16 and 17 February 2015
During a routine inspection
This inspection was carried out on 16 and 17 February 2015.
Ashmore House provides accommodation for up to 9 older people who need support with their personal care. The service is a converted domestic property. Accommodation is arranged over two floors. A stair lift is available to assist people to get to the upper floor. The service has 5 single bedrooms and two double rooms, which two people can choose to share. There were 6 people living at the service at the time of our inspection.
The registered provider is a partnership, one of the partners is the registered manager and they were working at the service on both days of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. 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. The registered providers worked at the service almost every day.
We received concerns about the care received by people living at Ashmore House from the local authority safeguarding team and commissioners. We inspected the service to make sure people were receiving safe, responsive and effective care and support.
The providers did not have a system to ensure the service was provided by sufficient staff with the right skills and experience. Care staff completed domestic and cooking tasks in addition to caring tasks. People had to wait for the care and support they needed. Some people were not able to call staff from their bedroom when they needed support. People were at risk as staff were completing two or more tasks at once, including serving meals and administering medicines. Staff had not completed all the training they needed and people could not be confident that staff had the skills and knowledge to provide their care safely and effectively.
People were at risk of loneliness, isolation and boredom and had very little opportunity to participate in activities and past times they enjoyed. People told us they had nothing to do. The providers had not asked people for their views about the service they received and had not responded to complaints people made. There was no process to review the service and make improvements.
Medicines were not protected from extreme temperatures (hot and cold) and there was a risk that the medicines may not be effective or may harm the person taking them. Guidelines were not in place for ‘when required’ (PRN), and there was a risk people would not get the medicines, including pain relief they needed.
Effective safeguarding processes were not in place and staff did not know how to report concerns they may have. Evacuation plans did not give staff the guidance they needed to keep people safe in an emergency. People were at risk as the building and equipment had not been maintained. People were unable to have a bath as the bath was broken. Important safety checks had not been completed to ensure that the premises did not pose a risk to people.
The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Systems were not in place to make sure that people’s liberty was not unlawfully restricted.
People were not offered choices about the food they ate. Food was not prepared to meet people’s specialist dietary needs and keep everyone healthy. Meals did not include fresh vegetables. People were not offered snacks regularly during the day. People who needed pureed food were not able to taste the flavours of each food as it was pureed together.
Risks to people had been identified and action to keep people safe had not been taken. Changes to the care people need had not been planned. Staff did not always deliver care in the way it was planned or as people preferred.
The staff did not know what the aims and objectives of the service were and were not supported to provide good quality care. Systems were not in place to check the quality and safety of the service and the providers had not identified the shortfalls in the quality of the service and practice we found at the inspection.
Effective systems were not in place for staff to share information about people and the care they needed. Records were kept about the care people received and about the day to day running of the service. Information about people could not be located promptly when it was needed.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.