Ashington Gardens

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. Under the previous registration we rated this key question inadequate. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The reporting of accidents and incidents had significantly improved in recent months. Staff were aware of the importance of reporting accidents and incidents and knew the correct processes to follow and when to escalate situations for immediate management oversight. Processes were in place for immediate staff feedback following a reportable occurrence and this was done in a constructive way with any learning points being highlighted and then shared with the wider staffing team. A member of staff said, “We have a strong team, a good learning culture.” The registered manager maintained oversight of all accidents and incidents and was able to identify any patterns or trends and take action to minimise the chance of recurrence. Relatives told us they were informed when situations affecting their loved ones occurred with one saying, “There have been a couple of incidents but well managed and nothing you would not expect. We’ve been contacted straight away.”

The provider had not always worked well with people and healthcare partners to establish and maintain safe systems of care. They had not always made sure there was continuity of care, including when people moved between different services. The registered manager had worked hard to improve transitions in and from the service which had, in the past, not always run smoothly. There had previously been an over dependence on positive behaviour support plans (PBS) that had been created by the college people attended, which had not then been revised to reflect people’s support needs within the home. Steps were being taken to update and make these plans more specific to where people were living however, this was a work in progress and needed time to fully embed. A professional told us, “A PBS plan was taken from the education setting from what had been observed in the classroom and college. It was raised by Adult Social Care that the plan should have been specifically relevant to the demands, routines and environmental factors associated with the residential setting.” Some people experienced an emotional reaction when they first moved into the home. With the support of other professionals, these were carefully managed and over time people had become more comfortable with their new environment. This had however, taken time for some people to fully settle at the home. A relative told us, “Yes, there were hiccups at first, but they know him well now and he knows them (staff) and he is quite settled.”

The registered manager worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. There had been significant learning at the service following a recent safeguarding investigation. We spoke with the registered manager and wider management team about this investigation and were shown some of the improvements and processes that had been put in place to safeguard people from avoidable harm. There were clear reporting pathways when a safeguarding incident occurred. Staff told us they were confident in raising concerns one telling us, “Yes, I am confident to report all errors and incidents, and the leaning is now shared with everyone.” We saw reports that had been completed by staff, and these were detailed and presented in such a way that provided easy, immediate and clear oversight for the registered manager. People told us they felt safe living at the home one telling us, “Feel safe here, oh yes.” A relative added, “They are completely safe there.” Some people needed support with making some decisions and they were supported by staff that knew them well to do this. Mental capacity assessments were in place where needed and best interest meetings had been held and were documented with people always being present at those meetings. Deprivation of Liberty Safeguards (DoLS) were in place and had been appropriately applied for and renewed as required. DoLS ensure that people who lack capacity to make specific decisions relating to their care and support are protected and any restrictions placed on them are lawful and in their best interest.

The provider did not always work well with people to understand and manage risks. Risks had been identified and documented but they were presented from the view of the college that people attended each day, rather than their home environment. This was partly mitigated by a team of competent staff who knew people well and were able to tell us about individual risks, how they were managed and were able to tell us about de-escalation processes for people if they were needed. From the known risks to people, assessments were in place for the actual support people needed but were not presented for time spent at the home, just the college. Most people required 1 to 1 support throughout the day whilst at home or at college. 2 to 1 support was provided for some people in the community. These support levels along with known risks were reviewed every college term and more frequently if there was an incident or a change in a person’s presentation. Staff told us they had time to read updates before starting their shift and that there was a thorough handover at shift change so they had all the most recent information about people. A staff member said, “I’m aware of risks and have chance to read plans. At handovers I learn what has happened.” A relative told us, “There are lots of risks but they are all covered.”

The registered manager detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People had access to several communal areas including a large garden, kitchen, lounge and sensory room. People’s bedrooms were personalised according to their wishes. The environment was safe but not restrictive. For example, people could access kitchen utensils and use them but were protected by staff who were always present to provide support if needed. People moved around the home as they wished and there was always the option of moving to a quiet area if they wanted. Fire safety equipment and documents were all in date and fit for purpose. Personal emergency evacuation plans (PEEPs) were within care plans but were not stored in an emergency grab bag for quick access in the event of an emergency. This was immediately rectified by the registered manager. Other environmental certificates were in place for example, electrical testing and legionella.

The registered manager made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. There were enough staff to meet people’s needs. In the event of unexpected staff absence then other staff members could be moved from other houses under the same registered manger to cover, these staff also knew people well. There was some dependency on agency staff, however the same regular staff were used and they knew people well. Staff had been recruited safely with all necessary checks and documents contained within staff files. New staff went through a thorough induction process which was followed by shadow shifts. Staff were, as far as practicable, matched with people according to interests and hobbies. Ongoing support was provided to staff through regular training, all of which was seen to be up to date. A staff member said, “There are always blind spots (meaning unexpected incidents), but the training covers nearly everything.” Staff had regular supervision meetings and staff told us these presented opportunities to raise concerns or issues. Although it was noted that the registered manager had only been in post for a few weeks and had not yet had 1 to 1 meetings with all staff. Comments from relatives about staff included, “They are brilliant” and “Some staff have changed over time but they match staff with people so they get on.”

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had received training and updates in infection prevention and control as well as the correct procedures to follow when using personal protective equipment (PPE). There was enough PPE available for staff and we saw correct usage throughout our assessment. Staff were seen to wash hands in-between tasks and activities including helping people with food preparation and administering medicines. Staff supported people to observe basic hygiene and encouraged them to wash their hands in-between different activities.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. As and when required (PRN) medicines had protocols for staff to follow however the reason for administration was not always clear. No analysis had been carried out as to the effectiveness of some PRN medicines which in one case, was sporadically requested by a person. Medicine administration records (MAR) showed that some people went without certain PRN medicines for up to 14 days but then requested it several days in a row. It’s effectiveness and the reason behind longer periods without were unclear. Staff wore gloves when administering certain medicines and regularly had competency checks to make sure correct processes continued to be followed. Staff were aware of the principles of Stopping the Over Medication of People with a learning disability, autism or both (STOMP). There were reviews of medicines carried out by the Learning Disability Team and by people’s GPs although in one case the most recent review could not be found. Medicines were stored safely in people’s rooms and administration was done with consent from people. Relatives generally were happy with the way medicines were managed at the home with one saying, “We see regular stock takes and they always make sure we have everything we need when we take him home for a stay.”