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Ashview House Residential Care Home Inadequate

We are carrying out checks at Ashview House Residential Care Home using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Inadequate

Updated 28 March 2018

We inspected this service on 15 and 16 January 2018. This was an unannounced inspection. Our last inspection took place on 4 September 2017. At that inspection, we identified some Regulatory breaches and we told the provider that improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as 'inadequate' and remained in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

As a result of previous enforcement action, a condition was placed on the provider's registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people's safety and remains in place.

At this inspection, we identified continued and new Regulatory breaches. The overall rating for this service remains 'Inadequate' and the service therefore remains in 'Special measures' whilst we continue our enforcement action.

Ashview Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection six people were using the service.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

Systems were not always effective at identifying quality concerns. Medicines audits were taking place but they were not always finding issues that were present. Other audits were taking place such as environmental, kitchen and infection control audits which did not always identify issues. Timely action had not always been taken to resolve actions if they had been identified. These shortfalls posed a significant risk to the people living in the home.

Quality assurance records were not always up to date, such as the training matrix which had a member of staff missing from it, despite them receiving training months before our inspection.

Medicines were not managed safely. Stock levels did not always balance meaning we could not be sure whether people were always having the correct amount of their prescribed medicine. Some medicines were out of date, guidance for ‘as and when required’ medicines was not always been followed and recording of the administration of medicines was not always accurate.

People’s health care plans were not always followed which meant there was a risk to people’s long term health associated with their condition.

People with specific dietary requirements were not always supported in a way that met their needs.

Health conditions were not always effectively monitored. People were supported to access other health professionals however guidance from health professionals was not always followed.

Staff knew how to recognise potential abuse and how to report it. Staff felt more supported. However, other staff training was not effective as people were not always being supported appropriately.

A notifiable safety incident was not reported to us, which meant that we could not accurately monitor safety at the service.

Improvements were noted about the provider complying with the Mental Capacity Act 2005 (MCA) however further improvements were required to ensure people’s ability to make decisions and any decisions taken on a person’s behalf were clearly recorded.

An action plan was in place based on feedback from previous inspections and from feedback from an external consultant who was working with the home. We found some improvements had been made but some of the actions were still on-going or were not fully embedded, so continued improvements were required.

People and relatives felt there were enough staff so people did not have to wait for support. Recruitment of staff had improved although further improvement were required.

The home was generally clean and infection control measures were in place.

People and relatives felt staff were caring and that they were treated with respect. People were encouraged to be independent where possible.

Relatives felt able to complain. Complaints were being recorded, although the outcome was not always available. The complaints policy was not up to date and had missing information.

The home environment was tidy however some décor needed updating to ensure it was suitable for people with dementia. Future plans were in place to make improvements to the home.

People and relatives were involved in developing their plans of care and staff had the opportunity to read these plans.

People had the opportunity to partake in activities and leave the home on trips.

The provider had considered people’s end of life choices and plans had been put in place with basic information.

There was an Equality Policy in place, which took account of the protected characteristics such as gender, sexuality, race, and religion, for example. The provider and manager were able to provide us examples where they had been supportive of some of the protected characteristics.

People, relatives and staff were complimentary of the acting manager.

The provider was continuing to display their inspection rating as required.

Inspection areas

Safe

Inadequate

Updated 28 March 2018

The service was not safe.

Medicines were not always managed safely.

People were not always supported appropriately with their health conditions.

Recruitment processes had improved but further improvements were necessary.

There were sufficient staff in place to ensure people had timely support, although staff could sometimes be rushed due to other duties.

Effective

Requires improvement

Updated 28 March 2018

The service was not always effective.

People were not always supported appropriately with their dietary requirements and there were mixed views about the food.

Staff felt more supported however training was not always effective.

People's health needs were not effectively monitored and managed and professional advice was not always sought or followed to promote people's health, safety and wellbeing.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure people's ability to consent to their care was assessed however improvements had been made from the last inspection.

Caring

Requires improvement

Updated 28 March 2018

We could not improve the rating for caring from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

The service was not always consistently caring. People's right to choose was not always respected.

People and relatives told us the staff were kind and caring and people were encouraged to be independent. Staff knew people well.

People could access private areas of the home when they wished to do so.

Responsive

Requires improvement

Updated 28 March 2018

The service was not always responsive.

A system was in place to ensure all complaints were recorded, people told us they felt they could complain however the policy required updating.

Reviews of plans were not always effective.

Activities were available for people to partake in and trips out of the home were taking place.

People and relatives were involved in planning of care.

Well-led

Inadequate

Updated 28 March 2018

The service was not well led.

New systems were being introduced to monitor and improve the quality of care and support, however these were not effective.

The registered manager and provider did not always report notifiable incidents to us as required.

People, relatives and staff found the acting manager approachable.