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Ashness Two Requires improvement

Reports


Inspection carried out on 16 September 2019

During a routine inspection

Ashness Two is a residential care home providing personal care to people with mental health support needs. The service can support up to five people. At the time of the inspection there were four people living at the service.

The care home is an adapted period property with 5 bedrooms with a small communal lounge and kitchen and medium sized garden.

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

People told us they felt safe living at the service. The provider had assessed the risks people faced, however, had not always developed guidance about how to reduce these risks and what to do in emergency medical situations.

Medicines were not always managed safely. Medicine errors found during the inspection were corrected immediately and the provider implemented a new system to check medicines immediately.

Care records were not always personalised to reflect people’s preferences. People told us staff knew them well and were caring. Staff supported people’s diversity. People were involved in planning their care and were supported to maintain their independence.

The provider’s systems were not always robust enough to identify the issues we found at the service and ensure quality care. The provider had an ongoing development plan to improve the service and had developed partnerships with other organisations to develop the service.

People knew how to make a complaint about their care and felt the service listened to them. The service was open and inclusive and people spoke highly of the management team.

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 were encouraged to eat and drink enough and to access healthcare services.

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 good (published 20 April 2017) and there was one recommendation about safe care and treatment. At this inspection we found enough improvement had not been made and the provider was now in breach of the regulation to provide safe care and treatment.

Why we inspected

This was a planned inspection based on the previous rating and to check the safety and quality of care people received.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified one breach in relation to safe care and treatment at this inspection.

We made a recommendation about good governance .

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 21 February 2017

During a routine inspection

We inspected this service on 21 February 2017. The inspection was unannounced. Ashness Two is a care home registered for a maximum of five adults who have mental health needs. At the time of our inspection there were four people living at the service. A fifth person was in the process of gradually moving into the service.

The service is located in a large terraced house with access to a back garden.

The last inspection took place on 26 November 2015. At that inspection we found two legal requirements were not being met in relation to safe care and treatment, as medicines were not being safely managed and there was insufficient action taken to prevent fire in people’s bedrooms.

At the time of this inspection there was a registered manager in place. 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 staff were kind, caring and offered them support as they needed. There was a calm and relaxed atmosphere at the service on the day of the inspection. We saw staff talking and working with people in a calm and respectful manner.

People told us they felt safe and that the service was a good place to live in. We spoke with staff who were aware of the importance of safeguarding adults and knew what to do if they had any concerns.

The majority of people living at the service were independent and went out to meet friends and participate in hobbies and activities without support. But staff offered assistance with appointments when required, monitored and supported people with their mental health needs and ensured they had appropriate additional professional support if their needs changed.

Care and support plans were comprehensive and up to date. Risk assessments were in place for identified risks, but not all gave clear detailed advice to staff in how to manage these.

Medicines were stored safely and within the correct temperature range. We noted that records did not show tablets carried over from one month to the next so it was not possible to check stocks against records for all medicines, but this has been rectified since the inspection.

Supervision took place regularly and staff received training in key areas to ensure they were skilled to carry out their role.

The provider had ensured that recruitment checks, including Disclosure and Barring Service (DBS) certificates, were completed before staff started working with people. For some staff the provider had obtained verbal references but was still awaiting written references. However, these staff had worked as agency staff prior to becoming permanently employed so at that point the provider had received historical references. In this way they had satisfied themselves staff were considered safe to work with people who used the service.

We found the premises were tidy and whilst it was clear that daily cleaning took place there were areas where the service had built up grime. The registered manager undertook to carry out a deep clean of the service by the end of March 2017. A number of rooms had been decorated in the last six months and there were plans in place for other areas to be decorated by the end of March 2017.

We found that measures were in place for infection control through the use of specific mops for particular areas and chopping boards for specific food stuffs. However we found a fridge in the kitchen with a meat product that was cooked but not entirely sealed or labelled. It had been cooked just prior to our arrival. Also staff had stored their own food in the fridge that required freezing. These issues were resolved by the end of the day of the inspection.

One person had their money managed by the service and we saw the process was robust with records maintai

Inspection carried out on 12 and 26 November 2015

During a routine inspection

This inspection took place on 12 and 26 November 2015 and was unannounced.

The previous inspection was in November 2014. At that inspection we found three legal requirements were not being met. These related to the safety of the premises, record keeping and the training and supervision of staff. We found at this inspection that the provider had made some improvements in these areas. The communal rooms were in good repair and much cleaner, some improvements had been made in the quality of records and the provider had arranged an improved training programme for staff to help them understand the needs of people living in the home.

Ashness Two is a care home registered to provide care and accommodation to five people with mental health needs. There were four men living in the home at the time of our inspection. Each person had a single room with an en suite bathroom and shared a kitchen, small dining room and lounge. This home only accommodates men with mental health needs.

The previous registered manager left after the last inspection and one of the company directors who is the registered manager for another Ashness service became the registered manager for Ashness Two and appointed a senior support worker to assist with the day to day management of the home.

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.

This home aims to increase people’s independence skills. Since the last inspection one person had progressed on to less supported accommodation and one of the people living in the home also planned to move to a supported living project.

People told us that there were sufficient staff to meet their needs. Staff had training and were aware of how to protect people from the various types of abuse.

People were supported to make decisions about their care and lifestyles and attend health care appointments with support when needed. Staff received support and supervision in their role.

People were offered the opportunity to undertake a range of activities of their choice, but their decisions were respected if they chose not to. They were aware of how to make a complaint if they were unhappy about their care.

There were quality assurance systems in place for the service, and people felt supported by the home’s management.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the safe management of medicines and fire risk for bedrooms. We have also made one recommendation regarding monitoring of people’s nutritional needs. You can see what action we told the provider to take at the back of the full version of this report

Inspection carried out on 5 November 2014

During a routine inspection

This inspection took place on 5 November 2014. It was unannounced, which meant nobody at the service was told in advance of the inspection.

Ashness Two is a care home registered to provide care and support to five people with mental health needs. There were five people living in the service at the time of our inspection.

A new manager was in post at the home, and they had applied to the Care Quality Commission to be the registered manager. A registered manager is a person who has registered with the 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.

We last inspected this service in July 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

All five people living at the home told us they were happy with the overall support provided to them. Comments included “The accommodation is OK,” “There are enough staff around,” “Staff are good,” and “There’s nothing to improve.”

People told us that they, and their family members where relevant, had been included in planning and agreeing to the care provided. We saw that people had individual plans detailing the support they needed. However, we found that some people’s individual risk assessments and care plans were not comprehensive in relation to their needs. This put people at risk of receiving inappropriate or unsafe care, for example in responding to challenging behaviour or specific health care issues.

The home had an appropriate recruitment system for new staff to assess their suitability, and we found that staff on duty knew the people they were supporting and the choices they had made about their care and their lives. Staff supported people to maintain their independence and control over their lives and treated them with respect and compassion.

There were systems in place to monitor and address deficiencies to the home environment, but these were not sufficiently rigorous to fully protect people’s safety and welfare. We found some maintenance issues within the home which had not been reported by staff, including faults in kitchen and toilet facilities, leaving people at risk of living in an unsuitable environment.

Staff in the home knew how to recognise and report abuse, and what action to take if they were concerned about somebody’s safety or welfare. However systems in place to provide staff with training and supervision did not ensure that people’s needs were met consistently and in line with best practice. For example not all staff had undertaken diabetes, mental capacity or managing behaviour that challenges training. This training was needed to meet the individual needs of the people living in the home.

Staff supported people to attend routine health checks, and there was evidence of attention to people’s physical and mental health care needs. However, the service did not address people’s nutritional needs, and records did not demonstrate proactive support and progress made towards their individual goals.

Quality assurance systems at the service were in place to assess and monitor the service people received and there was a business development plan detailing improvements needed to the service. No complaints had been received within the last year, but people had the opportunity to comment on the service at regular ‘residents meetings’ within the home and through satisfaction questionnaires. They told us that they were satisfied with the management of the service. Health and social care professionals working with people living at the home also provided positive feedback about the support provided by the service.

We found 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to the home environment, staff support and record keeping. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 4 July 2013

During a routine inspection

In this report the name of Mr. Amos Boyede appears as a registered manager for this location. Mr. Boyede was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that staff at Ashness Two care home encouraged people to be independent and provided a good service. People told us that staff supported them, their views were listened to and they were learning to be independent so that they could eventually live more independently. We found that people's mental and physical health needs were assessed and met.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard but the lack of experience of some staff meant that their knowledge of mental health was limited.

Inspection carried out on 3 October 2012

During an inspection to make sure that the improvements required had been made

We spoke to one person living at the home. He told us that staff had supported him when he had a recent operation and that he had now recovered.

We spoke to the provider and a staff member and looked at health and medication records to find the evidence that the home had made improvements to medication and health records.

We found that people's health needs were being met. There was information on each person's medical history so that staff knew their health needs. Staff supported people by going with them to their medical appointments and keeping clear records of their appointments and health support needs.

There was clear information for staff about people's medicines, what they are prescribed for and what were possible side effects. The provider had given staff written guidance about how they should support people to take their prescribed medication safely. Medication charts were clear and accurate. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.