Ashley Court Care Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in continued breach of the legal regulations in relation to consent and the Mental Capacity Act 2005.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people's care and treatment were effective because assessed needs were not consistently reflected within care plans and supporting records.

The provider told us assessments were completed before people moved into the service and were used to develop care plans intended to meet people's assessed needs. For example, one person had a urinary catheter in place. Information relating to catheter care was included within the person's continence care plan, which stated staff should monitor catheter care and maintain accurate records. However, monitoring records were not consistently completed. Whilst some entries recorded urinary output volumes, other entries only recorded that the catheter bag had been emptied. This meant the provider could not demonstrate that catheter monitoring was being completed consistently in line with the person's assessed needs. This did not provide assurance that changes in the person's condition or catheter-related concerns would be identified promptly.

Another person's care plan did not reflect their communication needs or record the communication aids they used, including cue cards and a communication pad, despite staff describing these as important tools used to support communication. This meant staff may not always have access to the information required to understand and meet the person's needs consistently, particularly where agency staff were supporting people.

However, a relative told us, "They do ask me about their care plan." Staff also told us care plans were reviewed regularly and one staff member said, "The care plans do reflect real life and are updated through monthly resident of the day reviews." Whilst these arrangements were positive, our findings demonstrated people's assessed needs were not always accurately reflected in care records or consistently translated into practice.

The provider did not always ensure care and treatment was delivered in line with recognised best practice and guidance.

At our previous assessment, we identified concerns regarding how the environment supported people living with dementia and told the provider to take action. During this assessment, we saw some improvements had been made. These included additional signage, pictorial signs for key areas such as toilets, bathrooms and lounges, and individually coloured bedroom doors to support people to navigate the service.

However, some signage primarily consisted of directional arrows and written instructions, such as "for the lift", which may not always be meaningful for people living with dementia. Whilst the provider had taken steps to improve the environment, we were not assured that environmental adaptations consistently reflected recognised good practice for supporting people living with dementia.

We also found care and treatment was not always delivered in line with people's assessed needs. For example, one person's care records identified they required a Level 6 Soft and Bite-Sized Diet. However, on both site visits we observed food that did not appear consistent with this requirement. This did not provide assurance care was always delivered in line with people's assessed needs or recognised best practice for supporting safe eating and drinking.

These findings demonstrated care and treatment were not always delivered in line with recognised standards and best practice guidance.

The provider did not always ensure staff, teams and services worked together effectively to support people to achieve positive outcomes. Information was not always shared, understood or acted upon, which resulted in people not always receiving coordinated care that met their needs.

Relatives raised concerns regarding communication and coordination of care. One relative described ongoing concerns regarding their family member's hearing and told us, "(Person's name) had an issue with their hearing, and it's been going on for months and months and you are going around in circles." We reviewed the person's care records and did not identify clear information relating to these concerns or actions being taken to address them. Following discussion during the assessment, the provider told us they had taken action and were awaiting further information. Another relative told us, "We are never told what is happening." These findings meant changes in people's needs were not always clearly recorded, communicated and acted upon in a timely way, or people, relatives and professionals always worked together effectively to improve outcomes. We also found information was not always communicated effectively across the staff team. Following concerns raised during our first site visit, the provider assured us additional oversight checks would be carried out to ensure people received care in line with their assessed needs. Records showed these checks had been completed on some occasions. However, on our second site visit, staff confirmed required checks had not been completed prior to support being provided. This meant the additional oversight arrangements described by the provider were not applied consistently to ensure people received safe and effective support.

Although staff completed handovers and daily records, our findings demonstrated these arrangements were not always effective in ensuring information was shared and acted upon. As a result, people did not consistently receive coordinated care in response to their changing needs.

The provider did not always ensure people's healthcare needs were effectively monitored and managed. This meant opportunities to identify deterioration and respond to health concerns could be missed.

Records we reviewed showed several people were not consistently achieving their prescribed fluid intake targets. For example, fluid monitoring records demonstrated some people regularly failed to meet their assessed fluid goals; however, records did not consistently demonstrate concerns had been escalated or action taken in response. This meant the provider could not demonstrate that risks associated with hydration were being effectively monitored and managed.

We also observed one person consume a drink immediately when it was offered. Taken alongside the fluid monitoring records reviewed, this did not provide assurance that people's hydration needs were consistently recognised and responded to. As a result, opportunities to identify deterioration and support people's health and wellbeing may have been missed.

The provider did not routinely monitor people's care and treatment to improve outcomes. Systems and processes were not always effective in identifying concerns and ensuring appropriate action was taken.

Records showed one person had experienced 3 falls from bed. The provider could not demonstrate that sensor mat intended to support staff to monitor the person's falls risk had been effective in alerting staff following these incidents. Records showed staff became aware of the falls when they entered the person's room and found the person on the floor. In addition, the person's care plan required two-hourly welfare checks; however, records did not demonstrate these were consistently completed.

During the assessment, records indicated checks of the sensor mat had been completed. However, we found the sensor mat positioned underneath the bed at the time of the assessment. This did not provide assurance that equipment intended to support the monitoring and management of falls risks was being used effectively.

We also identified inconsistencies within records. For example, one record indicated a check had been completed at 9:30am; however, other records suggested there had been a gap of approximately 5 hours between checks, with the person being found on the floor at 10:00am. This meant the provider did not have an accurate record of how long the person had remained on the floor following the fall.

Our findings were consistent with concerns raised by a relative, who told us, "When they fall out of bed they do call me and tell me they have fallen, but they can't tell me when." They also said, "The paramedic phoned me about (person name) concerns, they did not know how long they had been there. The ambulance worked out it was over 3 hours on the floor."

Another person required 2-hourly repositioning to reduce the risk of skin damage; however, records showed significant gaps between repositioning interventions. We also found care plans, risk assessments and monitoring records were not always accurate, complete or reflective of people's current needs. This meant monitoring systems were not always effective in identifying risks, improving outcomes or preventing avoidable harm.

These findings demonstrated the provider was not always effectively monitoring people's care and treatment to ensure outcomes were positive, consistent and reflective of people's needs.

The provider did not always ensure people's consent to care and treatment was sought and recorded in line with the Mental Capacity Act 2005 (MCA).

At our previous assessment, concerns had been identified regarding decision-making and consent processes. During this assessment, we found some concerns remained. For example, one person's records indicated CCTV was being used as part of their care and support arrangements. However, records did not demonstrate how consent for the use of CCTV had been obtained or recorded. As a result, the provider could not demonstrate the person had been appropriately supported to make an informed decision regarding the use of CCTV.

We also found another person required additional support with communication. Records stated the person had consented to the use of CCTV and that this had been discussed with them in English. However, English was not the person's first language and records did not demonstrate how information had been provided in a way they could fully understand. This meant it was unclear how the person had been supported to make an informed decision regarding the use of CCTV.

These findings meant the provider could not demonstrate people had been appropriately supported to make informed decisions about their care and treatment, in line with the principles of the Mental Capacity Act 2005.

However, staff demonstrated an understanding of the importance of obtaining consent before providing care. One staff member told us, "I ask them, I explain if it's okay if I can check them, I won't do anything without consent."