Archived: Ashley House

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.

This inspection was conducted by a single inspector. Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

We spoke with five people who lived at the home. We also spoke with the manager, the owner and three members of care staff. We looked at written records, which included people's care records, staffing rosters, medication systems and quality assurance documentation.

Is the home safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of the people living there, was suited to caring for people with limited mobility and was properly maintained.

There were sufficient skilled and experienced care staff on duty. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the home effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with positive feedback reported in the provider's own annual quality assurance survey.

People were treated with dignity and respect and were encouraged to promote their independence. People were given information and support to help them understand the care and support available to them. Care plans and risk assessments were informative, up to date and regularly reviewed. All of the staff we spoke with were knowledgeable about individual people's care needs, and this knowledge was consistent with the care plans in place.

Is the home caring?

We spoke with five people who lived at the home. One person said to us, "It's lovely here. I have lived here a long time and I've always been happy. The staff have a very nice way with you. They are attentive and they care." Another person said, "The food is nice and you get plenty of choice." Another person said, "It's pleasant here and it's quiet."

We witnessed the care and attention people received from staff. All interactions we saw were respectful, kind and friendly. There was a calm atmosphere throughout the home and a good rapport between staff and the people who lived there. People were treated with dignity and respect.

Is the home responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service. The manager responded in an open, thorough and timely manner to complaints.

Is the home well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

Staff treated people with respect and spoke to them in a polite and caring way. Personal care was carried out in a way that respected people's privacy and dignity and people were able to make choices about all aspects of their lives.

Staff had received training in how to protect vulnerable people and demonstrated they knew the procedures for reporting any concerns. Staff were recruited well, with all the required information being obtained by the provider before each member of staff started work.

A complaints procedure was on display in the hall and people we spoke with knew how to complain, and to whom, if they needed to. However, people told us they had never had to make a complaint. One person said, 'I've never had to complain: I really really mean that.' The provider had a folder full of complements and thank you cards, showing that many people had been satisfied with the service they had received.

We found on our inspection that Ashley House had all the necessary policy and procedures, records, quality assurance and monitoring systems in place for the care and wellbeing of people who used the service. Staff carried out their caring responsibilities well and people and their families were involved in their care arrangements. Internal improvements to the home were underway which would provide people who used the service with better and more updated facilities.

People who lived at Ashley House had a range of needs including those associated with dementia. People who were able to speak with us told us that they felt cared for, were given choices about meals and every day activities. One person said 'The food is lovely and I can have what I want.'

A number of people were not able to tell us directly about their experiences. However, we saw that they were relaxed and interacted positively in different ways with the staff. For example, people had one-to-one time with staff members who talked with them about things of interest and we saw that people enjoyed the gentle way staff were assisting them to eat.

One person said 'When I first came here, it was a bit confusing but they explained everything to me and made sure I understood. They are like that here, they take the time to tell you things.'