Ashlands Mews

Ashlands Mews provides personal care for up to 7 people living in independent living bungalows on the same site, with access to support staff 24 hours a day. The service supports younger and older adults, including people with a physical disability.

Not everyone who used the service received personal care. CQC only inspects 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 the inspection, 3 people were receiving the regulated activity of personal care.

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

Improvements to people’s support plans were identified. The registered manager had some plans in place to make these improvements. They also took immediate actions on the day of inspection to make improvements.

People received safe care and support from a stable and experienced staff team that knew their individual care and support needs, routines, and preferences.

Staff had received safeguarding training and were aware of their responsibilities to protect people from avoidable harm.

People received care calls at the expected times, staff stayed for the duration of the call and were unrushed. People could request additional support and staff were responsive.

People received their prescribed medicines when required and national best practice guidance was followed. Staff had access to personal protective equipment and had received training in infection prevention and control.

There were sufficient staff available to meet people’s individual needs. Staff had been safely recruited and received opportunities to discuss their work and have their competency assessed.

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 registered manager and provider understood their registration regulatory responsibilities. The last rating for the service was clearly displayed. There were effective communication systems. People received regular opportunities to discuss their care package.

People were positive about the care and support they received that enabled them to lead active and fulfilling lives. Staff were positive about working at the service and felt well supported.

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 15 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection. We have found evidence the provider needs to make some continued improvements. Please see the well-led section of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People were not fully protected from the risks of avoidable harm. Risks were not reviewed regularly and people who required assistance with specialised moving and handling equipment did not have these risks recognised or mitigated. Quality assurance systems had not been effective in identifying areas where the service could improve. People told us there were not enough staff to provide continuity and meet people's needs.

People were protected from the risk of harm. Staff had been trained in safeguarding people and understood how to assess, monitor and manage their safety. A range of risk assessments were completed, and preventative action was taken to reduce the risk of harm to people.

People were supported with their medicines in a safe way. People’s nutritional needs were met, and they were supported with their health care needs when required. The service worked with other organisations to ensure that people received coordinated care and support.

People were protected by safe recruitment process which ensured staff were suitable to work in care services. All staff received training for their role and ongoing support and supervision to work effectively. Some staff received specialist training for people with complex needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider followed the principles of the Mental Capacity Act, 2005 (MCA) in planning and delivering people's support. People's consent was obtained before they were supported.

People were involved in their care as far as possible and care plans were regularly reviewed and updated as people’s needs changed. Where appropriate people’s relatives were involved in planning and reviewing people’s care.

Staff were provided with clear guidance to follow in the care plan which included information about people’s preferences, daily routines and diverse cultural needs. Staff had a good understanding of people's needs and preferences and worked flexibly to ensure people’s care needs were met.

People and their relatives were encouraged to provide feedback about the service which was used to assess quality and make any improvements. The provider had a process in place which ensured people could raise any complaints or concerns and people felt comfortable to do this should they need to.

The registered manager and provider were aware of their legal responsibilities and provided leadership and supported staff and people who used the service. The registered manager and staff team were committed to the provider’s vision and values of providing good quality, person centred care.

Lessons were learnt when things went wrong, and improvements made to prevent re-occurrences. The provider worked in partnership with other agencies to meet people’s complex and diverse needs and people's health and well-being was monitored.

Rating at last inspection:

The last rating for this service was Good (published October 2016).

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.

Ashlands Mews provides personal care to adults with a variety of needs living in their own homes. This included people with physical disabilities, people with mental health needs and younger adults. At the time of the inspection there were six people using the service. Each person had their own flat that was based around a shared courtyard within the Ashland's complex. People were supported by staff who were based in an an office on the complex.

The service had a registered manager. 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 had to wait for their support at certain times during the day. This was because people did not have agreed call times and could request support when they wanted it. We found that people had often requested support at the same time and there were not enough staff available at these times. Staff had been checked for their suitability before starting work.

People were protected from the risk of harm at the service. Staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it. The provider dealt with accidents and incidents appropriately and reviewed these to try and prevent reoccurrences.

Risks to people’s well-being had been assessed. For example, where people required support with using kitchen equipment, staff had training and guidance available to them.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice when necessary.

Staff received appropriate support through an induction and supervision. Staff had received training in a range of subjects to provide and update them on safe ways of working.

People chose their own food and drink and were supported to prepare their meals. A healthy diet was encouraged. Staff supported people to contact healthcare services when required to promote their well-being.

People were supported in line with the Mental Capacity Act (2005). People's capacity to make specific decisions had been considered in their support plan. Staff told us that they sought people’s consent before delivering their support.

People received support from staff who showed kindness and compassion. They told us that dignity and privacy was protected by some staff.

People were usually supported to be as independent as they wanted to be. However people told us that they felt that some staff rushed them and did tasks for them. Staff knew people’s preferences and had involved people in planning their own support.

People knew how to make a complaint. The provider had a complaints policy in place that was available for people and their relatives. However, people had not always had their complaints responded to in line with timescales in the provider’s policy.

People had contributed to the planning and review of their support. People had support plans that had included information about their likes, dislikes and history. Staff knew how to support people based on their preferences and how they wanted to be supported.

People and staff felt the manager was approachable. The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

Systems were in place which assessed and monitored the quality of the service. People and their relatives were asked for feedback about the service.

We found the provider had robust recruitment procedures which meant people who used the service could be confident that staff had been checked as to their suitability to support and care for people who were vulnerable. Systems were in place to ensure newly recruited staff had a robust induction process which was supported by on-going training and supervision from the services registered manager.

We found that there were systems in place to monitor the quality of the service, and make improvements where required.

We spoke to one of the eight people using this service. They told us they managed their own medication. They told us staff respected their wish to maintain their independence in this area. We saw that everyone using the service had an assessment to identify whether they needed support with medicines. The provider had effective systems to protect people from risks associated with medicines.

We did not speak to people using the service about their records. We looked at care records for two people. Both people had been involved in writing and agreeing their care plans. One person had written documents for inclusion in their record. The records we looked at were accurate and up to date. The provider had systems to ensure records were properly maintained.

People were encouraged to be independent and they made decisions about their care and treatment. People told us they knew what was written in their care records. We found that these records were not reviewed in line with the provider's policies. Up to date written information about people's needs was not always available to care workers.

We found that care workers were trained to support people with their medicines. People told us care workers supported them properly. We found that some records were not properly completed. The provider had not always sought appropriate advice when medicines could not be administered in the prescribed way. There were not effective checks of all aspects of medicines management.

People told us they were confident that care workers who usually supported them were qualified and competent. Two people said, 'The staff have been really supportive.' 'I can't fault the support I've received.' Some people told us some care workers did not have the right skills to support them. The registered manager had taken account of these views and did not continue to employ care workers if people were not satisfied with them.