Archived: Ashlar House - Leeds

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.

Ashlar House is registered to provide accommodation for people who require personal care for up to eight people with autism. Care is provided on three floors in singly occupied rooms, some of which are very spacious. Each room is provided with all necessary aids and adaptations to suit a person’s individual requirements. There are communal areas for dining and relaxation. At the time of our inspection seven people were using the 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 and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. 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 intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Even though the management team were not fully aware of Registering the Right Support, the service applied these principles and values and other best practice guidance. These ensured people who used the service could live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people who used 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 as many opportunities as possible for them to gain new skills and become more independent.

The provider did not have effective systems in place to assess, monitor and improve the quality of service provided. Complete, accurate and contemporaneous records were not always kept. 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. However, best interest’s decisions had not always been recorded following a mental capacity assessment.

Individual risks to people's health and safety were assessed and mitigated. However, concerns were noted regarding fire safety risks and actions in the providers legionella risk assessment. The provider did not have robust infection prevention and control systems in place. The home needed redecoration and refurbishment. Some records and minor issues suggested medicines management was not always safe.

Staff did not receive appropriate training necessary to enable them to deliver effective care and support. Staff had not received sufficient formal supervision as outlined in the providers procedure or an annual appraisal.

People said staff were kind and caring. Staff understood how individual people preferred their care and support delivered and the importance of treating people with dignity and respect. The service was not supporting anyone who was at the end of their life. Support plans were person-centred and contained sufficient information for people’s care and support needs to be met. Staff involved healthcare professionals to support people's health needs where required. People received support with eating and drinking, when needed and were involved with weekly menu planning.

There were sufficient staff to meet people’s support and care needs. Recruitment processes were robust, and an induction was completed by all staff. People felt safe in the home and with staff. Lessons had been learnt from incidents that had happened. People were asked for their views about the service and the provider worked in partnership with other services to support people’s care and quality of life. There was a system in place to respond to any complaints.

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 Requires Improvement (report published 6 July 2018) and there were multiple breaches of regulation. The rating at this inspection has remained the same. 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 although, some improvements had been made the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified three continued breaches of regulation in relation to environmental risks, infection control, staff training and supervisions and lack of governance systems. 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 will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider is required as a condition of their registration to have a registered manager in post. A new manager started at the service in September 2017 and had applied to the CQC to become the registered manager. 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.

Ashlar House had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection, seven people lived at the service.

At our last inspection in February 2017 we rated the service as ‘Requires Improvement’ over all. We made a recommendation for the provider to formalise their system of audits to ensure risks, around the health and safety of the environment and recording of medicines, were not overlooked. At this inspection we found the quality assurance systems continued to be ineffective and have again rated the service ‘Requires Improvement’ over all.

People did not consistently receive person-centred care. Person centred care is when care and support is planned with the person and taking on board their preferences and choices. Records did not demonstrate people were involved in discussions about their care, had consented to this or been involved in setting their goals and outcomes. Regular care reviews were not completed. Some people’s carers noted they were not consistently involved in discussions about the person’s care. There were limited records to show people received adequate stimulation relevant to their needs and choices. Some concerns were raised that people did not receive adequate stimulation and that activities were not person-centred.

The assessment of risk and systems in place to prevent and control the spread of infection were ineffective. The provider did not have an infection prevention and control lead and we found the service was unclean and in need of redecoration and refurbishment.

When people had complex health care needs, which placed them at increased risk, care plans had not been completed.

Staff told us they received supervision however there were only two records of supervisions for the entire staff team. The provider and manager did not have oversight of how often supervisions were being completed. They were unable to confirm who had received support in relation to their well-being, role and professional development which was not in accordance with the provider’s own policy. Staff had not received an appraisal within the last 12 months. Some staff reported a lack of effective communication between them and management.

The provider had not implemented effective systems to monitor the quality and safety of the service. Audits were limited in their scope and had not consistently highlighted the issues we found during our inspection.

The provider’s representative and manager took some actions to address our concerns and reviewed some of the documentation between days one and two of our inspection. They were open and honest with us throughout the inspection and it was evident they wanted to make the necessary improvements for the benefit of the people who used the service.

Staff continued to be recruited in a safe manner and care was provided by a consistent team. The service used regular agency staff and completed checks to ensure they had the necessary skills and knowledge to safely support people. The provider had a safeguarding policy and staff understood how to safeguard people from abuse.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making decisions on behalf of people who lack the mental capacity to so for themselves. When a person lacks capacity to make particular decisions, any made on their behalf must be in their best interests. Where there were concerns about a person’s mental capacity assessments and associated best interest decisions had not been recorded. However, the manager was aware of this and was in the process of updating the documentation.

People received support to eat and drink and their weights were monitored. People had access to healthcare professionals and staff sought their advice when needed.

Staff were kind with the people they supported and promoted people’s dignity.

Each person who used the service had a care plan which contained some person-centred information, although these were not consistently in a format most suitable to the person’s needs. The provider had a complaints policy and complaints were responded to appropriately. The system of overview to document complaints received was being developed by the provider.

The manager had considered ways to include people in the running of the service and was in the process of embedding this.

We found breaches of regulation in relation to person-centred care, safe care and treatment, staffing and governance. You can see the action we asked the registered provider to take at the back of the full version of this report.

Ashlar House provides care and support for up to eight people with autism. Care is provided on three floors in singly occupied rooms. There are a number of communal areas for dining and relaxation. There is also a garden area to the front and a small courtyard to the rear of the home.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service some months previously. A new manager had been appointed and was in the process of making their application to become the registered manager. 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 and associated Regulations about how the service is run.

People told us they felt safe and well looked after at the home and there were enough staff to meet their needs. We saw there was a positive atmosphere in the service and people who used the service had developed very good relationships with the staff team. People had thorough management plans in place to manage risks, which staff understood and followed to ensure people’s safety.

There were systems in place to safeguard people who used the service and to ensure people were protected from abuse. Staff knew how to report any suspicions of abuse or poor practice and felt confident anything reported would be acted upon. Recruitment procedures were robust to ensure that staff were suitable and fit to be employed.

Overall there were systems in place to ensure people received their medication safely. However, one person’s medication needed to be reviewed to ensure up to date instructions were in place.

Some areas of the home were in need of cleaning and décor and furnishings were looking worn and in need of replacement and renewal.

People received care and support from staff that had the skills and knowledge to understand their role. Staff training was updated regularly and staff had regular supervision that helped identify training needs and improve the quality of care.

The management team and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had made appropriate referrals to the relevant authorities to ensure people's rights were protected. However, one authorisation to deprive people of their liberty had expired at the time of our inspection. This was immediately addressed by the manager.

People received timely access to healthcare; a range of other professionals were involved to help make sure people stayed healthy. People’s nutritional needs were met well.

People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Staff understood people's individual needs in relation to their care and communication.

There was opportunity for people to be involved in a range of activities that met their social and cultural needs. People were supported to pursue social interests relevant to their needs, wishes and interests. Arrangements were in place for people to maintain links with the local community, friends and family.

Systems of quality assurance were in place to monitor whether the service was providing high quality care. However, these had not always been effective to ensure continuous improvement in the service. Issues we identified through the process of our inspection had not been picked up from the audits in place. We made a recommendation that systems of audit need to be formalised to ensure risks are not overlooked.

All the people that we spoke with said they were happy at Ashlar House. One person said, "It's great, it's the best place ever." People said they were supported to live their lives as independently as they wished.

People we spoke with said they were involved in their care plans and any decisions made for example they helped decide where to go on trips.

We observed that people were treated respectfully and that staff were attentive to maintaining the privacy and dignity of those they cared for.

We saw that there were effective cleaning procedures in place which reduced the risk of infection. People told us they liked the people caring for and supporting them. People told us that it was always clean and tidy and everyone helped to do the cleaning.

There was an effective complaints procedure.