Aston House

About the service

Aston House is a residential care home providing personal care to up to 5 people with learning disabilities and autism. At the time of the inspection 5 people were using the service.

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

Right Support:

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.

People received care and support to maintain an environment that suited their needs and preferences.

Staff supported people to make decisions following best practice in decision-making. People were

supported to carry out their daily living activities and pursue their hobbies and interests.

Staff supported people to access health and social care services. Staff supported people with their

medicines safely and in their preferred way.

Right Care:

Some improvement was required to ensure that risks were fully assessed within people’s lives. Improvement was also required to ensure that cleaning tasks were fully documented and overseen.

People received care that was person-centred, and dignity, privacy and human rights were promoted.

Staff communicated with people in ways that met their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service employed skilled staff to meet people's needs and keep them safe.

Right Culture:

The ethos, values, attitudes and behaviours of the registered manager and staff team ensured people lead confident, inclusive and empowered lives.

People received good quality care and support because trained staff and specialists could meet their needs and wishes.

People and those important to them, including social care professionals, were involved in planning their care. The manager and the staff team ensured people received support based on best practice, respect and inclusivity.

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 6 May 2022.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check that the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Aston House is a residential care home providing personal care to five people at the time of the inspection. The service can support up to a maximum of five people.

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

Right Support

Risks in the environment had not always been assessed and mitigated. This meant people were at an increased risk of harm, such as scalding and fire.

Medicines were not always managed safely. Medicine risk assessments were not always in place and staff recording of medicines required some improvement.

People were not consistently protected from the risk of infection. The provider had not always ensured government guidance and their own policy and procedure was followed by staff.

A process for recording accidents and incidents meant the provider could monitor for trends and patterns and plan care accordingly.

There was a good supply of PPE in the service that staff were using appropriately.

Systems and processes were in place to protect people from the risk of abuse and staff had a good understanding of how to raise concerns. Relatives told us they felt people were safe and staff were kind, caring and knew people and their needs well. Staff were recruited safely and were checked for their suitability to work with vulnerable adults.

Right Care

Mental capacity assessments (MCA) had not always been completed to establish if people could or could not make some of the more complex decisions around care for themselves. We found deprivation of liberty safeguards (DoLS) had not been applied for in a timely manner. People were making decisions in other areas such as foods and drink, activities and washing and dressing.

People were assessed prior to moving into the service to ensure their needs could be met. The assessments and care planning process considered people’s health conditions, religion, relationships, culture, likes, dislikes and hobbies.

People were well supported with food and drinks and making their own choices. People were taking an active role in the kitchen and could access snacks and drinks whenever they wished.

The provider had worked in partnership with health and social care professionals to ensure people had timely access to health care and routine screening.

Right culture

The providers internal systems and processes had not been effective in identifying the concerns we found during the inspection.

Supervisions were not always conducted in line with the providers policy and some staff were overdue annual refresher training. However, we found staff to be knowledgeable around people’s health and social care needs.

New staff told us they felt well supported with a training and induction process and were given time to get to know people.

The provider was open to feedback and started work on improvements immediately after the inspection.

People and their families were actively involved in the service. People’s communication needs had been assessed and people were supported to communicate and express their opinions and choices.

The provider had started to refurbish the home, with some work already completed that included people’s choice and preference. People were able to personalise the home to their preference including personal possessions and artwork.

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

Rating at last inspection

The last rating for this service was good (published 17 April 2020).

Why we inspected

This inspection was initially a targeted inspection looking at the IPC practices the provider had in place. However, during the inspection we found concerns with safety, MCA and managerial oversight of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led. We assessed if the service is applying the principles of right support right care right culture.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, well-led relevant sections of this full report.

We have identified three breaches in relation to safe care and treatment, need for consent and good governance at this inspection.

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

Following the inspection the provider made immediate improvements around fire safety to mitigate the risks.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Aston House is a residential care home providing personal care and accommodation to five people aged 18 and over at the time of the inspection. The service can support up to five people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home domestic style property. It was registered for the support of up to five people. Five people were using the service. The building design fitted into the residential area and had no identifying signs to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

We made a recommendation about end of life care planning.

People received safe care at Aston House. Staffing numbers were sufficient to meet people’s assessed needs. Staff stored and administered medicines safely. They took steps to protect people from abuse and avoidable harm. The service had systems in place to minimize the reoccurrence of incidents and accidents.

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.

Staff were trained and experienced. They supported people to stay well by having enough to eat and drink, providing effective care and ensuring they could promptly access health care services when needed.

Staff treated people with kindness, compassion and respect. Their practice promoted the involvement of people in decisions about their care. They supported people to access advocacy services to ensure their rights and wishes were protected. People’s information was stored and managed confidentially.

The care and support people received was tailored to their individual needs. They had regular opportunities to engage in meaning activities. They were supported to maintain links with their friends, family and the local community.

The service had an experienced registered manager who maintained good oversight of the service. They fulfilled their regulatory responsibilities and monitored the standard of care to ensure it was of a good quality. People, staff and relevant professionals were involved in developing the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was Good (published 26 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection in July 2015, the service was rated Good. At this inspection we found that the service remained Good.

There was a registered manager who had managed the home since October 2010. 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 continued to receive safe care. Staff were appropriately recruited and there were enough staff to provide care and support to meet people’s needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

People were supported to improve their communication and expand their social circle. People were encouraged and supported to participate in activities that they were interested in.

People received care from staff that had the support, supervision, training and on-going professional development that they required to carry out their roles. People were supported to maintain good health and nutrition.

Staff and ensured they received people’s consent before providing care. The registered manager and staff understood their roles in providing safe care whilst people were under a Deprivation of Liberty Safeguarding authorisation.

Staff knew people very well and strived to understand the reasons for people’s displeasure and find ways to rectify these. The provider had implemented systems to manage any complaints made by professionals and relatives.

The provider and registered manager had quality monitoring processes in place to identify areas that required improvement and took action where issues had been identified.

Staff had a good relationship with people living in the home and people were calm and relaxed. Discussion with the three members of support staff who were working in the home when we visited showed that they had a good knowledge of people's care needs.

Care plans and assessments contained all the relevant information for staff to meet people's individual care needs. This included detailed information about people's preferences, routines and how they communicated their feelings and needs.

We looked at training records which showed that staff received safeguarding training as part of a planned training programme. We spoke with three members of staff about safeguarding. They were able to tell us about their responsibilities to safeguard people from harm including how to report any concerns they had within the organisation and externally if required.

We saw that new staff had induction programme followed by on on-going training to ensure that they had the skills and knowledge to support and care people living in the home.

We saw that care records contained all the relevant information for staff to meet people's individual care needs. Staff explained that they use visual aids to help communicate with people living in the home and to assist people in making choices. We saw that staff had received training to enable them to support and care for the people appropriately.