Archived: Ashton

Updated 13 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.

Inspection team

Two inspectors carried out the inspection. Following the first day of our inspection an Expert by Experience contacted relatives to gain their views of the service their loved ones received. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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

We gave 24 hours’ notice of the inspection to request consent from people to visit their home.

Inspection activity started on 18 January 2022 and ended on 31 January 202. We visited the office location on 18 January 2022 and 26 January 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. This included safeguarding information and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service throughout our inspection visits to gain their views. Where people were unable to unable to talk to us, we observed their body language, interactions with staff and viewed things they wanted to show us which were important to them. We spoke with three relatives about their experience of the care provided to their loved ones. We spoke with seven members of staff including the registered manager and regional manager.

We reviewed a range of records. This included four people’s care records and two people’s medication records. We looked at three staff files in relation to recruitment and training records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visited the service.

Updated 13 April 2022

About the service

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 services supporting people with a learning disability and autistic people and providers must have regard to it.

Ashton is a supported living service which provides support to people living in their own home. The service can support up to six people with a learning disability. CQC only inspects services where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection six people were receiving personal care and support.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support: The model of care and setting did not always maximise people’s choice, control and independence. For some people, living in a remote setting meant it was more difficult to access the community as their needs changed. The management team had plans to mitigate these concerns by looking at different transport options. However, these plans had not yet been embedded into practice which meant some people’s options were limited. Some people living at Ashton were able to make use of the local bus service and enjoyed the rural location.

Right Care: People’s care was not always person-centred and did not always promote people’s dignity and privacy. Staff did not always support people in a warm and respectful way. People were not always offered comfort when they were upset. Staff did not always show regard for people’s comfort or enjoyment and some of the ways staff described people’s support did not show respect. At other times we found staff treated people with kindness and took time to make sure they were comfortable and were enjoying what they were doing. People had access to healthcare professionals and were supported by staff to attend appointments.

Right Culture: The ethos, values, attitudes and behaviours of care staff did not always ensure people led confident, inclusive and empowered lives. The positive values and attitudes of the management team were not consistently embedded into the culture of the staff team. This meant people’s care was not always personalised and centred around the individual.

Risks to people’s safety were not always robustly assessed, monitored and managed. People were not always supported when anxious which put them and others at risk of harm. Assessments were not robustly completed and the provider had not ensured that information was shared between services. This meant they were unable to assure themselves people’s needs could be safely met.

People had allocated one to one hours although it was not always clear how these hours were used and how this benefitted the individuals. People’s records showed they enjoyed going out to places such as eating out, going to the cinema or bowling. Staff were unable to tell us about people’s preferred options and people did not have the opportunity to access the things they enjoyed doing on a regular basis. People’s sensory needs were not always supported and communication plans were not followed to enable people to be more involved in planning their care. Although people were supported to eat and drink, they were not always offered meaningful choices or options.

There was a lack of management oversight of the service. Quality assurance processes were not always effective in developing the service to make sure people had choices and were fully involved in making decisions regarding what they wanted to do and who they would like to live with. Records were not personalised and lacked detailed information in relation to the care provided to people.

Lessons were learnt from incidents and accidents which helped to keep people safe. Where concerns regarding medicines management were identified measures were taken and the issues addressed. Safeguarding concerns were taken seriously, reported and investigated in line with the guidance. People appeared comfortable in the company of staff and went to members of the management team if they had any concerns. Relatives and professionals who visited the service regularly were positive about the staff and described them as caring and kind.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This was the first inspection since the service registered with us on 1 December 2020. This is an established service which registered under a new provider on this date.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to people safe care and treatment, person-centred care and the governance of the service. We issued Warning Notices to the provider in relation to Person-centred care and Good governance.