Ashleigh House

Updated 3 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

Ashleigh House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ashleigh House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager registered with the commission, however they were no longer in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with 6 members of staff including the provider, manager, administrator, maintenance and carers. We looked at 2 people's care records in detail and records that related to how the service was managed including staffing, training, medicines and quality assurance. We also spoke with multiple visiting health professionals and 3 fire service professionals due to the immediate removal of all people from the service due to significant safety concerns.

Updated 3 August 2023

About the service

Ashleigh House is a residential care home providing accommodation for persons who require nursing or personal care to up to up to 24 people. The service provides support to older people and people living with dementia, people with a learning disability, substance abuse, sensory impairment and mental health needs. At the time of our inspection there were 18 people using the service. Ashleigh House provides accommodation in a single house across 3 floors.

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

The premises and environment were poorly maintained, placing people at risk of harm. Staff had received limited fire safety training on undertaking effective evacuation furthermore there was insufficient fire detection or staff to keep people safe in an emergency situation.

Fire Safety Inspectors from Nottinghamshire Fire and Rescue Service visited the premises on the day of our inspection and served a Prohibition Notice due to fire safety concerns. This meant the fire service was of the opinion the use of the premises involved a risk so serious to people that it should be restricted to ground and ‘basement’ (lower ground floor) area only.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

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.

Ineffective care planning led to people experiencing poor care and restrictive practices.

A failure to record and monitor incidents of a safeguarding nature meant there was no learning to avoid and reduce reoccurrence.

The service failed to provide a safe, well maintained environment; areas were unfit for purpose and significantly damaged, which posed significant risk to people.

Fire safety measures were completely ineffective posing a significant risk to life.

Medicines were not managed safely. The provider failed to appropriately store medicines leading to harm. Multiple medicines could not be accounted for meaning people were at risk of under or over administration of medicines.

Right Care

The service failed to protect people from poor care and abuse. Staff had failed to identify, record and report incidents. The provider had failed to monitor the quality of the service resulting in poor care and incidents of a safeguarding nature occurring.

The service did not have enough staff to meet the needs of people. Staff deployment meant people did not have suitably qualified and skilled staff to support them.

Risk management was poor. A lack of support plans and assessments in place meant people’s needs were not identified assessed or managed effectively.

Right Culture

There were indicators of a closed culture. Staff had a lack of support or guidance on how to support people to lead inclusive and empowered lives.

People received poor quality care, due to staff not having the required skills and abilities to meet people’s needs.

Staff did not always know the person due to a lack of training and support plans in place. This meant care was not personalised or tailored to their needs.

Staffing levels were consistently low, meaning people received inconsistent care from staff due to insufficient time to meet people’s needs.

The culture of the home was negative, the manager told us the home was not safe and people needed to leave. Meaning there was no drive for improvement or quality within the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 May 2020). At this inspection we found the provider remained in breach of regulations 12 and 17, additionally breaches were found for 13 and 18.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

We received concerns in relation to environmental and fire safety risks and infection control risks. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to risk management, safeguarding, staffing, leadership and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.