Ashdene

Ashdene is a specialist service providing supported living for up to 17 male ex-offenders and people who are at risk of homelessness. The project also expands to provide support to people in their own homes. The people receiving support have a variety of complex needs including some people with a learning disability and/or autistic people. 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 our inspection 15 people were receiving personal care.

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

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.

Right Support:

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. People’s needs and risks associated with their care were appropriately managed to ensure safe care could be provided.

Right Care:

Systems and processes were effective in ensuring people were protected from the risk of abuse and staffing was provided in line with people’s needs following safe recruitment procedures. People were supported by staff who knew them well and had the appropriate skills and training to support them to increase their independence and live a crime free life. People’s medicines were managed safely.

Right Culture:

Feedback from people and staff was mostly positive of the care provided. We found the culture of the service reflected a positive and empowering ethos which focused on people living together harmoniously and independence promotion. The service worked in partnership with other health and social care professionals to ensure safe and effective care was provided to people. The service was using governance processes effectively to learn lessons and identify any shortfalls in practice. Staff told us they felt supported in their roles.

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 6 March 2019) and we identified breaches of regulation in relation to safe care and treatment and good governance. At our last inspection we also recommended the provider reviewed their training procedures in line with best practice. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Why we inspected

We undertook this focused inspection to check the provider had taken action following the last inspection 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashdene 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.

This was an ‘inspection using remote technology’. This means as well as visiting the service, we also used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

This service is a domiciliary care agency. It provides personal care to people living within the building. Ashdene is a specialist service offering residential support for up to16 male ex-offenders and people who are at risk of offending aged 18 years or over. Some people have complex needs which require specialist support; which is in very short supply both locally and nationally. It provides a service to older people, adults, people with learning and profound disabilities. Not everyone using Ashdene receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’ 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 10 people were receiving personal care from the service.

Ashdene also offers an outreach service which supports people in their own accommodation after their stay in the project.

At the last inspection in February 2016 the service was rated good. Following this inspection, the service is now rated requires improvement.

There was a registered manager in post. 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 told us they felt safe. Staff knew how to recognise and report any concerns about people's safety and welfare. Risks to people’s health and safety were assessed to help protect people from harm. However, for one person we identified a significant risk had not been identified and assessed.

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training and they told us the training was good and relevant to their role. However, we recommend the provider reviews their training policy regarding staff competency for medication. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. People felt safe at the service and appropriate referrals were being made to the safeguarding team when this had been necessary.

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 service worked in partnership with other agencies including health professionals and multi-agency public protection arrangements (MAPPA) coordinator to help ensure people’s needs were met.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was good.

Activities were on offer to keep people occupied both on a group and individual basis.

Records showed complaints received had been dealt with appropriately.

We found the providers quality monitoring systems were not always working as well as they should be. Some of the concerns we found at our inspection should have been identified through a robust system of checks.

Everyone spoke highly of the registered manager who said they were approachable and supportive.

We found two breach of regulations in relation to safe care and treatment and good governance.

The inspection took place on 23 February 2016 and was unannounced.

Ashdene is a specialist service offering residential support for up to16 male ex-offenders and people who are at risk of offending aged 18 years or over. Some people have complex needs which require specialist support; which is in very short supply both locally and nationally. Ashdene has several ground floor rooms and is able to take ex- offenders who are dependent on a wheelchair for mobility Ashdene also offers a floating support service which supports people in their own accommodation after their stay in the project.

There was a registered manager in post at the time of our inspection. 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 we spoke with told us they felt safe living at the service. They told us staff were kind and considerate and always treated them with dignity and respect.

Staff we spoke with demonstrated a good understanding of their role in safeguarding people from harm and knew who they would need to report any concerns to.

We saw medicines were not managed safely. They were administered by trained staff. There was an issue with the medication fridge which was not at the correct temperature, which the registered manager told us they would rectify. There were also issues around the storage of used needles and signing for medicines when they were given.

This was a breach of Regulation 12 (2) (g) safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home was very clean and was pleasantly decorated. We found no evidence of any malodours anywhere in the home. We saw that there were communal areas where people chose to spend time socialising with other people who used the service.

We found that there were robust auditing processes in place which allowed the registered manager to monitor the quality and safety of the service. This information was shared in a report with senior managers of Langley House Trust and there was an action plan in place to continue to improve the service.

On the day of our visit we saw people were given choices about how they wanted to spend their time, and we saw that staff discussed choices with people throughout the inspection.

We saw there were sufficient numbers of suitably trained and skilled staff available throughout our visit to meet people’s needs safely.

The service was successfully supporting people to become independent and to make the transition from a custodial environment to living independently in the community.

People who used the service were able to access education and gain valuable skills and qualifications. People were attending the local college and one person was learning to drive.

There were very strong partnerships in place between Ashdene and other agencies including the Police, probation service and social services. This partnership approach allowed the people who used the service to benefit from both therapeutic treatment and consistent boundaries which allowed them to adjust from an institutionalised way of living to being able to live independently.

The cook in the service provided people with good quality ‘home cooked meals’ which were enjoyed by all the people we spoke with. The cook also offered valuable support in teaching people how to cook and their involvement had inspired several people to go onto study catering at the local college.

Care plans were created with the people about whom they were written, and were person centred as a result. People had a key worker who met with them weekly and reviewed their support needs and progress. This led to an evolving care plan which was up to date and met people’s needs.

We spoke to eight people who use the service. People who use the service said they were given choices about how they spent their days. One person said 'I like to do cooking so I do it every day. On a weekend I cook for everybody'. Another person said 'You can do what you want. I have a plan which is to encourage me to become independent. I have a meeting every week with my key worker'.

People said they were very happy with the care they received and that the staff were very supportive. One person said 'I love it here, the staff are great'. Another person said 'I am very nervous about going out but staff always help me. I come and talk to staff if I feel down'. People talked about how they had been supported by staff to regain confidence and about how they worked with their key worker to meet their goals.

People said they had the opportunity to visit the service to see if they were suitable to go there and whether it would be the best place for them. We spoke to a probation officer who was visiting the home at the time of the inspection who said 'I have come to see someone who has just moved in to see how he is getting on'. She said that he had settled in very well and had started mixing with other people; she said that the staff were working very well with him.

We spoke to five members of staff who had a very good understanding of what constituted abuse and what they would do if they suspected any abuse. All of the staff said they would be confident to report any alleged abuse to the manager or deputy manager.

We saw that all staff undertake induction training which included safeguarding when they commenced employment. We saw from training records that staff had received training in safeguarding and were able to demonstrate a clear understanding of their learning.

People we spoke to said that they felt supported by staff and were very complimentary about the care they received from them.

We observed that staff interacted very positively with people who use the service and that there was a focus on empowering people to make their own decisions.

We saw that staff received training on medication, risk assessment and management planning, moving and handling, infection control food safety and lone working and that all training was up to date.

The service had several audit systems in place. We saw copies of two audits that had taken place, one which covered referrals into the service and the various points of activity related to referrals, and another on health and safety within the home.

We saw that a draft internal report had been carried out by an external organisation to look at offender management. One of the areas audited identified that two out of six risk assessment plans were not completed before arrival or within 48hours of someone commencing their tenancy at the home. The manager said that staff were made aware of findings from audits in order to improve the quality of the service.