Ashburton House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider maintained a record of any falls or adverse incidents reported by staff within the service. Analysis of these incidents was undertaken and patterns and trends identified so action could be taken to prevent recurrence of events such as falls. Learning around accidents or incidents was shared with the staff team. Staff had a clear understanding of the action to take in the event of an accident or incident.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There was a procedure to follow before people were admitted to the home. This included a pre-admission assessment to establish a person’s needs. The provider undertook this in collaboration with the relevant funding authority, where appropriate. Where required, once people had moved in, staff continued to work closely with healthcare professionals to promote safe and consistent care.

The provider confirmed they had a process to ensure continuity of care. For example, if a person was admitted into hospital, key information from their care records, that hospital staff may need went with them.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were systems to ensure people were protected from the risk of harm, abuse or discrimination. The provider worked with safeguarding agencies where required and relevant information was shared. The provider had raised concerns with the local authority where safeguarding concerns had been identified. Staff were able to clearly describe to us how they would identify potential abuse and what action they would take to escalate this appropriately. No concerns were raised by people or their relatives about the care and support they received from staff.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found the provider had systems and processes to monitor approved and pending DoLS applications. There was a tracker that showed where DoLS had been approved and others that were pending with the relevant local authority.

We identified some improvements were required in relation to risk management. However, the provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Where people had specific health needs which placed them at risk of harm, risk assessments had been completed and the risks relating to the condition had been considered. However, for a person we identified was at risk of bowel impaction and pain from several days of constipation, it was not clearly documented this had been escalated. We discussed this with the registered manager and provider who were looking to develop a system to identify this earlier to reduce discomfort.

Management regularly reviewed care plans and risk assessments. Staff knew people well and understood how to support them safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider undertook regular audits to monitor the safety of the home environment and equipment. Mobility, fire equipment and emergency lighting were tested regularly to ensure it was in good working order. There were also water temperature checks, legionella testing, gas safety certificates, electrical hard wiring and portable electrical appliance tests.

People had individual Personal Emergency Evacuation Plans (PEEPs) to aid them in being safely evacuated from the service in the event of an emergency. The provider had a continuity plan in the event of an evacuation being required or the loss of essential supplies such as electricity or water.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider used a dependency tool to assess and maintain safe staffing levels. We received mixed feedback from people who used the service. Some people told us there was always enough staff, while others felt that at times staffing levels were occasionally low leading to a delay in care. Comments included, “There’s never enough staff. They are working at the limit. Saturday and Sundays are a problem,” and “I think that they have enough. I don’t have to wait too long if I need help. No concerns were raised by staff in relation to staffing levels. Sometimes they will sit and chat.” During our assessment visit we observed staff were attentive and responded to people’s needs quickly.

The provider had appropriate training and continuous staff support. Staff confirmed they received training and told us it was appropriate to their roles. One said, “I just finished my manual handling refresher, and I did my Restore training [teaches health and care staff how to recognise the early signs of physical deterioration in people] and we have the online training, so I think it is very good.” Staff received supervision and appraisal to support them and develop them in their role. Staff were recruited safely with appropriate checks taking place to ensure their eligibility to work and suitability to work with vulnerable adults.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

During our assessment visit, we observed that the environment was clean and well maintained. Staff were seen wearing appropriate personal protective equipment when required and used it correctly, demonstrating good awareness of infection prevention and control practices.

No concerns were raised by people’s relatives or healthcare professionals in relation to the cleanliness of the environment. The registered manager and provider used auditing systems and processes to monitor the cleanliness of the service.

The provider did not always make sure that medicines and treatments were safe and consistently met people’s needs, capacities and preferences. Staff did not always involve people in planning.

When medicines were administered, they were recorded on an electronic medicines administration record system. If medicines were prescribed to be taken ‘when required’, there were protocols to guide staff when these might be needed, and staff were knowledgeable about people’s medicines. However, we found one person who did not have full details recorded about how and when their ‘when required’ medicines would need to be given. This was followed up during our visit, and we were told the care plan would be updated to give personalised guidance for staff.

People were supported to manage their own medicines, and risks were assessed and recorded to make sure this was safe. Risks were also recorded for medicines such as anticoagulant blood thinners and flammable topical preparations.

We observed medicines being given safely and in a caring way. However, improvements were needed to the timings of medicines rounds. This was to reduce the risk of doses being delayed or not given, due to there being an insufficient safe time gap between rounds. New systems that addressed this issue were introduced immediately after the assessment.

There were suitable arrangements for ordering, storage and disposal, including items needing cold storage and those needing extra security. Storage temperatures were monitored to ensure medicines would be safe and effective.

Staff had training and competency checks to make sure they gave medicines safely. Medicines policies were in place to guide staff. Regular medicines audits took place which identified some areas for improvements, however the issue of timings of medicines rounds had not been identified in these audits.