Archived: Ashley House - Bristol

This inspection was undertaken by two inspectors. We looked at the operation of the home over the course of the waking day. Time was spent speaking with people who lived in the home, staff, and the registered manager. We also spent time looking at various records and touring the building.

There were 12 people living in the home during our inspection. We also spoke with seven people who used the service. Some of the people who were using the service were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible

This helped us to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was not safe. Appropriate arrangements had not been made to protect people from the risks of unsafe or inappropriate care. People we spoke with told us they felt safe living at Ashley House (Bristol) and felt able to raise any concerns with staff or the manager. Nobody we spoke with who lived at Ashley House told us or felt uncomfortable with the actions or attitude of the staff that provided support for them.

However, during the inspection, we raised a safeguarding concern with the registered manager. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. We asked the registered manager to take appropriate action by immediately informing the relevant authorities and following their own procedures for responding to it. The overall review of this matter was not yet concluded.

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There were insufficient qualified, skilled and experienced staff to meet people's assessed needs. The home had no dependency tool for calculating staffing levels. The registered manager was unsure how they arrived at the present staffing level and thought this was agreed with the local authority. This put people at risk of unsafe care.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people who lacked mental capacity to help keep them safe. We found that no policies and procedures were in place and staff had not been trained to understand when a DoLS application should be made and how to submit one. This meant that people who used the service could be unnecessarily restricted and deprived of their human rights.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. There were gaps in the medicines administration record sheets which could mean that people had not received there medicines to meet their health needs.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

Is the service effective?

The service was not effective. Staff had not received regular formal supervision or appraisal. The staff we spoke with all felt they were not well supported in their role. One member of staff we spoke with told us, we do not get any support here. I have not received supervision for a long time'. Another staff member told us, 'If you are unsure about anything there is no one to ask the manager is not approachable '. This meant that their knowledge and practice was not regularly assessed.

Is the service caring?

The service was caring. We spoke with three people who lived at the home during our inspection. Not all the people we spoke with were able to communicate using words but they were able to indicate they were content with the support they received by using gestures to indicate they were happy. One person who lived at the home told us, "I like it here; it's always been alright' People said staff did everything needed to support them with their day to day living.

We observed most staff continually working to support people with all aspects of care. We observed staff communicating and interacting well whilst supporting people.

People's preferences and diverse needs had been recorded and care and sup ort had been provided in accordance with people's wishes

Is the service well-led?

The service was not well led. There was a lack of effective systems to assess and monitor the quality of the service. There was no system of audits to identify areas that needed to improve and no plans to address these. We identified shortfalls in risk management , maintenance, incident and accident monitoring and medicines administration demonstrating that the provider had failed to provide service that met people's needs.

Staff spoken with had lost confidence in the management of the home.

When we spoke with staff they told us that generally staff morale was low at the present time and there were a number of issues that they felt needed addressing.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people were treated with dignity and respect and systems were in place to support people to make choices and decisions. Safeguarding policies and procedures were clearly displayed and staff understood what to do if abuse was witnessed, suspected or alleged. We saw that risks were assessed and plans put in place to manage risks whilst not overprotecting people. People's health care needs were assessed and planned for and plans were in place to deal with emergencies.

There was no system in place to identify safe staffing levels. Staff members told us they were concerned about staffing levels. We were told "we could do with more staff" and "staffing levels are uncomfortable" and "people just sit around or pace around because of boredom". We found that staff had not received training in helping people manage their behaviours. Staff told us "we are unclear how to handle physical challenges" and "we need training in mental health as I'm concerned over recent incidents".

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring they provide sufficient numbers of suitably qualified, skilled and experienced staff to care for and support people safely.

Staff members told us they had received training in understanding the Mental Capacity Act. We spoke with staff, who confirmed that they had received training in the MCA. The service had not submitted any applications for Deprivation of Liberty Safeguards. The provider told us that they worked closely with other professionals and that deprivation of liberty would only be used if it was in the person's best interests. We saw the provider had information available on mental capacity and deprivation of liberty including easy read versions.

Is the service effective?

We found that people's needs were assessed and plans drawn up to meet their needs. We saw that staff worked in accordance with people's individual plans and that plans were reviewed regularly. A named keyworker system was in place and one person told us "I like my keyworker". Staff told us this system worked well.

People's health care needs had been assessed with relevant professionals being involved in drawing up plans for epilepsy and emergency treatment if needed, with food and nutrition, with movement and exercise and with accessing and consenting to medical treatment.

We saw that people's mobility and other individual needs had been taken into account. For instance, with one person for whom regular routine was important, plans had been drawn up to give detailed information on how the person should be cared for and supported with their morning, afternoon and evening routines. There was evidence that these plans were being followed in the form of reviews of their plans of care and daily recordings. Another example we saw resulted from one person's needs having changed meaning that they needed more support with their mobility. Plans had been put in place for staff to follow detailing how this was to be done. When observing staff supporting people we saw that these plans were being followed.

Is the service caring?

We found that people were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, 'the staff are nice'.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns had been raised these had been addressed.

We saw in people's care plans that their preferences, interests, aspirations and diverse needs were recorded and care and support was planned and provided in accordance with people's wishes.

Is the service responsive?

Individual arrangements were in place for people to be able to use community facilities such as shops and churches independently. The service had its own transport for people to participate in activities outside of the home.

We found evidence of the provider responding to issues raised by people. One example was how one person had commented that they needed more money to spend each week. The provider had responded to this and made more money available to the person. We saw positive comments on questionnaires completed by family representatives including "we're very happy with the care and support".

Is the service well led?

We found that staff had not received supervision in accordance with the homes policies and procedures. Staff we spoke with told us "I haven't had supervision for a long time" and "supervision isn't regular".

Staff received induction training and training relevant to their roles, including first aid, safeguarding medication administration and epilepsy. The provider told us that staff training in supporting people to manage their behaviour was needed. Staff told us "we are unclear how to handle physical challenges" and "we need training in mental health as I'm concerned over recent incidents".

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to how they provide supervision and training to staff to ensure they can care for and support people safely.

We saw that improvements had been made in relation to making decisions for people who did not have the capacity to consent to aspects of their care and support. Recordings of the decision making process were clear.

People at Ashley House benefited from clear care plans about the support they required. These had been improved since our last visit and staff confirmed that information was now more easily accessible.

The provider had taken steps to protect people from the risk of abuse because staff had been trained in safeguarding. We found that staff may benefit from further consolidation of their knowledge in this area. Arrangements in place for the supervision and training of staff had improved, although work was still to be done in this area.

There were systems in place to monitor the quality of service that people received and this included gathering feedback from people using the service and their representatives.

We looked at the arrangements in place for gaining people's consent and assessing people's capacity to make decisions in relation to their care. We found that there was a lack of awareness of when the principles of the Mental Capacity Act 2005 should be put in to place. This is legislation that protects the rights of people who may not be able to make decisions independently. This meant that there was a risk of decisions being made on a person's behalf that were not in their best interests.

We found some lapses in the recording of care plans and risk assessments, however these were currently under review. On the day of our visit, people were supported with their care needs promptly and respectfully. People were cared for in a clean and hygienic environment and were supported and encouraged to raise complaints and concerns.

We saw that staff had received training to support them in their roles and told us that there was good informal support in place. However staff did not receive formal supervision in line with the home's own policy.