Archived: Ashlar House - Leeds

Updated 8 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector and an Expert by Experience on the first day; and one inspector on the second day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ashlar house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashlar House also provided a domiciliary care service. It provided personal care to one person living in their own house. The arrangements in place in relation to care planning, medicines, staffing and quality assurance were the same as in the care home.

The service had a manager who was in the process of registering with the CQC. The manager was being supported by the operations manager and the nominated individual, who were present during our inspection visits. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

We gave a short period of notice of the inspection because some people using this service needed to be informed of our visit in advance as they could otherwise have found an unannounced inspection difficult to manage.

What we did before the inspection

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the CQC. A notification is information about important events which the service is required to tell us about by law. We requested feedback from other stakeholders. These included Healthwatch Leeds, the local authority safeguarding team and commissioners. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection, we spoke with three people using the service and five relatives of people using the service. We spoke with one healthcare professional visiting the service. We spent time observing care in the communal lounges.

We spoke with seven staff members; this included the nominated individual, operations manager, home manager, shift leaders and care workers. We looked at care and medication records for two people living at the home and one person receiving domiciliary support. We looked at training, recruitment and supervision records for staff. We also reviewed various policies and procedures and the quality assurance and monitoring systems of the service.

After the inspection

We continued to review the information emailed by the provider to validate evidence found.

Updated 8 February 2020

About the service

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.