6 January 2015
During an inspection in response to concerns
This inspection was undertaken by two inspectors. We looked at the operation of the home over the course of the waking day. Time was spent speaking with people who lived in the home, staff, and the registered manager. We also spent time looking at various records and touring the building.
There were 12 people living in the home during our inspection. We also spoke with seven people who used the service. Some of the people who were using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible
This helped us to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
Below is a summary of what we found.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
The service was not safe. Appropriate arrangements had not been made to protect people from the risks of unsafe or inappropriate care. People we spoke with told us they felt safe living at Ashley House (Bristol) and felt able to raise any concerns with staff or the manager. Nobody we spoke with who lived at Ashley House told us or felt uncomfortable with the actions or attitude of the staff that provided support for them.
However, during the inspection, we raised a safeguarding concern with the registered manager. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. We asked the registered manager to take appropriate action by immediately informing the relevant authorities and following their own procedures for responding to it. The overall review of this matter was not yet concluded.
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There were insufficient qualified, skilled and experienced staff to meet people's assessed needs. The home had no dependency tool for calculating staffing levels. The registered manager was unsure how they arrived at the present staffing level and thought this was agreed with the local authority. This put people at risk of unsafe care.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people who lacked mental capacity to help keep them safe. We found that no policies and procedures were in place and staff had not been trained to understand when a DoLS application should be made and how to submit one. This meant that people who used the service could be unnecessarily restricted and deprived of their human rights.
People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. There were gaps in the medicines administration record sheets which could mean that people had not received there medicines to meet their health needs.
People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.
Is the service effective?
The service was not effective. Staff had not received regular formal supervision or appraisal. The staff we spoke with all felt they were not well supported in their role. One member of staff we spoke with told us, we do not get any support here. I have not received supervision for a long time'. Another staff member told us, 'If you are unsure about anything there is no one to ask the manager is not approachable '. This meant that their knowledge and practice was not regularly assessed.
Is the service caring?
The service was caring. We spoke with three people who lived at the home during our inspection. Not all the people we spoke with were able to communicate using words but they were able to indicate they were content with the support they received by using gestures to indicate they were happy. One person who lived at the home told us, "I like it here; it's always been alright' People said staff did everything needed to support them with their day to day living.
We observed most staff continually working to support people with all aspects of care. We observed staff communicating and interacting well whilst supporting people.
People's preferences and diverse needs had been recorded and care and sup ort had been provided in accordance with people's wishes
Is the service well-led?
The service was not well led. There was a lack of effective systems to assess and monitor the quality of the service. There was no system of audits to identify areas that needed to improve and no plans to address these. We identified shortfalls in risk management , maintenance, incident and accident monitoring and medicines administration demonstrating that the provider had failed to provide service that met people's needs.
Staff spoken with had lost confidence in the management of the home.
When we spoke with staff they told us that generally staff morale was low at the present time and there were a number of issues that they felt needed addressing.