11 July 2016
During a routine inspection
At the last inspection on 22 and 24 September 2015 we rated the service as overall ‘Inadequate’ and in ‘Special Measures’.
At the last inspection we identified seven regulatory breaches which related to dignity and respect, medication, person-centred care, meeting nutritional needs, good governance and the deployment of staff. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and the registered provider voluntarily suspended accepting new placements. Following this inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.
Ashlands is registered to accommodate up to 44 older people, most of whom have mental health and/or dementia related conditions.
At the time of our inspection the service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
Although we found some improvements had been made in respect of privacy and dignity, we found a number of continued breaches in safe care and treatment, staffing, person-centred care, meeting nutritional needs and good governance. We also found a breach relating to premises and equipment.
Relatives and staff told us they thought people living in the home were safe and protected from abuse. Safeguarding notifications had been made to the CQC as required. Appropriate recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people.
We found medicines were not managed safely as medicines were not check in to the home, stored and disposed of appropriately. People did not always receive their medicines on time and there were occasions when medicines were not given as prescribed. The use of topical creams was not robustly recorded. Medication competency was not checked for agency nursing staff.
Staff were uncertain how many people lived in the home and we found different instructions for staff to follow in the event of a fire. The registered manager had not responded to an identified need for further staff training in fire safety. Personal emergency evacuation plans (PEEPs) were in place, although staff were not aware they existed or where they could find them. Wall lights did not have covers fitted meaning people were at risk of harm as the exposed wires were live.
Staffing levels were calculated based on numbers of people in the home and there was no assessment based on level of dependency. On occasions, door sensors were seen to be unanswered or cancelled by staff who did not carry out appropriate checks to ensure people’s needs were met. Staff told us they felt more staff were needed.
The staff training matrix showed high levels of training had been completed. A programme of staff supervisions had commenced, although no staff appraisals had been completed.
The recording of people’s fluid intake was not consistently completed and we saw the quality of support people received from staff at lunchtime was variable.
People did not always receive timely access to healthcare. Healthcare professionals gave mixed feedback about this service.
People were more appropriately dressed since our last inspection and their preferences regarding when to go to bed were respected. However, not all people wore appropriate footwear. We noticed this had improved by the third day of our inspection. People’s privacy and dignity was observed by staff.
Care plans contained information regarding people’s likes and dislikes as well as other personal preferences. However, we found gaps in these records which could lead to people’s needs being missed or overlooked. Risk assessments were not always in place and staff did not take appropriate action to reduce risk as identified in risk assessments.
The quality manager was unable to demonstrate their oversight of the service as they did not have a system of checks in place separate to those carried out by the registered manager. The registered manager gathered information about the location, but did not analyse this to form meaningful action plans. Staff told us they liked the registered manager, but felt they needed a visible presence. The improvements identified in the registered provider’s action plan following the last inspection were not evident during this inspection.
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. if not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.