This inspection took place on 9 and 15 June 2015, was unannounced and was carried out by two inspectors.
Ashgold House is a privately owned service providing care and support for up to six people with different learning disabilities. People may also have behaviours that challenge and communication needs. There were five people living at the service at the time of the inspection. The house is a detached property set in its own grounds in a rural area. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to access facilities in the local area and to access a variety of activities.
There was a registered manager working at the service. 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.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that one person had an application granted to deprive them of their liberty to make sure they were kept as safe as possible. There were four applications still being processed by the DoLS office. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.
The care and support needs of each person were different and each person’s care plan was personal to them. People or their relative /representative had been involved in writing their care plans. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. People were satisfied with the care and support they received. However, some parts of the care plans did not record all the information needed to make sure staff had guidance and information to care and support people in the way that suited them best and kept them safe. On the first day of the inspection potential risks to people were identified but full guidance on how to safely manage the risks was not always available. This left people at risk of not receiving the interventions they needed to keep them as safe as possible. On the second day of the inspection the registered manager had reviewed and re-written the care plans and risk assessments. There was now clear guidance in place for staff on how to care for people effectively and safely and keep risks to minimum. Staff were aware of the changes and knew what they had to do to make sure that people received the care and support that they needed.
Staff had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. They said the registered manager was very supportive. Staff had received regular one to one meetings with a senior member of staff. Staff had not received an annual appraisal so did not have the opportunity to discuss their developmental needs for the following year. Staff had completed induction training when they first started to work at the service and had gone on to complete other basic training provided by the company. There was also training for staff in areas that were specific to the needs of people, like epilepsy and dementia. Some of the new staff had not received this training so there was a risk that they may not know what to do in certain situations. There were staff meetings so staff could discuss any issues and share new ideas with their colleagues to improve people’s care and lives.
A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. However, all the checks that needed to be carried out on staff to make sure they were suitable and safe to work with people had not been completed by the registered manager. When staff had gaps in their employment history this had not been explored and recorded when the staff member was interviewed for the job.
Emergency plans were in place so if an emergency happened, like a fire the staff knew what to do. However, we found that the checks for the fire alarms which should be done weekly had not been done for four weeks. The registered manager had not identified this in their regular audits. There was a risk that the fire alarm system may not be working effectively to alert people in the event of a fire.
People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People knew who their key worker was and had a choice about the keyworkers who worked with them. People had keyworkers that they got on well with. Staff were caring and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. Staff were kind and caring when they were supporting people.
People were involved in activities which they enjoyed and were able to tell us about what they did. Some planned activities did not take place regularly and there was no explanation as to why some activities had not occurred. There was no guidance for staff on how best to encourage and support people to develop their interests, skills and hobbies.
People who were not able to use speech to communicate were given choices about the meals they received. They had a choice about what food and drinks they wanted. People were being supported to develop their decision making skills to promote their independence and have more control. People said and indicated that they enjoyed their meals. People were offered and received a balanced and healthy diet. If people were not eating enough they were seen by dieticians or their doctor and supplement nutrition was provided. If people were unwell or their health deteriorating the staff contacted their doctors or specialist services so they could get the support that they needed.
People received their medicines safely and when they needed them and they were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.
People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safe guarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the registered manager or outside agencies if needed. The registered manager monitored incidents and accidents to make sure the care provided was safe.
Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service.
There were quality assurance systems in place. Audits and health and safety checks were regularly carried out by the registered manager and the quality assurance manager from the company’s head office. The registered manager’s audits had not identified some shortfalls, like the fire checks were not completed. Shortfalls in care planning and risk assessments had not been identified. The registered manager told us that over the past year they had been overseeing the management of another service owned by the provider and had to spend time away from Ashgold House. She said that because of this she ‘had taken her eye off the ball’ at Ashgold House and that was why there were shortfalls.
The registered manager had sought feedback from people, their relatives and other stakeholders about the service. Their opinions had been captured, and analysed to promote and drive improvements within the service. Informal feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within Ashgold House which allowed them to suggest new ideas which were often acted on.
The complaints procedure was on display in a format that was assessable to people. People, their relatives and staff felt confident that if they did make a complaint they would be listened to and action would be taken.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.