Ashring House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People's health and social needs were assessed before coming to live at Ashring House; This had ensured the service could meet the identified needs of the person and that staff had the necessary training to keep them safe and well.

The majority of people were non-verbal, and staff told us of ways people communicated with them, however these were not clearly documented or explored within the care plan. For one person it mentioned a communication board, but this was not in use, it also mentioned Makaton, but staff were not aware of the person using Makaton to communicate. This was an area that staff were going to explore with family.

People's assessments included sufficient detail about their individual care needs and preferences, which had ensured their needs were met effectively

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Recognised assessment and monitoring tools were used appropriately to track improvements or concerns. The management team had oversight of these and planned action appropriately with the involvement of family and the staff team. The service had links with other organisations such as continence community team, physiotherapy teams, learning disability community team and speech and language therapists (SaLT). People's GP visited the home regularly to check on their welfare. This meant that matters could be raised quickly, and the home had easy access to the surgery in between these visits if there were any emergencies so they could be responded to quickly.

Staff were given training which followed current good practice guidance. Staff told us how they worked alongside the GP’s, social workers and other health and social care professionals to ensure referrals were made and any recommendations were acted upon. For example, people’s ability to eat safely and maintain a healthy weight were assessed and monitored and appropriate action taken. Staff were knowledgeable regarding people’s nutritional requirements, and this was clearly recorded to ensure all changes were shared. Information was available in the kitchen to ensure people received appropriate drinks, meals and snacks. For one person who lived with dysphagia there was guidance in care plan regarding the importance of position whilst eating and of the food consistency required. Food and fluid intake was monitored to people’s intake, which allowed staff to provide support and encouragement to people who were struggling to eat and drink sufficiently to maintain their health and for those who were gaining weight.

Some people lived with epilepsy, and we saw that advice was sought from specialists and staff monitored seizures and looked for triggers such as lap belts, bowel management, and infections.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service arranged appointments for people including the dentist, chiropodist, physiotherapists and occupational therapists as required. Care plans contained summary documents highlighting people’s support needs that were immediately available to visiting professionals. These were currently being updated and reviewed. A new care plan format was being introduced.

People received the professional support needed which was in line with the ‘right care’ element of positive care for people living with a learning disability and promoted their human rights in receiving equitable care and support. Relatives told us that they felt improvements had been made over the past few months and that they had had contact regarding the change of managers. One family member said there were good lines of communication, and they were kept informed whenever their loved ones had appointments or in the event of an emergency when for example, people, had to be taken to hospital.

Health professionals confirmed that staff and the management team had worked alongside them in making improvements to people’s life.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The care staff cooked for people daily; the organisation provided a seasonal four-week menu and were aware of people’s dietary needs and requirements. There had been concerns raised regarding food, one of which was raised as a safeguarding. As a result of this, menus have been reviewed, new menus devised, and extra support given to staff regarding cooking. There were charts on the wall of the kitchen showed allergies, likes, dislikes and special requirements, for example those requiring a soft diet. The kitchen was clean and well equipped. Temperature checks of food and equipment were carried out and recorded. We saw staff supporting people during mealtimes, offering to cut up food, prompting them to eat, speaking kindly to people and making them feel comfortable.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s health and care needs were monitored and records kept using recognised systems of measurement. For example, the use of Waterlow scores, a process to measure people’s susceptibility to developing pressure sores. People’s weights were regularly checked and records kept. The Braden scale was used to closely monitor bowel movements as that was found to be a key trigger in epileptic seizures.

Care plans contained a medical history section which provided details of all medical appointments and interventions people had experienced. Relatives and health professionals told us that staff knew people well and they were able to detect subtle changes in people’s presentation which allowed early interventions to make sure people received the best possible care. For example, staff told us that one person expressed discomfort by certain signs which they immediately acted on and contacted the GP to commence antibiotics.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Whilst not every person could give verbal consent or have capacity to make decisions, staff told us that they always asked the person and assumed they had capacity. We saw this practice throughout the site visits. Staff also told us, “If they do not want something, we know from their reaction and body language to wait and try again,” and “We don’t force anything, sometimes assisting them to shower can be difficult, we offer and ask but if they don’t want to shower, we try later, they would get upset if we just did it.”
Staff we spoke with were able to tell us how they offered people choices in their daily care and demonstrated an understanding of people’s right to make their own decisions. We observed staff offering people choices for breakfast, showing different cereals and fruit and waiting for a response. When offering to take a person out, staff waited until they were ready.