Archived: Ashley House

Updated 17 May 2017

The inspection of Ashley House commenced on 30 of January 2017 and was unannounced which meant that the provider did not know that we were coming.

The inspection of Ashley House took place on 30 January 2017 and was unannounced which meant that the provider did not know that we were coming. The inspection was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service and specialises in dementia care.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give key information about the service, what the service does well and improvements they plan to make, a PIR was returned to us. We looked at previous inspection records and intelligence we had received about the service and notifications. Notifications are information about specific important events the service is legally required to send to us.

Whilst most people who used the service were able to talk to us, some could not. We carried out a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us.

During our inspection we observed how the staff interacted with people and spent time observing the support and care provided to help us understand their experiences of living in the service. We observed care and support in the communal areas, the midday meal, and we also looked around the service.

We inspected the care plans of five people and looked at information about how the service was managed. These included medicine records, staff training, recruitment and supervision records, accidents and incidents, complaints, clinical governance, audits and policies and procedures.

Reviewing these records helped us to understand how the provider responded and acted on issues related to the care and welfare of people.

As part of the inspection we also spoke with the registered manager, nine people who use the service, six relatives, four members of staff and a visiting District Nurse.

Updated 17 May 2017

Ashley House provides accommodation and personal care for up to 22 older people. On the day of our inspection there were 11 people using the service. Ashley House has 6 shared bedrooms and 10 single rooms. There is a communal area, which includes a sitting area and a quiet room along with a garden.

The overall rating for this service is 'Inadequate' and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that provider's found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this time frame so that there is still a rating of inadequate overall, we will take action in line with our enforcement procedures of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or varying the terms of their 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 questions it will no longer be in special measures.

The registered manager was present during our inspection. 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.

During our comprehensive inspection, we found a number of 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 the report.

Risk assessments were not personalised and relevant to the individual.

Information was not available for staff to know how to manage the risks and improve safety to people who swallowing or eating and drinking difficulties. Plans in place for managing risk were not detailed, informative, or specific to the individual. Therefore, staff did not have adequate information to guide them when a person’s risk of choking had increased.

Staff did not have training in the wider risks relating to Dementia, including dysphagia. Dysphagia describes any difficulties or pain in eating, chewing, drinking, or swallowing. The provider did not have a robust or effective system in place for monitoring and improving the quality of care people received related to this condition.

The premises and equipment was not visibly clean and infection control audits were not carried out and call bells were not always responded to in the most responsive and timely way.

The registered manager and staff did not involve people to make decisions about the service they received. Staff did not understand people’s needs and preferences well.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service.

Staff did not take an active part in meeting people's social wellbeing and people were not encouraged to take part in the activities they wanted to pursue.

The registered provider did not work within the principles of the Mental Capacity Act and did not always follow the requirements of the Deprivation of Liberty Safeguards.

The registered manager did not have adequate systems in place to continually review the quality of the service being offered to people.