16 January 2020
During a routine inspection
Ashlar House is a care home providing care and support for people with learning disabilities and autism spectrum conditions who may, at times, display behaviours that challenge others. The service can support up to eight people in one residential adapted building. At the time of this inspection, seven people were living at the home. Ashlar House is also registered to provide personal care to people living in their own home in the community. At the time of our inspection, one person was receiving services from the home care service. During this inspection, we looked at the care provided both at the residential home and by the home care service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 8 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home.
People’s experience of using this service and what we found
At this inspection, we found considerable improvements had been made by the provider to put in place systems to effectively assess, monitor and improve the quality of service provided. However, some areas required further work and evidence showed these improvements had been implemented only in the recent months; therefore, limited evidence was available to confirm improvements would be sustained. The provider was going through organisational changes and they told us about their plans to continue developing the service to improve people’s experience while living at the service.
The service provided safe care. People and relative’s feedback was mostly positive about the support offered by staff. Risk assessments were in place to manage risks to people's care, and staff told us about the approaches they would follow to manage people’s behaviours in the least restrictive way possible.
Overall, medication was managed safely.
The service followed safe recruitment practices and we found enough staff were available to support people. The service frequently used agency staff to ensure adequate staffing levels and the provider told us they were in the process of recruiting more staff. We received mixed feedback from relatives in relation the consistent approach followed by staff.
The premises continued in need of ongoing repairs and renovations. These were identified and planned and there was an action plan to ensure issues were addressed timely to guarantee the safety of premises. Regular checks on the building’s safety and hygiene were being done.
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. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.
The provider completed person -centred assessments and care plans were updated when required. People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well.
People remained supported by staff who were caring and respectful. People, relatives and when appropriate, advocates, were involved in making decisions about the care people received.
Staff told us they felt appropriately supported in their roles. We saw most staff had their training up to date and had regular supervision meetings with their line manager. There was an open culture within the service, where people, staff and healthcare professionals could approach the management team if they had concerns or suggestions.
There was not a registered manager, however we found appropriate management arrangements were in place. A new manager had been appointed and was in the process of registering with the Care Quality Commission (CQC); they told us about their plans and vision to develop the service and the support they received from the provider.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 30 July 2019) and we found three breaches in regulation in our last inspection.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on a previous rating.
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.