Ascot House - Nottingham

Ascot House is a residential care home. It provides support to a maximum of 20 people. At the time of the inspection, the service specialised in supporting people with mental health and/or substance miss-use difficulties. At the time of our inspection there were 19 people using the service.

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

People did not always have good outcomes. Staff did not have the training, competency or supervision to carry out their roles safely.

The environment was unclean and not safe. Medicines were not given hygienically or safely. Lessons were not learnt when thing went wrong.

Health professionals visited the service; however their recommendations were not always clearly followed.

The governance of the service did not ensure that high quality care was provided. Reviews and audits were not effective at identifying and driving improvements. Staff were not always safely recruited.

There were enough staff to support people safely. Staff knew how to report concerns of abuse.

The provider had notified CQC of events that occurred at the service. People’s complaints had been responded to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 9 November 2019).

At the last inspection, the provider was in breach of 3 regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about neglectful care and environmental safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staff skills, and governance.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Ascot house is a residential care home providing personal care for up to 20 people aged 65 and over. At the time of our inspection there were 18 people using the service.

The care home comprises of a row of terraced houses which have been adapted into one large home.

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

The environment was poorly maintained, unclean and not furnished to a good standard. The décor and furnishings were old and in a state of disrepair and most needed replacing. Management had failed to mitigate risk related to poor upkeep of the home and had failed to assess the impact over a sustained period.

Staff competency was not adequately assessed in key areas such as fire safety and administering medication. This meant that management could not be confident that care staff were fully competent in carrying out these duties. Staff training was not monitored or managed well. Staff were out of date with some training which was important to be able to support people safely.

People told us that their health was well managed, and staff had positive links with professionals which promoted wellbeing for them.

Staff had a good knowledge of how to keep people safe from avoidable harm. People told us that they felt safe living at the service. However, staff did not receive regular formal supervisions to ensure that they were competent and also to give them support.

People were supported to take their medicine in a safe way, however, medication competency checks were not fit for purpose and did not cover people being observed giving medication.

Staff showed a genuine motivation to deliver care in a person-centred way based on people’s preferences and likes. People were observed to have good relationships with the staff team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Records showed that when people became unwell or required additional support they had access to a range of health and social care professionals in respect of their wellbeing.

Enforcement

We found breaches in safe care and treatment in relation to infection control, Good governance in relation to management oversight and also in staffing in relation to staff training and competency.

Rating at last inspection: The last rating for this service was good (published 26 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

You can see what action we have asked the provider to take at the end of this full report.

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

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. 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.

Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people’s health and safety were regularly assessed and action taken to reduce the risks.

There were sufficient numbers of staff employed and people’s needs were met in a timely manner because staff were organised and well deployed. People received their medicines when they needed them and medicines were stored and recorded appropriately.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. There were systems in place to ensure people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received.

Staff felt well supported and were provided with relevant training to effectively meet people’s needs. There was a plan in place to ensure any gaps in training provision were rectified. People had access to sufficient quantities of food and drink and told us they enjoyed the food. People had access to a range of healthcare services and staff followed the guidance that was provided.

There were caring and friendly relationships between staff and the people living at Ascot House - Nottingham. People made decisions about how they lived their lives and staff enabled them to do so. People were treated with dignity and respect by staff and their right to privacy was upheld.

People felt that care was person-centred and staff responded well to any changes in people’s needs. Care plans provided up to date and relevant information about people’s care needs. Activities were provided although people often chose not to participate. People told us they would feel comfortable making a complaint and knew how to do so.

There was an open and transparent culture at the home, people and staff felt comfortable speaking up if they wanted to. The registered manager and deputy manager worked together to provide clear leadership to staff. People were able to provide their opinion on the quality of the service they received and their views were acted upon. Effective quality monitoring systems were used to identify areas of improvement and ensure that action was taken.

We spoke with four people who were using the service. One person said, 'I feel safe here, it's fine. I tell staff if there's a problem.' People's care plans did not always provide sufficient guidance to staff in how to prevent incidents occuring between people using the service.

We saw that improvements had been made in relation to the cleanliness and maintenance of the premises. However further action was required to become compliant. Procedures were not in place to ensure that all appropriate pre-employment checks were carried out before staff could start work.

The provider had appropriate arrangements in place to manage medicines. Staff we spoke with were able to clearly describe the procedures for the administration of people's medications. We observed medication rounds and saw that staff followed medication administration procedures.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. Shortfalls in both internal and external maintenance of the building may adversely impact on the safety of people who use the service. One member of staff told us, 'The home is old fashioned looking. The d'cor could be updated.'

Throughout the home, we saw windows which did not fit into frames, leaving gaps. This meant the windows did not provide residents with adequate protection from adverse climatic conditions. During our tour of the premises we observed that the premises were not fully maintained.

There were enough qualified, skilled and experienced staff to meet people's needs. One resident told us, 'There are enough staff on for every shift."

During our visit we spoke with four people who were using the service. Each person said they were happy with the care and support they received. One person said, 'It's alright here, staff help me when I need it, otherwise they let me get on with it. That's just the way I like it.' Another person told us, 'I get to go out to the pub once a week.' Another person said, 'I like the food here, it's really nice. There are some games and activities but I'm not really bothered about that.'

During our visit we spoke with four people who were using the service. Each of the people we spoke with told us they felt safe living in the home and did not have any concerns about any staff. One person said, 'Yes I have always felt safe living here.'

Resident's meetings were also being held every two months and we saw the minutes of previous meetings. These confirmed that people were given the opportunity to raise any queries and make suggestions.