Ashgale House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care. This was because the provider had not ensured people were at the centre of their care needs and received care and support that met all their needs.

This service scored 50 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s needs were assessed when admitted to the service, but care was not always designed and was not always provided in a way to meet people’s identified needs. People had a range of care plans addressing their various identified needs. Some of these contained enough detail so the staff supporting them knew the person’s needs, likes, dislikes and preferences. However, some were generic and did not provide enough information for staff to meet people’s needs. For example, most people had an ‘emotional support plan’. For 1 person it stated, “The kitchen should be kept closed and entry restricted to avoid potential harm”, even when the person used a wheelchair and was not able to move around without full staff support. The kitchen was not kept locked and nor was access restricted, so this was not relevant.

In other cases care plans were not updated when people’s needs had changed, so staff had the most up to date information to provide person centred care to them and to support them.

People’s communication needs were assessed and described in their support plans, but we did not see staff using this information proactively to promote effective communication with people.

At the time of the assessment, staff had not completed communicationtraining to better communicate with people. Training on communication was provided after our assessment after we had identified shortfalls in this area and pointed these to the manager. We were not assured the provider saw the need for staff to undertake this training to meet people's communication needs, prior to our assessment.

Notwithstanding the above, we observed two people becoming anxious and staff responded to them immediately and calmly, supporting them to move away from what was triggering their anxiety and soothing them. One person was regularly supported by staff to attend a place of worship, which they indicated they enjoyed and valued.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The service had not worked to ensure that one person received the coordinated support they needed for their needs to be met. The provider had not taken effective steps to ensure a person’s changing needs were assessed and identified and that relevant actions were implemented including making the necessary referrals to relevant health and care professionals. Their needs had changed to receiving support in their bed, this was not reflected in their care plan to include both practical and emotional support that would enhance their daily support and interaction with staff.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to people’s individual needs and was not able to consistently demonstrate compliance with the Accessible Information Standard (AIS). The AIS sets out how providers and commissioners of NHS and publicly funded adult social care services should ensure disabled people and people with impairments or sensory loss can access and understand information about their service and receive the communication support they need to use the service.

While some information was provided to people in ways they understood, other information was not. Menu displays were pictorial and there were some picture cards available for people to use. We observed that most staff used objects of reference to support people to make limited choices.

However, we also found that the provider had not fully considered whether people’s care records could have been provided in an alternative format for them to be able to access the information they contained, based on people’s assessed communication need. Support plans were all text-based and not available to people in alternative formats.

The service did not always make it easy for people to share feedback and ideas. There was however a process for people and other to raise complaints about their care, treatment and support.

The provider had a number of mechanisms to seek feedback from people for them to understand people’s experiences of using the service.

For example, people, relatives, staff and professionals were invited to complete surveys. These surveys were just yes or no answers with additional spaces for comments so individual could provide a qualitative description of their experiences. We did not see action plans or a follow up in place after a survey was completed and we could not see evidence of how feedback was gained and used to help improve the service. The surveys for people living in the home with communication needs were just yes and no tick boxes and were carried out for all people supported by one staff member.

The provider had a complaints policy in place, and they had received no complaints. The registered manager told us any complaint would have been recorded in the incident book and managed in line with policy.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People’s access to care, support and treatment was not consistent. During our assessment we noted people were not always referred to health and care professionals in a timely manner, so they receive an appropriate assessment of their condition and advice to support the person with their needs.

Notwithstanding the above, people did have appointments with their GP, dentist and other medical professionals when required.

Out of hours support was in place, covered by the management team to ensure staff always had access to advice and support so people could be appropriately cared for.

Staff and leaders did not always consider information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Care was not always personalised or delivered in line with people’s preferences, for example in relation to their social care needs, which despite having been identified were not always being met. Therefore, we were not assured people were always supported to achieve their individual goals, for example, in relation to activities and engaging with the local community.

A family member we spoke to raised concerns around their relative not accessing activities, “We
asked for [person] to be supported to go swimming, to their place of worship and the cinema. To date none of this has happened.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported people to consider the end part of their lives and to make plans and to start thinking about this period of their lives and what was important to them and this was documented in their care plans.