Archived: Ashbourne House

Ashbourne House is registered to provide accommodation and personal care for up to 28 older people. The service was previously registered with CQC as a partnership but was re-registered in March 2017 with a single provider who had been one of the partners previously registered.

On the first and second days of the inspection there were 18 older people living at the service. One person who required support with their care was also spending the day at the service. Nine people were living with dementia and five people needed the assistance of two care staff with their moving and transferring and personal care. On the third day there were 17 people living at the service. The service does not provide nursing care, and this service is provided by the local community nursing team.

The provider is registered as an individual and there is no requirement for a manager to be registered with CQC. However, the provider did employ a manager and deputy manager to assist them in the management of the service.

The provider did not have an understating of their legal obligations relating to their registration with the Care Quality Commission. The provider was not aware of the implementation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which came into force in April 2015. This meant the provider did not have an understanding of the requirements of this Act and where they were in breach.

The provider was not managing the service in a way that protected people from the risk of harm from unsafe care. Systems in place had not been effectively implemented to ensure people received safe, effective, caring and responsive care and support. Staff recruitment practices were not always safe and staff did not receive supervision and support to ensure they were supported to meet people’s care needs. Staffing levels were insufficient to ensure people received support from staff in a timely way. Care plans and risk assessments were not always detailed enough to provide guidance and information to staff about people’s care needs and how to mitigate risks to their health and safety. CQC had not been notified of all serious injuries without delay.

Shortly before this inspection, the local authority had provided support to the service through its Quality Assurance and Improvement Team (QAIT). A service improvement plan had been developed which detailed the actions the provider had taken to address the shortfalls in the management systems. However, we saw that some information detailed in the plan was not accurate. Following the inspection we spoke with the members of the local authority commissioning team and QAIT. They raised similar concerns as those identified in this report and took action to mitigate the risks identified.

Prior to this inspection, in July 2017 we had received concerns about staffing levels poor infection control practices, poor moving and transferring techniques and poor quality of food. We found evidence to support the concerns relating to low staffing levels and some poor infection control practices. We found no evidence to support the concerns relating to poor moving and transferring techniques or the quality of food being served.

There were insufficient staff on duty to ensure people received care in a timely way and in a manner that was person-centred. Records relating to people’s care needs and any associated risks were poorly recorded and did not provide an accurate or detailed description to ensure staff could provide safe care and support. People’s care plans had not always been updated to reflect their changing needs. Staff were not provided with clear information about people’s specific care needs and how they should offer support to reduce their anxiety. We observed some staff were focused on tasks such as completing records and ignored people who were distressed. Supervisions and observations of staff had not identified, or had not addressed these issues in a way that ensured people had positive experiences. This placed people at risk of receiving unsafe care.

Systems in place to reduce risks associated with people's care and support were not always effective and this exposed people to the risk of harm. In addition to this people were not protected from risks associated with the environment. We received information from the local fire service, following a routine inspection in July 2017 that indicated risks relating to fire safety matters had not been dealt with. Following the visit from the fire officer, the provider had met with them and agreed dates for the completion of these matters. Some areas of the service needed additional cleaning or maintenance, and there was a significant odour problem around the service.

Accidents and incidents were recorded but not monitored for patterns that may help reduce the risks of a reoccurrence.

Recruitment practices were not always safe. The provider had failed to properly assess the risks of employing staff who may be unsuitable to work with people needing help with their care needs.

The provider had failed to ensure all staff received appropriate induction and supervision to ensure they were able to meet people’s needs. Not all staff received sufficient supervision or had their competence to work thoroughly assessed. Not all staff treated people with respect and promoted their dignity. Staff new to the service and agency care staff did not always receive information about how to safely evacuate people from the building should the need arise.

People's right to privacy was not respected and they were not treated with dignity. Locks were not fitted to all bathroom and toilet doors. People were not always assisted to eat in a dignified and respectful manner that promoted their independence.

People were not provided with appropriate person-centred stimulation and activities. People spent long periods of time without staff interaction. Most people spent their time looking around the lounge area. The TV was on for most of our inspection, but people were not interested in it. Some activities and entertainment were provided and when we saw these taking place, people participated with enjoyment. However, we saw and people and their visitors told us, staff were often too busy to provide any meaningful stimulation for people.

We found the provider and manager were not always supporting people to have choice and make decisions about their care and did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. For example, people who were able to leave the service unaccompanied had to ask staff to open the front door for them before they could leave. However, care staff were aware of people's right to refuse support and asked people for their consent before they assisted them. People were supported by staff who had a good understanding of their responsibilities should they have concerns people were at risk of abuse.

Complaints were not well managed. Details of who to make a complaint to were incorrect and there was no evidence that all concerns raised with the provider had been dealt with.

Some people’s visitors were not happy with the care being provided to their relative and told us staff were unable to spend quality time with people due to low staffing levels. However, other visitors were happy with the care being provided. A quality assurance survey report produced in January 2017 showed 22 people had completed the survey and reported a high level of satisfaction with the overall quality of care being provided. People and their relatives were able to help plan the support people needed by being involved in regular meetings to discuss their needs.

People and their relatives told us they were happy with the quality, variety and choice of food being provided.

People received regular visits from healthcare professionals in order to ensure good health was maintained. People were supported to receive their medicines safely and on time.

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 made recommendations in relation to the Mental Capacity Act 2005. We also identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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