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Archived: Ashlands Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 22 October 2016

This was an unannounced inspection carried out on 11, 25 July and 5 August 2016.

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 othe

Inspection areas

Safe

Inadequate

Updated 22 October 2016

The service was not safe

Medicines were not safely managed. People did not always receive their medicines as required. Medicines were not safely stored and the use of topical creams was not robustly recorded.

Staffing levels were determined based on numbers of people and did not consider their levels of dependency. Relatives and staff felt people were safe.

Risks to people were not well managed as people were exposed to harm which had not always been identified, documented or responded to appropriately.

Effective

Inadequate

Updated 22 October 2016

The service was not effective

People did not always receive timely access to healthcare services. Mental Capacity Act (2005) (MCA) assessments were in place, although these were not always fully completed. Appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority.

A programme of supervisions had commenced, although no staff members had received an appraisal. Training completion rates were high.

The recording of people�s fluid intake was poorly managed. Staff did not have access to information regarding people who required additional supplements. People received meals which looked appetising.

Caring

Requires improvement

Updated 22 October 2016

The service was not always caring

People wore appropriate clothing, although they were regularly seen not wearing footwear.

Staff provided variable support to people with some positive and some poor practice witnessed. People�s privacy and dignity was respected better since our last inspection.

Responsive

Requires improvement

Updated 22 October 2016

The service was not always responsive

Care plans were not consistently completed with accurate information. Relatives were invited to attend reviews.

Complaints were reviewed and found to be managed appropriately.

A schedule of activities was in place and trips out took place. However, activities were poorly recorded.

Well-led

Inadequate

Updated 22 October 2016

The service was not well-led

Quality management systems in place were not effective as information was not analysed and used to create meaningful action plans and improvements. The storage of records was poorly managed.

The registered provider and quality manager were unable to evidence their oversight of the service to ensure continuous improvement.

Staff liked the registered manager, but felt they should have a visible presence in the home.