Ashfield Care Homes Limited

Updated 9 November 2023

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 Health and Social Care Act 2008.

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

The inspection team consisted of 3 inspectors.

Service and service type

Ashfield Care Homes Limited (99 Ashley Road) is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. 99 Ashley Road is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 16 hours’ notice of the inspection on 27 July 2023. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us. The inspection on the evening of 16 August 2023 was unannounced.

Inspection activity started on 27 July 2023 and ended on 17 August 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 staff and 3 people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff interactions with people. We spoke with 2 relatives and received feedback from 3 social care professionals. We met with the registered manager, area manager and nominated individual to discuss our findings.

Updated 9 November 2023

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.

About the service

Ashfield Care Homes Limited, 99 Ashley Road is a residential care home providing personal care to 6 people at the time of the inspection. The service can support up to 10 people.

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

Right Support

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; the policies and systems in the service did not support this practice. The environment was cramped and not suitable for people who used wheelchairs. Corridors were narrow and we observed 1 person trying to get around a corner and needing help. The dining area was cramped and did not allow sufficient space for the 4 people who used a wheelchair to eat with enough personal space. There was no room for others to eat in the dining area at the same time, had they wished to. The registered manager said they would turn an upstairs bedroom into a lounge/dining room for the person that lived upstairs, along with a second person who was mobile. However, this did not offer meaningful choice and could lead to isolation and exclusion and did not resolve the small, cramped dining area downstairs. In response to our feedback about the limited space available in the dining room, the provider removed the breakfast trolley to increase the space available. In the longer term the provider told us they were planning to extend the current dining space.

Right Care

Some aspects of people’s support were person centered. For example, 1 person was being supported with the aim of them moving into supported living when they were ready. However, we observed some institutionalised and restrictive practice which did not promote people’s independence, dignity, privacy and human rights. For example, 1 person waited around the front entrance hall for much of the morning wanting to go out but was told they would need to wait until the driver got back and then everyone could go out together. Staff told us there was only 1 driver on shift which made it difficult to support people to go out. One person had their back to the wall with a table in front of their wheelchair. The registered manager told us the person was able to propel themselves backwards or push the table away from them. However, no staff were in the lounge to help the person manoeuver if they got into difficulty which meant there was a risk the person would not be able to move freely. Another person was told to sit down, and staff put their hands on the person’s shoulders to emphasise this without discussing the person’s wish to stand up. The environment was in a poor state of repair with rubbish and disused items left in the garden areas. The home was dirty and unloved which did not respect the fact it was peoples’ home. Shared areas were not very homely or personalised.

Right Culture

Staffing levels did not always enable people to live inclusive and empowered lives. There were not enough staff hours rostered to ensure people received their assessed 1 to 1 support hours. Activities were often shared and based around staff availability rather than personal preferences. Care practice was very mixed depending on people’s abilities. Whilst 1 person was able to live quite independently, others were not. For example, 1 person wanted a coffee at 10.46 am and was told by staff it was nearly 11.00 (coffee time) when they would make one for the person.

We identified concerns with medicines management and administration and staff practice. Staff lacked knowledge of emergency procedures relating to people medicines and health conditions. This put people at risk of harm.

The provider had systems in place to monitor the quality and safety of the home. However, these were not always effective in identifying shortfalls which put people at risk of harm and/or poor outcomes.

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 requires improvement (published June 2021)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

We have made a recommendation about the recruitment of agency staff.

Why we inspected

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 carried out an announced comprehensive inspection of this service in May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashfield Care Homes Limited on our website at www.cqc.org.uk.

Enforcement

At this inspection we have identified breaches in relation to safe care and treatment; dignity and respect; person centred care; good governance; staffing; safeguarding people from abuse; and the requirement to display ratings. We also identified the provider was not meeting the requirements of Right Support, Right Care, Right Culture.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 6 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.