Ashbrook House

We found the following examples of good practice:

The provider had developed new ways of recording daily observations about people’s health which were shared with healthcare professionals and appointments were arranged where required.

The provider was following best practice guidance to prevent visitors to the home spreading the Covid-19 infection. The provider had set up a room designated for visiting on the ground floor of the building, which had a separate entrance to the home. Facilities were available in this room for visitors to wash and sanitise their hands. The provider requested that all visitors booked appointments for visiting and staggered visits. The provider ensured that visitors had no contact with other residents and minimal contact with staff. It provided drinks in disposable cups and toilet facilities were directly outside of the visiting room. The provider supported visitors to wear a face covering when visiting. It screened all visitors for symptoms of acute respiratory infection before being allowed to enter the home and asked visitors to put on personal protective equipment (PPE) before the resident was brought to the room so as not to cause alarm. Visitors were required to undertake a lateral flow test, either on the premises or at home, and provide a negative result prior to visiting. There were multiple signs on the premises about infection control and PPE. The provider checked the vaccination and Covid-19 status of relevant visitors, recorded vaccination or exemption status and provided assurance of meeting vaccination requirements.

The provider supported alternative forms of maintaining social contact for friends and relatives; for example, keeping in touch using video calls, visiting in the communal garden in the summer months and using a telephone to communicate. The provider had previously supported visits in the car park and residents being brought to the window and had arranged for a local shop keeper to attend the car park for residents to purchase items when they were unable to leave the home due to Covid-19 restrictions. The provider completed risk assessments for residents who were leaving the home for outside visits and reviewed the risks and how these could be mitigated.

The provider ensured that the home was well ventilated, with windows and doors opened where appropriate to facilitate ventilation. Risk assessments had been completed for staff, which were updated in January 2022, and staff wore appropriate PPE.

The provide had arranged activities for residents to promote well-being and morale, including a first aid course in the garden, regular takeaway nights and visits to a local park. The provider had engaged with the Positive Behaviour Support (PBS) team who had helped prepare social stories, which had helped explain the Covid-19 pandemic to residents. The provider had received a certificate from the local authority in April 2021 in recognition of its dedication and commitment in providing ongoing care for residents during the challenging period of the Covid-19 pandemic.

The provider had supported staff well-being throughout the Covid-19 pandemic and held regular one to one sessions with staff to provide support and guidance. It held regular meetings with staff to disseminate infection prevention and control guidance.

The provider had an admissions policy in place and there were clear procedures for people admitted to the home. The home had not had any recent admissions. Residents were assessed twice daily for development of a high temperature and PCR tests were undertaken on residents every 28 days. The provider had a procedure for testing and isolation of residents if they returned from a hospital admission and for testing of residents who had a scheduled outside visit.

The provider had an outbreak procedure and policy and recovery strategy plan.

Rooms were designated for specific activities, such as for visitors, and were subject to regular enhanced cleaning. The registered manager had oversight of infection prevention and control (IPC) at the home alongside two IPC champions. The provider completed a weekly IPC checklist to ensure compliance with IPC responsibilities.

Further information is in the detailed findings below.

Ashbrook House is a residential care home providing personal and nursing care to 7 people with a learning disability and/or autism. Ashbrook House accommodates up to 9 people in one adapted building.

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.

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

People lived in a safe environment with enough staff to support them. Staff knew how to report any suspected abuse and ensured they took action to help mitigate risks to people. Medicines were managed to ensure people received them as they needed them. Incidents and accidents were appropriately managed.

Staff were trained and supported to meet people’s needs. People were appropriately assessed and supported with their nutritional and healthcare needs. People were supported to make decisions and consent was sought in line with legislation.

People’s needs were met by caring staff that knew how to support them. Staff treated people with dignity and respect and encouraged people to make decisions about their care.

Care plans reflected guidance that supported people’s individual needs. People were supported to express their end of life wishes where necessary. Systems were in place to respond to any complaints or concerns.

The registered manager had good oversight of the service to ensure people, relatives and staff were supported. Steps were taken to make improvements to the home and review the quality of care received. Management worked alongside other agencies to ensure people received support.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 on 23 February 2017 (last report published 23 March 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 Care Quality Commission (CQC) inspection in January 2015, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

At the January 2015 inspection the service did not have a registered manager in post. The service had not done so since May 2014 and there were no immediate plans to register a manager. We considered this to be an unnecessary delay and therefore rated the service Requires Improvement for Well-led.

Since our inspection in January 2015, the acting manager has become registered with the CQC June 2016. The provider was therefore meeting their registration requirements. and therefore we have changed the rating for Well-led from Requires Improvement to Good.

People continued to be safe living at Ashbrook House. The provider ensured suitable checks were completed prior to staff being employed at the service. Staff were alert to the signs of abuse and knew what action they should take if they suspected anyone was at risk.

Staff received training and support in line with their roles and responsibilities to ensure they continued to provide quality care to people. Staffing levels were sufficient to meet people’s needs.

We saw staff were compassionate and provided care that ensured people had privacy and dignity. Staff were alert to people’s individual needs, including their ways of communicating. Staff sought consent from people before providing any care.

People were supported to maintain good health. This included receiving their medicines as prescribed and being supported with their nutritional needs.

The service provided for diverse needs. People were encouraged to be involved in accessing community resources in line with their interests and preferences. There were risk assessments in place which helped to ensure potential risks were identified and mitigated, but people were also encouraged to be as independent as possible.

The provider had a range of audits and checks in place to continually monitor the quality of the service. There was learning from any accident and incidents. People were positive about the registered manager and felt he was open and inclusive. There was a range of opportunities to raise any issues or concerns. People felt their views would be listened to and acted on.

Ashbrook House was clean and hygienic and staff took appropriate measures to prevent the risk of the spread of infection. The communal areas of the home were tired and looked dated, although there were some plans to make improvements in this area.

At our previous inspection visit on the 18 September 2013 we found that living at the home were only able to make limited choices in relation to their care. We therefore asked the provider to make improvements so that people were fully involved in making decisions about their care. During this inspection we found that the provider had made the necessary improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe living at Ashbrook House. People were cared for as individuals. Assessments were carried out by staff to make sure that people's needs were identified and met. Risks were assessed and reviewed regularly to make sure people's changing needs were identified so appropriate plans could be developed to minimise risks to people. People's rights were respected in that they were involved in making decisions about how they wanted to be cared for.

People were cared for in a safe environment that was clean and hygienic. People were able to move around the home freely as the environment had been adapted for people with restricted mobility or for those who were wheelchair users. People were supported to take thier medicines in a safe way.

The Care Quality Commission monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. Staff had undertaken training on the Mental Capacity Act 2005 and were aware of their responsibilities in relation to the Mental Capacity Act.

Is the service effective?

People received effective care from staff that were trained and supported by the manager.

People using the service and their relatives were involved in planning and developing their care and support. Their views and experiences were used to develop their plan of care. Their specific needs were taken into account and staff demonstrated a good understanding and awareness of these.

Staff encouraged and supported people to keep healthy and well through regular monitoring of people's general health and making sure they attended scheduled medical and healthcare appointments. People were encouraged to eat a well-balanced, healthy and nutritious food.

Is the service caring?

People were supported by attentive and patient staff. We saw them give encouragement to people and these interactions were caring and compassionate. Staff respected peoples' privacy, dignity and right to be involved in decisions and make choices about their care and treatment.

All the people we spoke with gave us positive feedback on the care and support they received in the home. Comments we received included, "all the staff are really nice' and 'I don't have any problems here'.

Is the service responsive?

People regularly completed a range of activities in and outside the service and these were constantly being reviewed so people's individual recreational needs were being met.

People using the service met with their keyworker on a regular basis to discuss the care and support they received. People's preferences and choices for how they wanted to be cared for and supported were well documented in their care plans and staff were given appropriate guidance on how to meet these needs.

People knew how to make a complaint if they were unhappy. We looked at the complaints log to see how these complaints had been dealt with and found the responses had been open, thorough and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well led?

The provider carried out regular checks to assess and monitor the quality of the service provided. People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

The home had a registered manager. Staff told us they were clear about their roles and responsibilities. Staff felt well supported to raise concerns and said that their manager was approachable and would act on concerns raised.

We spoke to five members of staff and met all the people living at the home. Many had lived there for a long time and staff understood their needs well. People were well cared for and content. One person told us that they liked living at the home and said 'I am able to do what I want to do'. Another said that they could choose what to eat and told us about what they liked doing. We heard from one person about going to college. He said 'I am learning to speak up for myself'.

People indicated that they felt safe at the home. Staff said that they enjoyed their work and that there was a good team spirit with everyone working together to create a family atmosphere for the people living there.

We noticed that not enough was being done to ensure people were helped to understand and make choices about their care as much as they were able. Where people did not have capacity to make informed choices it was not always clear how their representatives had been consulted on their behalf.

We visited on two separate occasions. The first time we were able to speak with two people who used the service. Others had gone out, some to college or a day centre, others for lunch. We went back a second time to try and speak with more people. On that occasion we met two other people who used the service, although they were reluctant to talk with us.

Comments we received included "I really love it here, the staff are so friendly" and they (the staff) are great".

One person told us "I never complain I wouldn't need to. If anything's not right I just tell them"

People confirmed that they were supported in the way that they preferred. They said staff asked for their views, both about the running of the service and about how they liked to be helped. They said they took it in turns to chair the regular meetings they had where they discussed any changes they might like.

The service worked closely with other healthcare professional to ensure that any decisions were made in the best interests of those people using the service. They had also developed quality assurance processes to monitor their service provision, so that it met people's needs.