Archived: Ashford Lodge

Ashford Lodge is a residential care home providing personal care for up to nine people with a learning disability. At the time of the inspection there were seven people using the service. One person lived in an annex on the grounds of the service giving them their own space.

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

People were not always treated in a way which was person- centred or took into account their wishes. Some people were restricted by staff and prevented from having a choice in their day to day activities. A few staff had raised some concerns with the registered manager, however, when these were they had not been acted upon or escalated outside the service

Professional help or guidance had not always been sought when people had unaccounted for lost weight. Fire checks and drills had not been completed in a timely fashion. Risk assessments had not been updated when people’s needs changed. Relatives stated that communication was poor, and they were not always informed of changes in their loved ones needs.

There were not always enough staff to keep people safe and ensure they could go out or take part in activities they enjoyed. Staff did not have regular supervision and told us their views were not listened to. Incidents were not reviewed for learning and had not been shared with relevant professionals or notified to CQC.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, people had restrictions placed on them for example the times they could watch television. People had limited access to food and were given food staff knew they did not like with no alternative available. Low staff levels restricted people’s ability to go out or take part in activities they enjoyed.

The provider had put in place temporary managers from two of its other services to support the service, after the registered manager recently resigned, identify shortfalls and take action to improve the care people received. The manager had identified the shortfalls found at this inspection and a plan was in place to address them. When action was urgent such as seeking medical advice for people this had been done. The managers were working to challenge poor practice and role model for staff.

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 good (published 06 July 2018).

Why we inspected

We received concerns about people being restricted and not having full choice in their lives, a closed culture and a lack of consistent support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashford Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safeguarding people from abuse and improper treatment and good governance. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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

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 work alongside the provider and 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.

Ashford Lodge is a residential care home for nine men and women with learning disabilities ranging from the age of 20 to 60. Ashford Lodge is a detached property in the village of Chilham, on the outskirts of Canterbury. At the time of our inspection, there were eight people living in the main building, and one person living in the on-site annex.

The service has 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 using the service can live as ordinary a life as any citizen.

Rating at last inspection

At our last inspection on 20 April 2016, we rated the service as Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

People had been safeguarded from potential harm and abuse. Risks had been assessed and mitigated, and people were encouraged to take positive risks. Staff had been subject to the relevant pre- employment checks and there were sufficient staff to keep people safe. One person told us “I feel safe because the door is locked at night, and there is enough staff.” People received their medicines when they needed them. The service was clean and protected by the prevention of infection control. The provider ensured lessons were learnt and improvement plans put in place when necessary.

People received effective care, in line with best practice, that achieved good outcomes for them. Staff received training tailored to the needs of the people they supported. People told us they were supported to eat and drink sufficient levels and were encouraged to live healthy lives. People received coordinated care when they moved between healthcare services. The service had been adapted to meet the needs of the people living there. Consent to care and treatment had been sought.

People told us they were treated with kindness and respect, and were given emotional support as and when they needed. People were actively involved in making decisions about their care as far as possible. People’s privacy and dignity were respected and all documentation was held securely.

People received person centred care that was responsive to their needs. People told us they were involved in activities that were meaningful to them. All complaints and concerns were logged and responded to appropriately. People and their relatives told us they knew how to raise concerns and felt confident they would be addressed. The service was not supporting anyone at the end of their lives.

People, staff and relatives told us the day to day culture of the service was positive, inclusive and focused on good outcomes for people. There were suitable arrangements in place to ensure the regulatory responsibility was met. The provider sought feedback from people, relatives and staff and used it to learn, improve and ensure sustainability for the service. The manager had formed relationships with external agencies including safeguarding.

Ashford Lodge is registered to provide accommodation and personal care for up to nine people who have a learning disability. Ashford Lodge is in the village of Chilham, on the outskirts of Canterbury. Eight people were living at the service, seven people lived in the main building, and each had their own ensuite bedroom. People had access to two communal lounges, dining room, kitchen, laundry room and a communal shower room and toilet. Adjacent to the main building is a self-contained annexe which has one bedroom, lounge, kitchen and bathroom facilities. There is a well maintained garden, with vegetable patch and outside area with off street parking within the gated grounds.

The service has a newly appointed manager, who was present throughout the inspection and is in the process of applying to be registered with the commission. 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 received their medicines safely and when they needed them. They were monitored for any side effects. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. When staff had completed induction training they had gone on to complete other training provided by the organisation. There was also training for staff in areas that were specific to the needs of people, like epilepsy and autism. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The manager and deputy manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager, their deputy and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted. Some of these had been authorised and they were waiting for the outcome for others from the local authorities who paid for the people’s care and support. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people moved into the service their support needs were assessed by the manager or deputy manager to make sure the service would be able to offer them the care that they needed. The care and support needs of each person were different, and each person’s care plan was personal to them. People had in depth care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff spoke about people in a respectful way which demonstrated that they cared about people’s welfare. Staff knew people and their support needs well.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they were able and wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Staff told us that the service was well led and that they had support from the deputy manager, who had managed the service whilst a manager was recruited, to make sure they could care safely and effectively for people. Staff said they could go to the new manager or deputy manager at any time and they would be listened to. Staff received regular one to one meetings with either the manager or the deputy manager. They had an annual appraisal, so had the opportunity to discuss their developmental needs for the following year.

Is the service safe?

The service was safe. People told us they felt safe and staff understood how to protect people's rights and safeguard the people they supported.

Systems were in place to make sure that the manager and staff learned from events such as accidents, incidents and concerns. People's care needs and the qualifications, skills and experience of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.

Is the service effective?

The service was effective People's health and care needs were assessed with them, and they were involved in their plans of care. Specialist dietary, mobility and developmental needs had been identified in care plans where required. People who used the service said that they had been involved in the planning of their care and we found that the care plans reflected their current needs.

People's needs were taken into account with the layout of the service, which enabled people to move around freely and safely.

Is the service caring?

The service was caring. People were supported by attentive staff who knew them well. We observed that support workers showed patience and gave encouragement when supporting people. One person told us "The staff are good, they help me."

We found that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We observed that people were supported by staff who focused on person centred support.

Is the service responsive?

The service was responsive People regularly completed a range of activities of their choice both in and outside of the service.

The provider and the staff worked in collaboration with outside professionals such as speech and language therapists and dieticians, where necessary and staff followed the recommendations made.

Is the service well-led?

The service was well led. This was a responsive inspection to follow up on some concerns We did not substantiate these concerns. At the time of our visit the service had a new manager who had been in post for four weeks and who was in the process of applying to us to be the registered manager. The manager was being supported by the area manager who visited the home regularly.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home.