Ardsley House

We found the following examples of good practice.

• Visitors had to sign a COVID-19 risk assessment and declaration before entering the building and had their temperature checked on entry.

• The home completed PPE competency checks on all staff to ensure they were competent in donning and doffing PPE.

• People and staff had access to regular COVID-19 testing.

• Staff used easy read materials and meetings to discuss COVID-19 and reduce anxieties around COVID-19, with people who used the service. .

Ardsley house is a care home providing care and support for people with learning disabilities.

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 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to thirteen people and thirteen 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 no identifying signs, cameras, industrial bins or anything else outside to indicate it was a care home.

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

People told us they were happy living at the home and felt safe. Relatives also told us their loved ones received safe care.

Overall, medication was managed safely. However, improvements were required in the recording of ‘as and when required’ medication and medication to thicken people’s drinks to manage risks of choking. The provider was completing regular medication audits, but these had not identified the recording issues found at this inspection. Staff’s competency to administer medication was regularly assessed and people were supported to self-administer their medication, when safe to do so.

Risks to people's care were managed safely. However, some risk assessments required further detail. We did not find the recording issues found with medication or risk assessments had any detrimental impact on the care people were receiving; the registered manager took immediate action to review these.

People were supported by staff who were trained and received regular supervision. Most staff had been working in the service for several years and knew people’s needs and preferences very well.

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 provider was completing decision specific mental capacity assessments and related best interest decisions for relevant aspects of people’s care.

The provider completed person centred assessments and most care plans were updated when required. People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well and according with their specific dietary requirements.

People's independence was promoted and encouraged. People received care that met their needs. People had opportunities to take part in activities in the house and outings of their choice.

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.

People remained supported by staff who were caring and respectful. People and, where appropriate, relatives and advocates were involved in making decisions about the care people received.

People, relatives and staff shared positive feedback about the management of the service and the registered manager. We saw people were consulted regularly to comment on the care they received and about plans for the future development of the service.

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 14 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.

Ardsley House is a care home which supports up to 13 younger adults with a learning disability. The care home is just located off the motorway and near to local shops and amenities. Ardsley House At the time of our inspection there was 13 people using the service.

Rating at last inspection

At the last inspection, the service was rated Good.

Rating at this inspection

At this inspection we found the service remained Good.

Why the service is rated Good

People received support which was individual to their needs, and risks were minimised wherever possible. Staff received training and support from the manager which helped them be effective in their roles. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible. The service provider’s policies and systems supported this practice. We observed a relaxed atmosphere in the service, and saw people were free to decide how and where they spent their time and with whom. The home provided a separate building in the grounds where people could access arts and crafts, and support with the vegetable gardens. The registered manager ensured the quality of the service was monitored, and improvements were made when required.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on observing care, speaking with people who used the service and the staff supporting them and from looking at records.

Is the service safe?

People who used the service were not protected from the risk of abuse. Before we visited the service we noted from our records there had been an increase in the number of incidents where people who used the service were abused by another person they lived with. Four of the nine people we spoke with told us they were unhappy because the behaviours of others they lived with had upset them. One person said, 'There's lots of swearing and shouting and it upsets me.' We observed people getting angry with others during our visit. Staff told us there had been an increase in incidents and this was impacting on the lives of others.

It was evident from the care records and from what we were being told people were living in a tense and often unpleasant environment. There had been a number of incidents between the same two people. We looked at one person's care plans but there was no behaviour management plan or guidance to help staff prevent incidents recurring.

The provider had introduced systems to help ensure they acted in accordance with legal requirements where people did not have the capacity to consent. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

Is the service effective?

The provider supported staff to deliver care to an appropriate standard. Staff we spoke with told us everyone worked well together and they felt well supported. Training records showed that appropriate training was being delivered. This included an introduction to learning disabilities, health and safety, crisis management, basic life support, infection control, confidentiality and data protection, food safety for food handlers and level two health and social care (adults).

Staff had received an annual appraisal but they had not received regular supervision sessions with their supervisor. The provider's supervision policy stated that staff should receive supervision every eight weeks but this had not happened.

Is the service caring?

We observed staff assisting people who used the service and saw good care being provided. It was clear from our observations that staff knew the people they were supporting very well. People were involved in daily living tasks within the home and staff assisted when appropriate. We spoke with nine people who used the service and they told us they received good support from staff.

Everyone said they had lots of opportunities to do things within the home and accessed the local and wider community. One person said, 'I like going shopping with my keyworker.' Another person said, 'We do arts and crafts, gardening and Zumba.

Is the service responsive?

The service sometimes responded to people's views but this did not always happen. One person talked to us about what they wanted to do but their care plan did not reflect their wishes. Another person had requested a change in their room because it was upsetting them but this had not been actioned and there was no record of how this was followed up.

We also found that a clear assessment of people's needs was not always carried out. One person's daily notes showed they often got distressed and had been very unsettled. There were clear signs that the person got more distressed at specific times and with specific people. There was no risk assessment or care plan around these triggers or guidance for care delivery.

People had health action plans but these were not up to date. These should identify the actions needed to maintain and improve the health of the person. People who used the service and staff told us they received support with healthcare but we could not establish from the records if people's healthcare needs were being properly met. One person had required some recent healthcare treatment but there was no reference to this in their health action plan.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of the service that people received. Staff told us senior managers visited and talked to them about the service.

The registered manager discussed the various systems they had in place to monitor quality and safety. The provider was carrying out an audit at the time of our visit. We looked at a selection of reports which showed the provider had assessed and monitored the quality of service provision. The provider carried out checks to make sure the premises were safe and adequately maintained.

In the main, people could make day to day decisions such as choosing what to wear, when to get up and go to bed and where to spend their time. People said they met with their keyworker and talked about what they wanted to do. However, we found that it was unclear why or how some decisions were made and staff did not always act in accordance with the provider's guidelines.

The provider had effective systems to monitor the quality and safety of the premises. We looked at service records and certificates which showed the premises had been checked.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider carried out annual satisfaction surveys, which were analysed and used to help improve the service. We looked at the last survey results which showed there was a high level of satisfaction. Everyone said they felt safe, were happy about the way the service was managed and had opportunities to try new things.

Two people we asked told us they met regularly with their key worker and could input into their care record.

People told us they had chosen how their rooms were decorated and could put their own belongings in their room. Two people commented that their rooms were going to be redecorated soon and that they had chosen the colours.

People we spoke with told us they had jobs to do around their home, such as cooking, cleaning and washing, which helped people to remain independent.

People told us they felt 'safe' living at Ardsley House and Cottage. We asked four people what they would do if they didn't like something that was happening at the home. All the people knew to speak to the registered manager, general manager or any member of staff.