We carried out a review of the data available to us about Ashlong Cottage on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Ashlong Cottage, you can give feedback on this service.
We found the following examples of good practice.
People were supported to stay in regular contact with their family and friends, who were able to visit with no undue restrictions. Staff made sure this was done in a safe way. Family and friends who were not able to visit, kept in touch with people through video and telephone calls.
Staff screened all visitors for symptoms of infection and gave them information about the safety procedures to follow when at the service. People and staff were tested for COVID-19 at appropriate intervals. The service made sure staff and visiting professionals had been vaccinated against COVID-19. Staff only worked at this location which helped reduce infection risks. The provider had been able to maintain staffing levels to make sure people experienced the same level of service.
Staff had been trained in COVID-19, infection prevention and control (IPC) and in the use of personal protective equipment (PPE). There were enough supplies of PPE and there were designated areas for donning and doffing this. Handwashing facilities were easily accessible to people, staff and visitors. Staff followed current guidance and practice throughout our visit.
The environment was clean and hygienic. Enhanced cleaning took place throughout the environment on a daily basis. Communal spaces were well ventilated and used creatively to ensure people could continue to interact with each other and staff in a safe way.
There was a designated lead for IPC at the service who undertook regular audits to make sure staff complied with current guidance and practice. The service’s IPC policy and plans for managing an outbreak were up to date and in line with current guidance.
Further information is in the detailed findings below.
Ashlong Cottage is a residential care home providing personal care to six people with learning disabilities at the time of the inspection. The service can support up to six people in one adapted building.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
As part of thematic review, we carried out a survey at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
The provider's safety checks did not always ensure people were safe, because they had failed to keep harmful and controlled substances stored securely. However, the risk was reduced because the people using the service would not have been able to access these substances independently and the registered manager made sure the materials were locked away as soon as we raised this.
Otherwise, the service was safe. There was a clear process for staff to recognise and report signs of abuse. The provider assessed and managed risks to individual people well and used learning from incidents to improve risk management. They made sure there were enough suitable staff to meet people’s needs. People received their medicines as prescribed. Staff knew how to reduce the risk of infection spreading and kept the home clean and hygienic.
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. The home environment was suitably adapted to meet people’s needs. The provider used evidence-based guidance to assess people’s needs and plan their care. Staff worked well with other agencies to make sure people received healthcare and other specialist support they needed, including meeting their diverse nutritional needs. People received support from staff who had the skills and knowledge they needed to provide effective care.
People received care and support from staff who knew them well, were caring and empathetic, and were able to recognise and meet their emotional support needs. Staff understood how to support people to make choices, including the use of communication aids and recognising how people communicated their choices. Staff respected people’s dignity and independence, although they sometimes compromised privacy by talking about people’s confidential matters in front of other people who used the service. The registered manager told us they would make sure this did not happen any more.
People benefited from well-planned care that met their needs, because the provider made sure staff had the information they needed about people’s preferences, support needs and what was important to them. The care people received as they approached the end of their lives was designed to support their comfort and dignity. People had a person-centred programme of activities both at home and in the community. People received information in appropriate formats that they could understand and staff knew how to communicate with people effectively. The provider dealt with complaints and concerns appropriately.
The standard of record keeping at the service was good and this meant clear, complete and accurate information about people’s care was available to those who needed it. However, records were not always kept securely which meant there was a risk of people’s confidential information going astray. The registered manager addressed this as soon as we raised it. The provider promoted a person-centred culture that valued people and celebrated their achievements. The registered manager was open and approachable, and sought feedback regularly from people, staff, relatives and other agencies so everyone could have their say about how the service was run.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 18 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last Care Quality Commission (CQC) inspection in November 2014, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.
People were safe living at Ashlong Cottage. Staff knew how to keep people safe from harm. The provider ensured there were sufficient pre-employment checks so as far as possible, only suitable staff were employed. Staffing levels were sufficient to meet people’s needs.
We saw staff received sufficient training and support in order to undertake their roles and responsibilities. We saw staff were knowledgeable about the needs of people and provided personalised support in line with people’s needs and wishes.
Relatives told us staff were kind and caring. We saw care was provided in a sensitive manner that took account of people’s privacy and dignity. Staff communicated with people using a range of methods and always sought consent from people prior to providing care.
People’s health needs were met. This included access to appropriate healthcare professionals, receiving their medicines as prescribed and nutritional needs being met.
The service had identified risks to people and how these risks could be minimised. Accidents and incidents were recorded and analysed in order to reduce re-occurrences.
People told us the registered manager was approachable and they could raise issues or concerns and felt they would be listened to. The registered manager was aware of their responsibilities and knew when they had to inform CQC of significant issues.
The provider had established good governance systems to regularly assess, monitor, and where required, improve the quality and safety of the service people received. The provider sought the views of people who used the service and their relatives, through informal and formal mechanisms.
This unannounced inspection took place on 12 November 2014. At our last inspection of the home the provider was meeting the regulations we looked at.
Ashlong Cottage is a care home that provides accommodation and personal care for up to six people with learning disabilities. People living at the home also have care needs in relation to a physical disability. At the time of our visit there were five people living at Ashlong Cottage.
The service did not have a registered manager in post at the time of the inspection. They had left in May 2014. 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.
People using the service told us they felt safe living at the home. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures. The atmosphere was calm and relaxed when we visited. We saw risks to people were identified and plans put in place to address these. Staff were visible in all parts of the premises to provide support to people. Relatives we spoke with were happy with the care provided.
People’s needs were assessed and their preferences identified as much as possible across all aspects of their care. Risks were identified and plans were in place to monitor and reduce risks. People were involved in writing their own plans and reviewing them so they were getting the care they wanted and information about them was always kept up to date. People had access to relevant health professionals when needed. People were supported to eat and drink sufficiently to meet their needs.
Staff received regular training and support. They were knowledgeable about their roles and responsibilities in caring for people living at Ashlong Cottage. The provider had made sure staff had sufficient skills and experience to do their job effectively.
People were encouraged to be as independent as possible. There was a range of activities for some people to participate in, if they wanted to. However this was not consistently offered to everyone living in the home. The result of this was some people had a variety of activities, whilst others were restricted on what was available to them.
Staff told us the manager was approachable and listened to their views and acted on them. People who used the service told us the manager was not visible in the service and tended to stay in the office. Both of the relatives we spoke with were unaware a new manager had been appointed to the service. However, people told us if they had to make a complaint then they would ask to speak to care staff.
We spoke with people using the service. One person told us, "I've been asked if I want to go out more." Another person told us, "There has been an improvement in the amount of activities we are offered and I am happier now but there is still room for improvement."
We found that people's needs were assessed and care and treatment was planned to promote people's health and safety.
However, we were concerned that care was not planned and delivered to ensure people's welfare and general well-being. One person told us, 'I like it here but they hardly ever take me out. I would like to go and live somewhere else because of that, but I'm worried I won't be treated well somewhere else. I have nobody to talk to. I just stay in my room most days." A relative told us, "on the whole I think the care is good but they don't have enough activities. X is very bored and frustrated."
People living in the home were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that people were cared for or supported by suitably qualified, skilled and experienced staff because there were effective recruitment procedures.
People were protected from the risks of unsafe care and treatment because accurate and appropriate records were maintained. We looked at several people's care files, staff files and files relevant to the management and maintenance of the home. We found the files we looked at were comprehensive, well organised, accurate and fit for purpose. The files were stored securely and were readily located.
We observed that people appeared well cared for. Their support plans addressed their personal care in detail and the extent to which people were independent with meeting these needs. One person said 'my key worker is very good and ensures I am well looked after'. Another said, 'staff encourage me to do as much as possible for myself'.
People's individual social and recreational needs were appropriately met. A programme of weekly activities was in place for each person. One person was able to tell about all the activities they were engaged in and showed us a copy of their programme. The support plans also contained information about how to support people in meeting their cultural and spiritual needs.
People's care records contained risk assessments to ensure their safety while promoting their independence and rights. Where people had behaviours that challenged the service, appropriate risk assessments and guidelines were in place so staff knew how to support people.
Appropriately skilled and experienced staff worked in the home in adequate numbers to care for and support people. They were supported by the provider to make sure they could do their job appropriately.
The provider had effective systems in place to monitor and assess the quality of the service to ensure people received safe and appropriate care.
Overall, we have found that Ashlong House meets the essential standards but to maintain this we have suggested that some improvements are made. Please see main report for this information.