Ashurst House

Ashurst House is a residential care home providing personal care to seven people with a learning disability at the time of the inspection. Ashurst House accommodates up to eight people in one adapted building.

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

A new leadership team had been appointed since our last inspection and had made significant improvements to the care and support people received. People told us they were happy and fulfilled at the service and staff were kind and supportive. Relatives told us the service had vastly improved and the management team were “on top of things”.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The leadership team had developed a culture centred around people’s preferences and goals. Staff were flexible to people’s changing needs and wishes and supported them to make informed decisions. Staff actively asked people for their views on all areas of the service, including their care and support, and these were acted on. People had privacy, held keys to their bedrooms and staff only entered their room with permission. Staff ensured people were treated with dignity and respect at all times. They were confident to challenge the practice of their colleagues and raise any concerns they had with the leadership team.

People were relaxed in the company of each other and staff and people no longer felt scared of each other. Staff had supported people to understand the risks of abuse and how to raise any concerns they had. Concerns raised had been acted on and people were confident action taken would keep them safe in the future.

People were supported to take positive risks to develop their skills and maintain their independence, such as making hot drinks and going out alone. Staff had supported people to have health and medicine reviews and any advice was followed. This had improved peoples’ quality of life and people were more independent.

Recruitment processes had improved and people were now involved in interviewing staff. Something they told us they enjoyed. The number of staff on shift each day had increased and this enabled people to go out more, as well as doing more at home. Staff worked well as a team, were motivated and felt appreciated. New staff told us they had a career path and were supported to develop in their role.

Medicines were now managed safely, and people received their medicines as prescribed. Regular medicines audits were completed to identify and address any errors. Other audits had been effective, and action had been taken to resolve any shortfalls and stop them happening again.

The service was clean. People understood COVID-19 restrictions and were supported to follow the latest government guidance. They received visitors safely and were supported to remain as safe as possible when they went out. People were involved in household tasks such as cleaning their bedrooms and doing their laundry.

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 Inadequate (published 8 December 2021).

This service has been in Special Measures since 10 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance, safeguarding people from abuse, staffing, fit and proper people employed and notifications.

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 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 Inadequate to Good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashurst House on our website at www.cqc.org.uk.

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.

Ashurst House is a residential care home providing personal care to 8 people with a learning disability.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

The model of care setting did not maximise people’s choice, control and Independence.

Right care:

Care was not centred around people to ensure they had control over all areas of their life. People were not supported to be as independent as possible and were not always treated with dignity.

Right culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people could lead confident, inclusive and empowered lives.

People’s views had not been used to develop the service and there was no evidence to demonstrate concerns they raised had been addressed. Other stakeholders including staff and relatives had not been invited to share their views of the service. The manager and provider lacked oversight of the service and shortfalls had gone unnoticed. There had not been a registered manager at the service for eighteen months and there was a lack of strong leadership.

People told us they did not always feel safe at the service. Some people’s behaviour scared other people and staff at times. Staff did not know what caused people to become anxious or frustrated or how to support them to remain calm. The manager had not notified us about safeguarding concerns so we could check action had been taken to keep people safe.

People were not supported to develop their independence and take risks. They were not involved in planning how risks were mitigated. Sufficient guidance had not been provided to staff about how to manage some risks. Action had not been taken to learn lessons when things went wrong. People’s medicines were not always managed safely.

People were not involved in recruiting the staff who supported them. New staff had not been recruited safely and in accordance with the provider’s recruitment process. There were not enough staff on duty each day to support people in the way they preferred.

Records about people’s care and support were not accessible to them. They were not always accurate and completed or written when things happened. Electronic records were not easily accessible to staff due to poor Wi-fi.

People were protected from the risk of infection.

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 24 May 2019).

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. We did not inspection the other key questions. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe 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.

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 monitor the service.

We have identified breaches in relation to protecting people from abuse, managing risks to people, medicines management, staff recruitment and deployment, poor record keeping, ineffective checks and audits and a failure to act on people’s views.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of the inspection there were eight people with a learning disability living at the Ashurst House. The service was a large home, bigger than most domestic style properties. It was registered to support up to eight people. This is larger than current best practice guidance. However, the size of the service was not having a negative impact on people as the building design fitted into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs outside 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:

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. One person described the service as, “It’s the best thing in the world living here”.

The provider and registered manager had oversight of the service. They checked that the service met the standards they required and worked to continually improve the support people received.

People were involved in everything that happened at the service. Staff knew people well and supported them be independent. Staff were caring and treated people with dignity and respect. People told us they felt safe at the service and they got on well with the staff.

Assessments of people’s needs and any risks had been completed. People had planned their support with staff and took managed risks. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. People were not discriminated against and received care tailored to them.

People were supported to be as independent as they wanted to be and took part in tasks and activities they enjoyed at the service and in the community. People chose the staff they wished to support them each day.

People were supported to remain as healthy as possible. Staff supported them to health care appointments and for check-ups. People’s medicines were managed safely. People were supported to plan and prepare balanced meals, of food they liked and met their cultural needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when people were at risk of being deprived of their liberty.

Staff felt supported by the registered manager and were motivated. The registered manager was always available to provide the support and guidance staff needed. Staff worked as a team and supported people in a consistent way. Records in respect of each person were accurate and held securely.

There were enough staff to support people in the way they preferred. Staff had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and shared the providers vision for the service. Processes were in place to recruit safely.

The service was clean and well maintained. The building had been adapted to meet people’s needs and make them feel comfortable. People used all areas of the building and grounds and were involved in planning the refurbishment.

A process was in place to investigate and resolve any complaints or concerns received.

The registered manager had informed CQC of significant events that had happened at the service, so we could check that appropriate action had been taken. The CQC performance rating was prominently displayed.

Rating at last inspection: Requires Improvement (8 May 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

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

Ashurst House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashurst House accommodates up to eight people who have learning disabilities and physical disabilities in one building. There were eight people living at the service when we inspected. Five people lived on the ground floor and three people lived upstairs. The service had a stair lift in place which was used by one person to safely use the stairs.

There was a registered manager employed 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.

At the last inspection on 16 February 2016, the service was rated Good.

Ashurst House was designed, built and registered before ‘Registering the Right Support’ and other best practice guidance had been published. Ashurst House had not been operated and developed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen, but this was not always the case for every person living at the service.

Risks had not been appropriately assessed and mitigated to ensure people were safe.

Medicines were not always managed safely. Records had not always evidenced that people had received their medicines as prescribed.

There were enough staff deployed to meet people’s needs in the mornings. However, staffing levels had been reduced; there were less staff on shift in the afternoons which meant there were times in the day where people did not have adequate supervision. We made a recommendation about this.

The provider operated safe and robust recruitment and selection procedures to make sure staff were suitable and safe to work with people.

Staff knew what they should do to identify and raise safeguarding concerns.

The service was clean, tidy and equipment had been properly checked. Shower heads had not always been cleaned in accordance with the legionella policy. We made a recommendation about this.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always maintained adequately and kept securely.

People were encouraged to make their own choices about every day matters. Where people may not have the capacity to make decisions and choices about their care, there was no evidence that capacity assessments and best interests meetings had taken place.

People were supported to have enough to eat and drink. People had choices of food at each meal time. People were enabled to make their own breakfasts, drinks and snacks. Staff had not followed good practice guidance to ensure meals were appetising. Food records did not always identify what was eaten.

People continued to be supported to maintain good health. Staff ensured people attended scheduled appointments and check-ups such as with their GP or consultant overseeing their specialist health needs.

One person was not always receiving care and support which met NICE guidance in relation to prevention and interventions for people with learning disabilities whose behaviour challenges. We made a recommendation about this.

Staff had received training to carry out their roles and further training had been planned. Staff received support to carry out their roles. Staff received regular supervision with their line manager.

Staff respected people’s privacy and dignity. Interactions between staff and people were caring and kind. Staff were patient, compassionate and they demonstrated affection and warmth in their discussions with people.

The service was homely. There was plenty of laughter and chat, people were seen smiling and laughing with staff indicating they were happy.

People knew who to talk to if they were unhappy about the service. No complaints had been received.

People’s care plans contained information about their own skills and abilities and detailed what they needed help with. People’s care records had not always been updated as their needs had changed. We made a recommendation about this.

Activities were taking place for some people. Some people undertook activities within the service and in the community, whilst others appeared to be socially isolated. The registered manager was in the process of improving activities for people to ensure people could keep active and stimulated when they wanted to be.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Ashurst House provides care and accommodation to up to eight adults with a learning disability. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. There were eight people using the service at the time of our inspection.

The service had a registered manager. 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. A senior member of staff was in day-to-day charge of the service whilst the provider was actively recruiting a new manager.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff.

Staff had been trained to recognise and respond to the signs of abuse. Discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Staff respected people in the way they addressed them and helped them to move around the service. We saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs. They had access to health services and referrals for additional support were made when people needed it.

Medicines were managed, stored, disposed of and administered safely. People received their medicines in a safe way when they needed them and as prescribed.

People received the support they needed to eat and drink. They had a choice of meals from a varied menu. Mealtimes were a relaxed and pleasant experience for people.

People’s care was planned and delivered in a personalised way. The service had been organised in a way that promoted a personalised approach to people’s activities. People were involved in making decisions about their care and treatment and had been supported to decide how they would like to be occupied, for example social activities and going out. People were given individual support to take part in their preferred hobbies and interests.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. The risks to individuals, for example in moving safely around the service, had been assessed and action taken to reduce them. Staff understood how to keep people safe. The registered provider had taken action to ensure the premises were safe and met people’s needs.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People knew how to make a complaint if they needed to. Complaints were responded to quickly and appropriately and people were given feedback in a way they could understand.

There were systems in place to obtain people’s views about the quality of the service and the care they received. People were listened to and their views were taken into account in the way the service was run.

People indicated that they liked living at Ashurst House. We observed people being involved in discussions about the help they needed and their preferred day to day routines. We saw that people had enough to do and could join in with activities if they wanted to. We observed that the staff were kind, caring and on hand to help when needed.

People were asked for their consent before any care or treatment was given.

People received care and support that was well planned and sensitively delivered.

People benefited from the homely environment.

We found that there was a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.

Effective quality assurance procedures ensured that people were provided with a good service.