Ashburton House

Ashburton House is a residential care home providing accommodation and personal care to up to 24 people. The service provides support to older people, including people who are living with dementia. At the time of our inspection there were 23 people living at the care home.

Accommodation is provided over the ground floor and first floor, including a recently adapted annexe. There were four separate staircases in the home and a passenger lift, which enabled people to access some areas of the first floor. The first floor could be accessed by stairlifts

Communal rooms included an open plan area, with two lounges and a dining room and interconnected by a gradual slope with handrails. There was also a separate lounge, which provided a quiet space for people and their families, as well as a space for religious worship or spiritual practice. Outside of the dining room was a patio and a large lawn.

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

Since our last inspection, the provider had reflected on their role and how the service was run and staffed. Consequently, there had been significant changes to the staff team, resulting in a positive impact on the quality of care and the running of the care home.

The new registered manager was popular with the staff group and relatives. People living at the home also responded well to the registered manager who knew them well. Staff said, “The registered manager is amazing… Staffing has totally changed, we work as a team, the new starters come together. Best job I have ever had.” A relative said, “The home now has a manager who is working extremely hard to put good/safe practice in place, gaining the trust and respect of staff, residents and their families.”

There was an improved approach to managing risks both to people and linked to the environment with improved recording in most areas. During and following the inspection, actions were completed to address other issues linked to potential risk, such as the layout of the laundry and the fencing around the garden.

There was improved oversight in place to ensure accidents, incidents or near misses were reviewed by the management team and remedial action was taken to reduce any identified or emerging risk. Since the last inspection, there have been no further safeguarding concerns. The service provided safe care to people. People looked at ease and comfortable in the company of staff. For example, they said, “I like it here, it’s a nice space and they’re always kind.” Relatives said they would recommend the service to other families. For example, they said “Atmosphere is lovely, friendly and homely, staff always talking to residents, certainly I would recommend.”

Changes were being made to how staff were recruited, including a new staff member to oversee the process. The staff team met people’s care needs. For example, we saw staff were attentive, checking on people’s well-being and taking time to listen to them. People told us staff were friendly and kind. Relatives were positive about the skills and approach of the staff group. One noted there had been a number of staff changes but said all were caring.

Medicine records showed people received their medicines in the way prescribed for them. Staff support including training and induction had significantly improved since our last inspection. Most of the staff working at the home were new in post but we saw they worked well as a team to benefit the people living at the home. Staff looked calm, cheerful and relaxed during the inspection.

Improvements had been made to the environment. The large lawn had a perimeter fence and security had improved. The registered manager told the inspector there were further plans to enhance the area for people living with dementia.

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.

Staff spoke respectfully and with compassion about the people they supported at the home. Throughout our inspection, we saw gentle shows of affection by staff, both through their actions and their conversation and tone of voice. Staff showed a genuine interest in the well-being of each person. They recognised how the new registered manager had established an improved ethos at the home, which included celebrating people’s difference. A staff member said, “I would just like to say how much the home has improved and is still improving. Staff are coming together as a good functioning team ensuring care comes first.”

Care records information had improved, which was personal to each individual. This had been noted by a visiting health professional. We saw personalised information in care plans which gave important information to staff in how to work alongside people and maintain their dignity and trust. A health professional said the registered manager and staff went the “extra mile” to meet people’s individual care needs and worked closely with families. There had been improvement to people's end of life care wishes. This meant people could receive the care and support they needed to reassure them, for example, the last rites or to listen to a piece of music which gave them comfort.

Social events were now delivered by a skilled staff member who treated people as equals. There was a good range of social opportunities for people, including visiting musicians, quizzes, trips to the pub and cafes.

The management of complaints was improving. For example, how they were recorded and the tone of the response. The registered manager was supported by the new operations manager which worked well. This meant there was increased oversight of concerns and provided an extra layer of response if complainants were not satisfied with the initial response.

Care staff recognised how important it was to understand and get to know each person so they could provide individualised care. Throughout the inspection, staff checked with people to ensure they had understood their wishes and had their consent. A person told us, “Nothing is too much trouble. They treat me with dignity and respect.”

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 inadequate (published 25 October 2022).

At this inspection we found improvements had been made and the provider was no longer in breach of 8 regulations. This service has been in Special Measures since 25 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

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

Ashburton House is a residential care home providing accommodation and personal care to up to 24 people. The service provides support to older people, including people who are living with dementia. At the time of our inspection there were 23 people using the service.

Accommodation is provided over the ground floor and first floor, including a recently adapted annexe. There were four flights of stairs in the home and a passenger lift, which enabled people to access some areas of the first floor. The second floor could be accessed by stairlifts. Some bedrooms had ensuite facilities; one room was used specifically for respite stays.

The lounge and the dining room were open plan and interconnected by a gradual slope with handrails. There was a second lounge, but staff said this was rarely used by people living at the home. Outside of the dining room was a patio area and grounds, including the laundry, a tool shed and various other storage areas. This area was not secure.

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

Lessons were not learnt when things went wrong. Risks were not safely assessed, monitored and managed, even after a person using the service had died. Effective action wasn’t always taken promptly when risks were known. Some people told us they felt safe at Ashburton House, others told us they had changed their routine to avoid conflict from another person. People were not always protected from abuse and improper treatment. There were not enough staff deployed in the evening. Medicines were not stored or audited appropriately. Medicine records showed people did not always get their medicines in the way they were prescribed. The risk and spread of infection were not well managed.

People were put at risk because staff had not received appropriate support, training, and professional development. Areas of the home were not suitable for the purpose for which they were being used. This included the grounds which put people at potential risk of harm, particularly those at risk of falls, living with dementia, or a visual impairment. There was information missing from care plans, including mental capacity assessments and best interest decisions. People were not supported to live healthier lives.

Care plans contained minimal information about people’s cultural and spiritual needs, despite this being a very important issue for some people. People weren’t always supported to express their views or be involved in decisions about their care. Staff practice we observed was not always person centred and people’s dignity was not always respected.

Although some staff knew people well and were therefore able to engage with them about their lives, care records did not contain information which was personal to each individual. This could mean people did not receive personalised care when agency or new staff were on duty. The lack of information about people’s communication needs, and suitable ways to respond to people when they were distressed, meant staff were not equipped to meet people’s emotional needs. There was a failure at the service to ensure everyone living there received social stimulation to match their preferences and abilities. There was no system to identify, record or respond to complaints.

The service was not well-led. The provider failed to carry out their regulatory responsibilities. Quality assurance processes were in ineffective. This meant risk of harm was not suitably acted on. The provider failed to ensure there were systems and processes in place to guarantee people received person-centred care, or that promoted a positive inclusive and empowering culture which achieved good outcomes for people.

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

This service was registered with us on 6 October 2021 and this is the first inspection.

The last rating for the service under the previous provider was Good published on 11 August 2017.

Why we inspected

The inspection was prompted in part by a notification of an incident where a person using the service had died following a fall. During the inspection, we found known risks were not well assessed, monitored or managed which put people at risk of harm.

The information CQC received about the incident indicated concerns about the management of risk for people who fell and for people living with dementia who were independently mobile. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We met with the provider and the nominated individual on 11 August 2022 to discuss our regulatory response. We continued to participate in whole service and individual safeguarding meetings to monitor the management of the service and the well-being and safety of people living at Ashburton House.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.