Ashleigh House

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.

People’s experience of using this service:

People that we spoke to said that Ashleigh House was a good place to live and that staff were kind and caring.

There was not always enough staffing to meet people’s needs. There were only two staff on duty at any time and the manager during the day.

People’s health and social care needs were managed well by management and the staff team. There were positive relationships with professionals which supported people’s overall wellbeing.

Medicine was administered safely, however handwritten entries on medicine administration records were not always signed by two people and not all medicine to be taken ‘when required’ had completed protocols.

The manager showed evidence of quality monitoring across aspects of the service. However, this was not always effective as the manager was frequently involved in delivering care and not given supernumerary hours to effectively manage the home.

People had enough to eat and drink. Special diets and cultural needs were catered for and the kitchen staff were happy to prepare meals at the request of people who didn’t like the options available.

There were activities available. However, not all people were engaged or consulted about activities and there was no activity co-ordinator which meant staff provided the activities available.

Rating at last inspection:

At the last inspection Ashleigh House was rated as requires improvement. The last inspection took place on 5 March 2019. At this inspection the home had remained the same.

The overall rating for this service is requires Improvement. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive. The service has been rated as ‘Requires Improvement’ on three consecutive inspections.

At our last inspection the service was in breach of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance). At this inspection we found that although some improvements had been made, this was not sufficient and they remain in breach.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s needs were assessed and known risks had been identified this ensure people were fully aware of any risks involved. However, risks arising from the laundry being left unattended and doors left open were not managed effectively. One bathrooms being used a sluice room was not secure. There were also risks to people’s health and wellbeing in the outside areas. We found many disused or broken items stored in the garden and car park adjacent to the home, that could cause harm to people.

People living at Ashleigh house felt safe and well looked after by caring compassionate staff. There were sufficient staffing levels to ensure people were cared for safely. However, people could not be assured they would be cared for in a clean environment. This was also raised at the last inspection see the full body of the report for action we have taken.

Medication was managed in a safe way and people received their medicines as prescribed. There was evidence of investigations when things went wrong and lessons learned from outcomes. Staff were fully committed to reporting incidents and concerns.

Care and support was planned and delivered to ensure people received effective care. Staff were knowledgeable about the people and their needs, but we found gaps in the training matrix. We could not tell if staff had completed any recent training or refresher training. The training matrix was not up to date.

People had sufficient to eat and drink to ensure they had a nutritious diet and were kept hydrated. Staff provided consistent care where necessary equipment was used to ensure people were independent. The home was not tailored to suit people with Dementia. Areas were not fully adapted to meet people’s needs. The outside area was accessed by a ramp, but this was not fit for purpose. There was a thorough approach to planning and coordinating care when people moved to different services. Staff worked within the principles of the Mental Capacity Act.2005.

People were treated with kindness and compassion. There was a visual person-centred culture at the home. People were treated with dignity and respect, which was reflected in all feedback we received from people and their families. Staff had sufficient time to develop relationships and friendships with people they cared for.

People’s Communication needs or information they received was not in a format suitable to their needs as required by the Accessible Information Standard.

People experienced positive impact on their health and wellbeing when participating in activities out in the community that were tailored to their needs. People knew how to raise a complaint or concern. People were confident if they had to raise concerns or complaints the manager would act upon their concerns. Staff were aware of people’s life history and preferences and they used the information to develop relationships and deliver person centred care. There were systems in place to record and plan people’s end of life care, but these plans were not required at the time of our inspection.

There was no registered manager at the service. The manager told us they were in the process of submitting their application. The registered manager left the service in July 2018. The provider did not have effective systems to monitor the quality and safety of people’s care or to ensure timely improvements were made when needed. The manager told us they had plans in place to improve the environment and implement audits and quality monitoring, but not all had been fully implemented. This was also raised at the last inspection. There was an open and transparent culture running throughout the home. The manager submitted notifications required to CQC in a timely manner. More information is in the full report

Rating at last inspection: Requires Improvement (17 August 2017)

About the service: Ashleigh House provides accommodation and personal care for

up to 24 older people in the Sherwood area of Nottingham. On the day of our inspection 17 people were using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had not been made since the last inspection and the impact on the environment and infection control has meant the rating remains required improvement. This is the second time the service has been rated requires improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

At the time of our inspection there was no registered manager in post. The previous registered manager had deregistered on 1 June 2017. An acting manager was in place and the owner told us they were in the process of recruiting a registered manager. We will continue to monitor this. A registered manager is a person who has registered with the Care Quality Commission 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.

People could not be assured they would always be supported by sufficient amounts of staff or in a clean and hygienic environment. People were protected from the risk of abuse and that their medicines would be administered safely. Risks to people’s safety were assessed and acted upon.

People were supported by staff who received training to help them carry out their roles and responsibilities effectively. Plans were in place to ensure all staff were up to date with the required training. People’s right to make decisions for themselves were respected and staff acted in the best interests of those people who lacked the capacity to make their own decisions. People were supported to maintain their nutrition and healthcare.

People were cared for by staff who were caring and attentive and treated them with dignity and respect. Staff knew people well and respected their choices and preferences. People felt involved in planning their own care and had access to advocacy services if required.

People received care and support in line with their needs and preferences. People provided mixed feedback on the activities provided at the home but were supported to maintain their interests. People felt confident that any concerns or complaints they had would be responded to and records showed this to be the case.

People could not always be assured that the systems in place to monitor and improve the quality of the home were effective in identifying and addressing areas of improvement. People and staff told us the acting manager and the provider were visible, approachable and responsive to any issues. People were given the opportunity to be involved in the development of the home.

We spoke with two members of staff about the care and support that was provided to people using the service. Staff displayed a good understanding of the needs and current condition of people using the service.

We carried out a detailed tour of the premises. We saw that work had been carried out to improve the standard of the decor in some areas of the home. We saw that work was required to make some areas of the building and exterior safe.

During our inspection we observed that there was always a staff presence in the communal areas of the home. Staff were attentive and asked people using the service if they required any assistance. Where assistance was required this was provided in a timely manner.

We asked people if they would feel comfortable making a complaint should they need to. We were told, 'I would have no hesitation, the manager is very approachable.' Another person said, 'I would make a complaint if I had to. I am sure it would be dealt with properly.'