Ashgale House

We found the following examples of good practice.

The home had an up to date infection prevention and control policy. All staff had received training about infection prevention and control (IPC), and in the use of personal protective equipment (PPE). Management staff carried out monitoring checks of staff IPC practice and shortfalls were addressed.

Personalised COVID-19 risk assessments had been carried out on people and staff who may be disproportionately at risk of COVID-19. These included management strategies to reduce the risks of infection from COVID-19.

The provider had ensured the home always had a suitable supply of PPE including face masks, disposable gloves and aprons. This minimised the risk of spread of infection in the home and people and staff becoming unwell. We observed staff used PPE effectively to safeguard the people living in the home, staff and visitors.

The home was very clean. Staff completed two hourly cleaning of high touch surfaces including light switches to minimise the spread of infection. Infection prevention and control champions completed comprehensive monthly IPC checks of the environment and other areas of the service. Action was taken to address any shortfalls found.

The provider followed current government visiting guidance. Management recognised the importance to people’s well-being of having visits from friends and relatives. They ensured that safe visiting arrangements were in place. Visiting procedures included ensuring visitors had a confirmed negative lateral flow test, used hand sanitiser and wore a face mask. Personalised visiting was supported. People’s friends and relatives told us they visited their loved ones. Some people were supported by staff to visit their relatives. People also kept in contact with their families and friends by telephone and video calls. Two people told us they had regular contact with friends and relatives.

During the pandemic the provider ensured that staff kept up to date with all relevant pandemic guidance. The management staff ensured that updates were promptly communicated to staff, people and relatives. This and regular communication with the host local authority and public health teams helped to ensure the home carried out good IPC practice that kept people safe.

Ashgale House is a residential care home providing personal care to 14 people. The home provides care and support for people living with learning disabilities who may have autism and additional physical disabilities. The home also delivered a respite service for people, but currently due to the Covid19 pandemic this service was not being provided. At the time of the inspection there were 7 people using the service.

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

Following the previous inspection in January 2020, the provider sent us their action plan. This included information about the steps they had taken to make improvements at the home.

Improvements had been made following the previous inspection. Staff, people and their relatives told us people were safe and well supported at the service.

Systems for storing and administering people’s medicines had improved. Medicines audits were taking place more frequently. Improvements were made when deficiencies were found.

Records of people’s expenditure and details of their purchases had improved. Checks and monitoring of the handling of people’s monies were carried out to minimise the risk of financial abuse and confirm that financial policies were being followed.

Improvements had been made to the quality monitoring systems. Audits and monitoring procedures were used effectively to monitor the service and to make improvements.

Monitoring records were better completed. They were easier to read, and fully completed. Staff had signed they had read guidance about people’s care, Covid19 and other areas of the service.

The registered manager had started to analyse and evaluate incidents to identify patterns and trends to help prevent similar events being repeated.

Systems were in place to ensure people were protected from abuse and treated with respect and dignity. Staff told us staffing levels were sufficient to provide people with the care and support they needed.

Risks to people’s safety in a range of areas including the Covid19 pandemic were assessed and understood by staff.

Suitable infection prevention and control measures and practices were in place to keep people safe and prevent people, staff and visitors catching and spreading infection.

The outcomes for people using the service in some areas reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People had a choice in what they ate and in how they spent their day, but some people’s routines and activities that had taken place outside the home had been reduced or stopped due to the Covid19 pandemic.

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 18 March 2020). There were two breaches of regulation. Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance. We told the provider to make a number of improvements. 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 in the areas inspected and the provider was no longer in breach of regulations in these areas.

Why we inspected

We undertook this focused inspection to check they 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 and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Ashgale House is a residential care home providing personal care to 14 people. The home provides care and support for people living with learning disabilities who may have autism and additional physical disabilities. The home also provided a respite service for people. At the time of the inspection there were eight people using the service, none of whom were receiving respite care.

The care home had been registered before Registering the Right Support (2015) and other best practice guidance had been developed. Registering the Right support 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.

The care home is a large house in a residential area, located close to a range of community amenities and facilities. It is registered to provide care and support for up to 14 people. This is larger than current Registering the Right Support standards and other best practice guidance. However, at the time of the inspection there were only eight people using the service. The building design of two floors with bedrooms, kitchen facilities and communal areas on both floors enabled people to be cared for individually and in smaller groups when fully occupied. This mitigated any negative impact that may occur from accommodating more people than current best practice guidance for a similar service.

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

Quality monitoring systems including audits and checks of the environment and other areas of the service were not always fully effective in identifying shortfalls and for driving improvement. Some checks had not been carried out within the provider’s timescales. Whilst it was not evident this had any significant impact on people, it did not show that a fully effective governance system was in operation.

Records did not show that regular written analysis of incidents, accidents and complaints had taken place to identify any patterns and trends and to help prevent similar events being repeated.

There were gaps in people’s care monitoring records. This could mean that people received ineffective care due to a lack of up to date, accurate information about people’s needs. This had not been identified by senior staff.

Improvements were needed in some areas of medicines management and administration to ensure that people always received their prescribed medicines safely.

People did not always have the opportunity to take part in a range of personalised meaningful activities to keep themselves stimulated and minimise the risk of social isolation.

Staff received the training and support to enable them to carry out their roles competently. Sometimes refresher training had not been completed within the provider’s timescales.

Feedback from people’s relatives was mixed. Some relatives provided positive feedback about the care people received. Others told us that communication between them and staff about people’s needs and progress could be improved.

Some healthcare and social care professionals told us that staff had not always understood people’s communication and behaviour needs, so engagement between some people and staff was ineffective.

The service applied some principles and values of Registering the Right Support and other best practice guidance. People were provided with choices and involved as far as they were able to be in decisions to do with their care. However, it was not evident that all the people using the service had the opportunity to frequently spend time out and about in the local community.

Staff knew what their responsibilities were in relation to keeping people safe. Recent action had been taken by management staff to better protect people from the risks of harm, abuse and discrimination.

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.

The provider had systems in place to manage and resolve complaints.

People had a choice of meals, snacks and drinks. People received the support they needed to access healthcare services.

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 22 November 2017). The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

We have made a recommendation about developing and improving the opportunities for people to take part in a range of personalised meaningful activities.

Why we inspected

This comprehensive inspection was brought forward due in part to concerns received about some areas of the service, including, medicines, moving and handling, reporting of incidents and staff engagement with people.

Enforcement

We have identified breaches in relation to the management and administration of medicines and governance. 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.

Ashgale House is registered to provide accommodation and personal care for fourteen people. The home provides care and support for people with learning disabilities who may have additional physical needs. At the time of the inspection there were ten people using the service including a person who was receiving a respite service.

There was a registered manager in post. 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.

At our last inspection of the service on 14 March 2017 we rated the service as "Requires Improvement". This was because we found deficiencies in the way that people’s finances were managed by the service so people were not always protected from the risk of financial abuse. This meant the provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan setting out the actions they would take to meet the regulation. During this inspection we found appropriate systems were in place to ensure that people’s monies were managed in a proper and safe way.

There were systems in place to keep people safe. Staff had received training on how to identify abuse and understood their responsibilities in relation to safeguarding people, including reporting concerns relating to people’s safety and well-being.

Accidents and incidents had been appropriately recorded and risk assessments were in place to minimise the risk of people and staff from being harmed. Checks and appropriate service tests had been carried out to make sure that the premises were safe.

We saw positive engagement between staff and people using the service. Staff were respectful to people and showed a good understanding of each person’s needs and abilities. Person centred care records ensured that the service met people’s individual needs and preferences.

Arrangements were in place to make sure people received the service they required from sufficient numbers of appropriately recruited and suitably trained staff.

People's medicines were managed appropriately and their healthcare needs were understood and met by the service.

People's dietary needs and preferences were supported. People chose what they wanted to eat and drink and healthy eating was promoted.

Staff respected people's privacy and dignity and understood the importance of maintaining and supporting confidentiality. People were provided with the support they needed to maintain links with their family and friends.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS]. Staff understood the importance of ensuring people agreed to the care and support they received and knew they needed to involve others when people were unable to make important decisions. People were supported to have choice and control of their lives and were supported in the least restrictive way possible; the policies and systems in the service supported this practice.

There was a management structure in the service which provided clear lines of responsibility and accountability. Checks were carried out to monitor and improve the quality and safety of the service.

Further information is in the detailed findings below

Ashgale House is registered to provide accommodation and personal care for fourteen people. The home provides care and support for people with learning disabilities who may have additional physical needs. The home is owned by Ashgale House Limited. On the day of our visit there were ten people living in the home and two people who received a respite service on a daily basis.

Since the last inspection a new manager had recently been appointed and at the time of our visit was in the process of registering with the Care Quality Commission [CQC]. A registered manager is a person who has registered with the 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.

People were cared for by staff who knew their needs well including people's individual ways of communicating. We saw staff engage with people in friendly and respectful manner.

Staff respected people's privacy and dignity and understood the importance of confidentiality. Staff showed us that they knew the interests, likes and dislikes of people and supported them to choose and take part in a range of activities of their choice. People were provided with the support they needed to maintain links with their family and friends.

There were procedures for safeguarding people. Staff understood how to report possible abuse and knew how to raise any concerns about people’s safety so people were safeguarded. However, the systems and processes for handling people's monies were not effective as they did not ensure people were protected from financial abuse.

People's individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. Accidents and incidents were addressed appropriately.

Staff were available to meet people's individual needs promptly and demonstrated good knowledge about people living at the home.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff received a range of training to enable them to be skilled and competent to carry out their roles and responsibilities.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed. People’s dietary needs and preferences were supported, and they were encouraged to choose what they wanted to eat and drink.

Staff understood the importance of ensuring people agreed to the care and support they received and knew when to involve others to help people make important decisions. The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS).

There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider’s management and handling of people’s monies was not meeting legal requirements You can see what action we told the provider to take at the back of the full version of the report.

Our inspection on 16 December 2013 found that the provider was non-compliant in respect of Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010: Cleanliness and infection control.

During our follow-up inspection on 14 March 2014, we saw evidence that since our inspection in December 2013, the provider had implemented suitable arrangements to ensure that the environment was suitably cleaned and that potential risks of contamination or infection were minimised.

Our follow-up inspection found that the provider were now compliant with Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010: Cleanliness and infection control.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. We saw safeguarding concerns had been reported and dealt with in the correct way, and the provider had worked in a collaborative manner with local safeguarding authorities.

We saw people used a range of equipment to support their independent living. They were protected from unsafe or unsuitable equipment by the arrangements in place to ensure equipment was properly maintained, was suitable for its purpose, and was used correctly.

Staff were supported in their roles and were able to successfully access on-going supervision, training, and development.

People, staff and representatives were invited to comment on the quality of the services provided either through face to face meetings or satisfaction surveys, and their comments were acted upon.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The environment was clean and appropriately maintained.

Staff told us that they were well supported and that they had the training they needed to support people living at the home. There were enough qualified and experienced staff working at the service.

People were aware of how to make a complaint. They felt that they were listened to and that any concerns they had were dealt with.