Ashford Lodge Also known as 1-19173028272

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The key question of Safe was rated Good at our last inspection and continues to be rated Good following this assessment. However, during this assessment of this key question, we found concerns around the management of medicines which resulted in a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were receiving support following Right Support, Right Care, Right Culture guidance. There were enough staff to meet people’s needs, and they had received training to make sure they had the skills required to meet people’s needs. Potential risks to people’s health and welfare had been assessed and there was guidance in place for staff to mitigate the risk.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff told us they had received training in safeguarding people from discrimination and abuse. They were able to describe how they would recognise abuse and the signs they would look for. Staff were confident about reporting concerns to the management team and would take any concerns to head office if they had not been dealt with by the management. Some new staff were not aware they could contact the local authority if they had concerns which had not been dealt with by the management team. The registered manager understood their role to report concerns to the local authority and work with them to reduce the risk of them happening again.

There were effective processes in place to report safeguarding concerns to the local authority, these were recorded on a log, to make sure the process had been followed. The outcome and any actions taken were also recorded. There was a system in place to learn lessons from incidents and communicate any changes to staff. The operations manager completed investigations into incidents, they sent the outcomes and actions required to staff individually to make sure they were aware of actions required. People's support plans included information about how people may be at risk in the community and how staff should support the person to safeguard them from abuse.

Relatives told us people felt safe at the service. A relative told us their loved one asked to return to the service on occasions when they were out. They felt this demonstrated the person felt safe and comfortable at the service. Another relative told us their loved one was “very settled and would not want to move elsewhere”, and "The know what they want, never given any indication that they are not happy."

Strategies were in place to support people to remain calm, we observed these were effective. For example, one person became frustrated while waiting to go out. The registered manager showed the person their purse and explained they were getting money for their trip. Seeing the purse reassured the person they were going out and they calmed. Another person ate their meals on their own in a quiet environment. This supported the person not to rush their meal or become anxious. The person remained calm throughout their meal and ate it slowly.

Staff understood the potential risks to people's health and welfare. Staff had a very good understanding and came across as passionate in supporting people positively, they understood how to implement their training to keep people safe. Staff were aware of people's support plans and the guidance within them and how to follow this. They told us they were made aware of changes to people's support plans when their needs changed. Staff gave really good examples of how they support 2 people. They clearly knew them both very well, they gave details about triggers and signs of discontent and how to prevent any escalation at these points.

People's support plans contained information about potential risks to people's health and welfare. There was clear guidance for staff about how to support people including when they went out. There was information for staff to recognise when people were becoming unwell such as the signs when someone was becoming depressed and how to support them. Support plans were reviewed regularly and when people's needs changed to make sure they remained up to date and relevant.

People were unable to communicate their views with us. We observed people’s interactions with staff and other people to understand their views. Most relatives told us people were supported to manage risks. One relative disagreed and felt their loved one was not consistently supported to remain safe, they thought staff did not always follow their instructions and therefore placed the person at risk. A relative told us staff supported and encouraged their loved one to get washed and dressed each day. Sometimes the person did not wish to do this and staff spent time with them chatting to them about their feelings. The person would change their mind and get ready for the day.

We observed people at lunchtime. Meals were prepared in line with Speech and Language Therapists guidance to reduce the risk of people choking. Some people were at risk of falling when they walked. Staff consistently supported people to walk using walking aids if needed. Staff reminded one person to, “Walk like a soldier”. The person stood up straighter and held their head up, this reduced their risk of falling. There was a system in place to monitor people who chose to stay in their bedroom were safe and well. The monitor in place could only be heard in the lounge. Staff were supporting people all over the house and there was not always a staff member in the lounge to hear it. There was a risk staff would not know if the person was unhappy or unwell. We discussed this with the registered manager during our inspection and more mobile monitor was ordered.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There had been changes within the staff team. New staff we spoke with were positive about their experience of working at the service, older staff felt the changes had impacted on the quality of support, though there was no evidence to support this. Staff confirmed they had received training to give them the skills needed in their role. Staff had received face to face positive behaviour support training, and confirmed the training had helped them to support people positively. New staff confirmed they had received an induction and had worked with more experienced staff until they were confident to support people independently. Staff told us they did not have regular meetings with the registered manager but felt they were supported and able to discuss any concerns they may have. Staff told us they thought there were enough staff to support people.

Staff had been recruited safely. There were processes in place to check staff were of satisfactory character to support vulnerable people. Staff numbers were calculated to support people's needs and support them to go out. Staffing rotas showed there were enough staff to meet people's needs. Staff had received training to meet people's needs, these included face to face and online courses. Staff had received an induction and their competency had been checked before they supported people by themselves.

Staff knew people well and had positive relationships with people. We observed staff encouraging people in all areas of their day to day life, including when they were playing games, drawing pictures and having their meal. We observed people’s levels of engagement increase with the encouragement, for example one person learned forward to be more involved in a game and smiled at the staff members praise. We also heard people and staff laughing together and they completed tasks.

People were unable to communicate their views with us. We observed people’s interactions with staff and other people to understand their views. One relative raised concerns with us about changes in the staff team and a risk of inconsistency in support. They felt this had had a negative impact on their relative because they had become used to agency staff. Other relatives were happy with care provided by the staff team and told us their relatives knew the staff well.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

During our on site assessment we reviewed the medicines with the staff member who had been responsible for medicines management. However, they had only returned to work recently and was surprised at our findings during the assessment. They told us, they had previously completed weekly audits and had managed medicines in line with current best practice guidance for National Institute for Clinical Excellence. The operations director was also surprised at our findings but suggested the changes in staff may have had an impact and (name) not being around. They also told us their monthly checks did not always include medicines, so they had not checked them for a couple of months.

Medicines were not managed safely. Records were not accurate, some people went on home visits, there were no records of the medicines taken home. The medicines stock balance did not match, tablets were missing and staff did not know where the tablets had gone. When medicine dosages changed these had not been clearly recorded on the medicines administration record (MAR), staff had become confused and had not administered the medicine correctly. Some MAR charts had handwritten directions on them, but these had not been signed by 2 staff, to confirm they were correct. Staff had not signed the MAR charts to confirm people had their cream applied. There had been little oversight of medicine of medicines, while the staff member had been away from the service. There had been no audits, either weekly or monthly, completed during this period.

Relatives had mixed views about the support people received with their medicines. One relative was concerned as a medicines error had occurred, while a new medicines was being introduced and the dose was changed. Other relatives were happy with the support their loved one received with their medicines.