• Care Home
  • Care home

Archived: Ashbourne House - Torquay

Overall: Inadequate read more about inspection ratings

213 St Marychurch Road, Torquay, Devon, TQ1 3JT (01803) 327041

Provided and run by:
Mr & Mrs R G Williamson

Important: The provider of this service changed. See new profile

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Background to this inspection

Updated 22 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We visited the care home unannounced on 27 and 29 September 2016. The inspection team consisted of one inspector.

Before our inspection we reviewed the information we held about the service. We reviewed notifications of incidents that the provider had sent us since the last inspection. A notification is information about important events, which the service is required to send us by law. We also contacted Healthwatch Devon and the local authority.

During our inspection we spoke with five people, observed how people spent their day, as well as people's lunch time experience. We also spoke with four relatives, four members of care staff, one domestic, the chef, a kitchen assistant, the manager and the registered providers. We also spoke with a social worker and district nurse.

We looked at ten records that related to the care and support of people, three medicine administration records (MARs), accident and incident records, staffing rotas, staffing dependency tools, the provider’s training matrix, and five personnel files. We also looked at quality assurance and monitoring paperwork, complaints and

After our inspection because of identified concerns we raised a safeguarding alert with the local authority. We also contacted a GP practice and district nurse to obtain their views about the service.

Overall inspection

Inadequate

Updated 22 November 2016

We carried out an unannounced comprehensive inspection of this service on 27 and 29 September 2016.

Ashbourne House – Torquay is a residential care home for older people. It is registered to accommodate a maximum of 28 people. On the days of our inspection there were 21 people living at the service. The service provides care and support for people living with dementia. The service also offers a day care facility.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

The provider managed the service and was registered with the Care Quality Commission. 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.

Prior to our inspection the Commission had been advised by the local authority that two safeguarding alerts had been raised. Concerns related to staffing levels, people not always being kept safe from avoidable harm or abuse, the training and competence of staff, and the management and leadership of the service.

People and their relatives told us there were not enough staff to meet their needs. Staff told us they felt pressurised and explained they were struggling to meet people’s personal care and social care needs. The provider and manager recognised more staff were needed and were taking action, but had faced a delay in obtaining employment checks for some people. At the end of our inspection on day one, the provider was reviewing their day time staffing levels and had increased their staffing levels at night.

People received care from staff who had undergone training to meet their needs. However, essential training, such as dementia care had not been undertaken by staff, but the provider told us this had been booked for October 2016. Staff were not supported and supervised to ensure people’s needs were met effectively. Staff told us they did not feel supported by the manager or provider, telling us they did not feel they listened to their concerns about the current staffing pressures they faced and the impact that this was having.

People told us staff were kind. Staff, interacted with people in a kind way but were observed to be rushed in their approach, and predominately focused on tasks. People’s friends and relatives could visit at any time and were made to feel welcome. People’s privacy was respected.

People’s dignity was not always promoted. People appeared unkempt. Relatives commented that sometimes their loved one was found to be wearing other people’s clothes, and that their clothing had not been changed for a number of days.

People were not protected from risks associated with their care. People did not always have risk assessments in place, and staff did not know how to meet people’s moving and handling needs safely. Risks associated with people’s nutrition and hydration, were not being effectively monitored to help ensure prompt action was taken when necessary. Risks associated with people’s skin were not being managed to help reduce the likelihood of people developing pressure sores. Accident reports and records were not always legible or detailed. This meant the provider was unable to effectively investigate incidents, to be able to put plans for improvement into place.

The provider had environmental risk assessments in place to identify how risks should be managed to ensure people’s safety. However, action had not been taken to address previous environmental concerns raised at our inspection in July 2014.

Moving and handling and fire equipment was serviced in line with manufacturers’ guidelines, to ensure it was safe to be used. People had personal emergency evacuation plans (PEEPs) in place which meant emergency services could be informed of how people should be assisted in an emergency, such as in the event of a fire. Thermostatic valves ensured the water temperature was regulated so people did not burn themselves.

People were not protected from avoidable harm and abuse, because the provider did not learn from mistakes and staff did not fully understand safeguarding procedures. People were not always protected from infection control practices to help prevent and control the spread of infection. Infection controls audits had not helped to highlight when improvements were required.

People were supported with their medicines in a respectful manner; however people’s care plans did not always provide details about their medicines. This meant staff may not know how people needed to be supported. People’s medicines were not always recorded accurately when administered which meant it was not clear if they had been given the correct dose. Monitoring checks did not always highlight where improvements were required. People had access to health care services to support them with their ongoing health and wellbeing.

People’s human rights were not protected because the manager and provider had a limited understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Where decisions were being made for people, there was no evidence to show that a best interests process had taken place to ensure the least restrictive options were considered. People’s consent to care was asked for prior to the person being supported, however people’s care plans did not document their consent to the care and support they were receiving.

People enjoyed the meals provided, however, people and their loved ones had not been involved in the creation of the menu which meant people’s likes and dislikes were not always being considered. People’s nutritional care plans were not always up to date and reflective of the support they needed, which meant people may not be supported correctly. People’s care plans did not always prompt staff to take responsive action to help ensure people were effectively supported with their nutrition and hydration, and to ensure that concerns were escalated to healthcare professionals when necessary.

Pre-assessments were carried out prior to a person moving into the service. However, the recent pre-assessments had failed to take into account the staffing pressures at the service and that staff had not undertaken dementia training. The admission of new people had therefore placed a further pressure on the service and had negatively impacted on the care and support people already living at the service received.

People did not receive personalised care which was responsive to their needs. People had care plans in place, but care plans were not up to date and reflective of the care they required. This meant staff did not have the correct information to provide safe, effective and responsive care to people.

Care plans which had been created by external healthcare professionals were not always followed to ensure people’s needs were met. People, who were cared for at the end of their life did not have care plans in place. This meant staff did not have information about what people’s wishes and preferences were to enable them to provide personalised care and support.

People’s care plans had not been created with the person or their families to ensure they reflected their wishes and preferences. People, living with dementia did not have care plans to inform staff of the best way they should be supported. People had little to do through-out the day to occupy themselves. Social activities were limited.

People’s complaints were not always effectively listened to and resolved, and complaints were not always used to improve the service. The provider and manager told us they would reflect on how they had handled previous complaints, in order to make improvements.

There was a management structure in place which included the provider and manager. However, the manager was unable to manage the service effectively because they had been working as a member of staff, due to staff shortages. Relatives, staff and some external health and social care professionals told us they did not feel the service was well-led; and the findings of our inspection also demonstrated the service did not have effective leadership.

The provider had some systems and processes in place to help monitor the quality of care people received. However, the tools which were in place had not identified areas requiring improvement and people’s