Archived: Ashbury Court

Ashbury Court provides accommodation and personal care for up to 37 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 22 people living at the service at the time of our inspection. The service is situated next door to another care home service run by the same provider. Ashbury Court no longer share staff and management with the other service. The number of people using the service and the complexity of their needs had reduced since our last inspection. No new people had begun using the service since December 2016.

At the last inspection on 30 November and 1 December 2016, we found the service was in breach of six regulations and required the provider to make improvements. The service was rated Inadequate and placed in special measures. The provider sent us information about actions they planned to take to make improvements. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

At this inspection we found some of the necessary improvements had been made, however we found continued breaches of regulations and new breaches of three regulations. Further improvements were required in other areas. People told us staff were kind, however we found that people were not always treated with care and respect.

A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager was supported by an operations manager and a deputy manager. The provider’s oversight of the service had improved however, they had failed to take action to make sure they and the registered manager had made all the necessary improvements. The registered manager had not monitored staff to make sure they had completed tasks correctly. Shortfalls in the practice of some staff had not been identified so they could be addressed. Other checks, such as checks on the building and equipment had been completed and action had been taken to address any shortfalls.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager. However, the registered manager had not always taken action to keep people as safe as possible.

Some people had behaviours that may challenge and did not receive consistent support to manage this. Records of behaviours to help staff and health care professionals plan the support people required were inaccurate. Other records, such as reviews of people’s care were not always accurate. Important information, such as letters from people’s doctors had been removed from their records and had not been used to plan their care.

Changes in people’s health had been recognised and acted on, however there had been a delay in supporting one person to have an injury checked at the hospital. People had been supported to have regular health checks such as eye tests.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) and supported people to make choices in ways they understood. However, people’s capacity to make specific decisions had not been assessed correctly. People who knew people and their wishes well had been included in making decisions in people’s best interests.

People, their relatives, staff and health care professionals had been asked for their views of the service. This information had not been used by the registered manager to continually improve the service.

The provider’s complaints policy had not been consistently followed. Some people told us they had made complaints but had not received a response to these.

Assessments of people’s needs were now completed consistently and reviewed monthly. Some risks to people had not been assessed and mitigated. There continued to be unsafe medicines practice.

Staff had completed training and were supported to meet people’s needs including keeping them safe in an emergency. Risks identified in the fire risk assessment had been mitigated.

People told us they had enough to do during the day. They were involved in planning and taking part in a range of activities.

CQC had not been notified of two significant events that had happened at the service. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We received the notifications following our inspection.

People no longer had to wait for the care they needed. Sufficient staff were deployed to at all times to meet people’s needs. Safe recruitment procedures were followed for most staff. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

People had privacy and were able to choose the gender of the staff member who supported them.

People told us they liked the food at the service and were able to choose what was on the menu. Meals were prepared to help keep them as healthy as possible.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the reception and on their website.

The overall rating for this service is 'Inadequate' and the service is therefore 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 providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process 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.

This 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 to 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 key questions it will no longer be in special measures.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of the report.

Ashbury Court provides accommodation and personal care for up to 37 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 34 people living at the service at the time of our inspection. The service is situated next door to another care home service run by the same provider and shares staff and management with the other service.

The registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager was supported by a deputy manager who had been appointed shortly before our inspection. They gave us records we needed during the inspection. The previous deputy manager was working at the service next door and gave us information about people and other records relating to moving and handling, training and people’s care needs.

The provider and registered manager did not have oversight of the service. They had not supported staff to provide a good level of care or held staff accountable for their responsibilities. Checks on the quality of care being provided had been completed but the shortfalls in the service we found at the inspection had not been identified.

Risks to people had not been consistently identified, assessed and reviewed. Action was not always taken to reduce risks. Detailed guidance was not available to staff about how to keep people safe.

Staff did not have the skills they required to keep people safe in an emergency. Action had not been taken to mitigate risks identified in the fire risk assessment, including risks relating to the building. Following our inspection we informed the local Fire and Rescue Service about the risks we found.

Assessments of people’s needs had not been consistently completed. Staff had not always acted on identified risks to keep people safe and well. Detailed guidance had not been provided to staff about how to meet people’s needs. Staff did not always follow the guidance provided to support people to remain independent. One person’s needs had not been assessed and no guidance had been provided to staff about how to provide their care.

Changes in people’s health had were not always recognised quickly and acted on. One person told staff they felt unwell and wanted a doctor. Staff had not acted on the person’s request and they were later admitted to hospital. People had been supported to have regular health checks such as eye tests. Recommendations made by healthcare professionals following these tests had not always been followed to keep people as safe and healthy as possible.

People’s medicines were not always stored securely and there was a risk that people could take medicines that were not prescribed to them. Medicines were not recorded accurately, including why people’s medicines had been changed.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA). Assessments had not been completed of people’s capacity to make specific decisions. People who knew people and their wishes well had not been included in making decisions in people’s best interests. Care staff assumed people could make day to day decisions, however, guidance was not provided for staff about what decisions people were able to make.

Staff had completed training in key areas but had not completed training to make sure they had the skills to provide effective care to everyone, such as communication training.

Accurate records were not maintained about the care people received and their medicines. Information was not available to staff and health care professionals to help them identify any changes in people’s needs. People’s personal information was stored safely.

Action had been taken to resolve people’s complaints to their satisfaction and use them to improve the service.

People and their relatives were asked for their views of the service. However, staff and other stakeholders such as district nurses and GP’s had not been asked for their feedback on the quality of the service to help the provider identify shortfalls and continually improve the service.

People had to wait for the care they needed, for example, support to walk to the toilet. The registered manager had not made sure sufficient staff were deployed at all times to meet people’s needs.

People told us they had enough to do during the day. They were involved in planning and taking part in a wide range of activities. People made craft items such as Christmas decorations which they sold to staff and visitors.

Safe recruitment procedures were followed for staff. Gaps in employment had been questioned. Staff regularly met with the registered manager to discuss their role and practice and told us they felt supported. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager.

Although people told us staff were kind, people were not always treated with respect. For example, the registered manager referred to people as ‘naughty’ throughout our inspection. People’s tea was made with milk in a pot and not to their preference.

People told us they liked the food at the service but their meals were often cold. Meals were balanced and included fruit and vegetables. All meals were homemade. People were offered a choice of food to help keep them as healthy as possible.

The manager had notified CQC of significant events that had happened at the service. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process 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. This 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 to 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 key questions it will no longer be in special measures.