable arrangements in place to monitor the quality of care being provided.