Ashtead House

Ashtead House provides accommodation and personal care for up to 10 people who have a learning disability and autism or have a mental health diagnosis. At the time of our inspection, there were 7 people living at the service. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

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.

Right Support

Risk associated with people’s care were not always managed well by staff. There were not sufficient staff deployed to ensure the safety of people. The service was not well maintained, and the décor was outdated.

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 told us they felt safe, and staff were knowledgeable on safeguarding procedures. People had access to external health care support.

Right Care

Staff were not trained effectively, and their competencies were not assessed. Assessments of care were not completely sufficiently to ensure people’s needs and preferences were considered. There were times people were not treated in a kind and respectful way. People did not have access to meaningful person-centred activities. Meals did not always look appetising, and people did not have a choice at mealtimes.

Right Culture

The recruitment of staff was not always undertaken in a robust way. There had been a lack of management oversight at the service. Systems in place to audit the service were not robust and actions were not always taken where shortfalls were identified.

Incidents and accidents were reviewed, and actions taken to mitigate the risks. There had been a delay in responding to complaints, but this was being addressed by the providers team.

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 March 2020). At our last inspection we recommended that staff were supported to obtain the necessary skills to meet people’s needs and to ensure documents in care plans were accurate and properly analysed. At this inspection we found the provider had not acted on these recommendations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to people not being protected from unsafe care, staff not being appropriately trained and supervised, and people not being supported appropriately with meaningful activities. We also identified breaches in relation to dignity and respect and the lack of robust oversight.

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

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

Ashtead House is a residential care home providing personal care to up to 10 people living with learning difficulties and physical support needs. The service supported eight people at the time of the inspection.

Although the service has not been designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance, the values that underpin the service were in line with these principles. 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 received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. Eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People did not always receive consistent support as not all staff had the necessary skill and experience to effectively address their behavioural support needs. Some staff were able to redirect people to another activity and provide them with reassurance, whilst others did not always follow the guidance in people’s care plans. We have issued a recommendation to the registered provider in this respect.

People’s records including ‘when required’ medicines protocols and monitoring charts were not always up to date. Staff were recording information about people getting distressed only in handover notes and not on behavioural incident forms. Hence the behaviours could not be analysed for any patterns or lessons learned. We have issued a recommendation to the registered provider in this respect.

The provider’s audits did not identify issues we found during our inspection such as lack of reporting of incidents, inconsistencies in records or inconsistent support provided by staff when they supported people to proactively address any behavioural triggers. The systems and processes were not robust enough to demonstrate the provider effectively monitored the quality and safety. This meant actions were not always addressed to reach best outcomes for people and continuously improve in line with legal requirements and national best practice guidance. Although following our inspection, the registered manager took action to review and improve their records and governance systems, we have issued a recommendation to the registered provider.

Staff supported people to take their medicines as prescribed, and the provider had processes and systems to safely order, store and monitor medicines stock. Staff knew how to protect people from the spread of infections and were trained in infection control.

Staff were offered regular training to be able to better support people. People were referred to other health care professionals where required, and staff followed their guidance to ensure people received appropriate care. Staff knew how to support people to eat and drink enough and followed speech and language therapy recommendations for people who required a modified texture diet.

People were supported to attend activities in the community and staff treated them in a kind, respectful and caring way. People felt safe in the home and staff knew how to report any safeguarding concerns. Risks to people were assessed and support was provided to protect them from avoidable harm.

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 asked people for their choices, involved them in their care and promoted their independence.

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 1 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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, the service was rated Good. At this inspection we found the service remained Good.

People were kept safe by staff who knew their role in safeguarding them. Incidents were responded to appropriately. Risks to people were assessed and measures were put in place to keep people safe whilst encouraging their independence. There were sufficient numbers of staff present to meet people’s needs and checks had been carried out to ensure staff were appropriate for their roles.

People’s nutritional needs were met and they had access to a range of healthcare professionals. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were trained to carry out their roles effectively.

Staff were caring and knew people well. Independence was encouraged by staff. People’s privacy and dignity was promoted by respectful staff. Staff involved people in their care and created an inclusive atmosphere.

There was a wide range of activities on offer for people. Care plans were person centred and information was kept up to date with frequent reviews. There was a complaints procedure in place, complaints were responded to and acted upon appropriately.

The registered manager was accessible to people and staff. Staff had opportunities to be involved in the running of the service. The registered manager carried out regular audits to assure the quality of the care that people received.

Further information is in the detailed findings below.

We saw positive interactions between people and staff. We saw that staff had information about how to support each person to express themselves and what different gestures or signs meant for that person. We observed staff carrying out this guidance.

We observed that people had opportunities to be involved with their local community from getting to know neighbours, visiting local shops and amenities to attendance at specific events or programmes in the area. One person we spoke with told us about a course they were undertaking, ' I am a student at the moment, I really enjoy it'.

We found that staffing was sufficient to provide the service. We spoke with one member of staff who told us ' We plan the shift around the needs of people'.

We found that medicines were stored and managed safely and that people received their medicines when they needed them.

We found that there was the staff promoted the involvement of people in the service and in decisions about their care. One person told us that they had one to one time from their keyworker and had help to fill in forms and manage their money. They told us 'staff explain things and advise me'.

We found that the service identified and managed risks appropriately and that quality and safety was effectively monitored.

People told us that the staff supported them to make choices everyday about their activities, food and shopping. On the day of the inspection we observed staff ask each person individually what they wanted for lunch. One person went to the food cupboard to select their choice.

People who used the service told us they felt safe at the home because the staff were kind to them. One person told us 'I would tell them if they weren't kind to me I'd tell the staff'.