Ashfield Care Homes Limited

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.

Ashley Care Home Limited (referred to in this report as 99 Ashley Road) is a residential care home providing personal care for up to 10 people with a learning disability, autism and/or mental health. At the time of the inspection there were four people living there.

99 Ashley Road is an ordinary house and fits in with the other houses in the street around it. The bedroom accommodation is over 2 floors with communal living and dining areas.

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

People seemed happy and relaxed at home with the staff. We spoke with one person who said they were able to enjoy spending time on things which interested them. Surveys showed people were happy with their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

However, we found the provider did not have robust systems in place to consistently identify and manage all risks associated with the premises. The provider had not always provided appropriate training for the registered manager and staff to ensure they were competent to carry out their delegated duties relating to the management of the premises effectively and safely. The provider had not acted on the concerns in relation to infection prevention and control that we found at our previous inspection.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture.

The home is registered to support up to 10 people. This is more than the number recommended, however, there was a strong focus on person centred care, independence and choice. We observed people were treated with respect and dignity and were asked for their opinions. Staff told us the new manager was making improvements to ensure there were no institutionalised practices and empowered people to make decisions to do things at times that suited them. The new manager had a positive vision to ensure people had a full quality of life in line with their own choices and interests. We observed people accessed the community to take part in activities, for example, choosing plants for the garden. Refurbishment plans were in progress to increase the communal areas and provide more flexibility in how people could use the space within the home.

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 March 2019).

We made a recommendation that the provider followed relevant infection prevention and control guidance. At this inspection we found the provider had not followed this recommendation.

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.

During our targeted inspection to look at infection prevention and control, we identified that the provider had not addressed concerns found at the previous inspection in relation to the poor state of repair in some areas of the home and the infection risk this created. We also identified new concerns with the management and control of legionella. As a result, we returned to widen the inspection to a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. We have identified breaches in relation to infection prevention and control, staff training and governance of the home.

You can see what action we have asked the provider to take at the end of this full report.

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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• Ashfield Care Home limited (99 Ashley Road) is a care home for people with a learning and/or physical disability. The home is registered to provide accommodation and personal care for up to 10 people. At the time of our inspection there were six people living at the home.

People’s experience of using this service:

• People told us they felt safe living at Ashfield Care Home. Relatives told us they found Ashfield Care Home provided a safe place for their relative to live and had no concerns.

• People had individual risk assessments completed which ensured they were supported to live their lives as independently as possible while minimising any identified risks.

• People received care and support in an individualised way, which was planned and delivered to meet their needs.

• Ashfield Care Home was staffed with sufficient levels of trained staff who were themselves supported with a system of regular supervision and annual appraisals. Staff felt supported and commented positively on the training they received.

• People’s medicines were being managed safely, stored securely and administered by trained staff.

• We have made a recommendation regarding the upkeep of the premises to ensure infection control risks are minimised.

• People and their relatives were fully involved in assessing and planning the care and support they received. People were referred to health care professionals as required.

• People were supported to maintain and increase their independence. People were supported to access the community and trips to places of interest each day. People’s privacy was protected and they were treated with dignity and respect.

• People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

• Relatives expressed confidence in the management team and felt the service was well led.

• More information in Detailed Findings below.

Rating at last inspection: Good (The date the last report was published was 8 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains rated as Good overall.

Follow up: We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.

Ashfield Care Homes Limited (99 Ashley Road) is a care home for people with a learning and/or physical disability. The home is registered to provide accommodation and personal care for up to ten people. At the time of our inspection there were six people living there. The home is set in well maintained gardens and consists of a main house with a large lounge and dining room. The house and gardens are accessible for people who use a wheelchair.

The service had a registered manager in place. 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. The registered manager also managed another small home which was a short distance away on Ashley Road.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005, which applies to care homes. The registered manager did not fully understand how to implement this legislation and had begun to address this during the inspection.

Staff supervision and appraisals had not taken place regularly although staff told us they felt supported with on-going training and were involved in the development of the home. The provider operated safe recruitment and retention processes. Relevant checks were carried out before staff were employed.

People were protected from possible harm. Staff understood the home’s safeguarding and whistle blowing procedures and who to contact if they had any concerns.

People told us they felt safe. There were sufficient staff deployed to provide person centred care and keep people safe.

There were systems in place to manage, record and administer medicines safely. Staff had a good knowledge of people’s medicines and received regular training to maintain their competency.

Risks relating to people and the environment were assessed and managed. There were systems in place to report repairs and maintain the premises.

People received personalised care, in line with their needs and preferences. People were supported to maintain their health. Specialist medical advice, treatment and support was sought promptly when required, including GPs, speech and language therapists and behavioural support specialists.

Staff interacted positively with people and were caring and kind and respected their dignity. Staff encouraged people to maintain their independence, to make decisions and to have as much control over their lives as possible.

People were offered a choice of drinks and meals, prepared in a way that met their specific needs. Important information, such as their likes and dislikes and allergies, was known by staff who assisted and encouraged people to eat if they needed help.

Staff seemed to know people well and had time to sit and chat about things that were important to them. Activities took place daily both within the home and in the community.

There was an open culture and a clear management structure within the home. People living at the home, their relatives and health care professionals were complimentary about the management of the home.

Quality assurance systems were in place to assess and monitor the quality of care and drive improvements. Incidents and accidents were recorded and trends identified for learning and minimising future incidents. Records were well maintained and regularly reviewed.

We last inspected the home in December 2013 when we found no concerns.

We found that people's needs had been comprehensively assessed when they were admitted to the home. Care plans had been developed from these assessments to inform staff about how people should be supported.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff were appropriately supported to carry out their duties through regular one to one supervision sessions, annual appraisals and through day to day supervision of practice.

The home had systems in place to make sure that the quality of service was monitored.

The people who lived at the home seemed at ease with the staff and told us that they enjoyed living at the home. No one raised any concerns about the way they were cared for and supported.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans included up to date risk assessments that addressed the individual needs of people using the service. People told us that they were supported in promoting their independence and community involvement and that they enjoyed a variety of activities inside their home and in the community.

People were provided with a choice of suitable and nutritious food and drink. We saw evidence of discussions with people about their likes and dislikes and food preferences.

There were enough qualified, skilled and experienced staff to meet people's needs. Staff training records that we looked at showed us that staff had regular and up to date training.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. Quality assurance surveys that we looked at showed us that people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Discussions with staff showed us that people's privacy and dignity was maintained and respected.