Ash House

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.

At our last assessment we rated this key question requires improvement because the provider was in breach of the legal regulations in relation to safe care and treatment. At this assessment we found the service was no longer in breach of that regulation, but further improvements were required. At this assessment the rating has therefore remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Evidenced improvements in the management of accidents and incidents needed to become embedded and communication in this area needed to improve.

The provider required accidents and incidents to be reviewed by a senior member of staff and then transferred onto an electronic system to enable an effective review and analysis. Improvements had been made to ensure these were completed in a timely way. This helped the provider to maintain effective oversight to identify trends or patterns at individual or service level and to support the mitigation of emerging risks. However, we did identify 2 incidents where we were assured appropriate action had been taken to investigate and resolve the concerns, but they had not been recorded on the system.

Relatives told us communication regarding accidents and incidents still needed to improve and outcomes were not always shared. One relative told us about an incident and commented, “I had to keep asking about it but just kept getting fobbed off. We never got an apology about that.” Another relative told us, “I sometimes get an email as to what the conclusion is but often, I will ask.”

Improvements had been made to support staff in understanding the importance of reporting and recording in detail any accidents and incidents in the home. Staff told us they had received specific training in accident and incident management. One staff member told us, “I just know to record and report everything and there are certain things that go straight to the management.” Another staff member commented, “If there’s an injury to [people], staff or damage to property it’s a rule here you must document it and let the team leader know. We all review the incident forms each week and look for gaps in what we do.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

One person was being supported to move to a different service at the time of our inspection. A gradual transition plan had been developed which involved the person, other healthcare professionals and those important to them. The transition plan included meeting and spending time with staff from the new service. However, others involved in the transition explained some challenges in communication with Ash House. A party who informally advocated for the person told us they had received limited feedback about the progress of the transition from Ash House.

The deputy manager described the processes in place to ensure people did not miss important medical appointments. One relative told us there had been a phase when their family member had missed several medical appointments. They described recent improvements in this area.

Each person had their own hospital passport which clearly set out important information for hospital staff to understand how to care for the person. People also had individual health action plans to support the sharing of information between healthcare professionals involved in people’s care.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

Relatives generally felt their family members were safe but described how issues with communication could impact their confidence in how safeguarding concerns were managed. One relative told us, “If I raise concerns, they often come back as being inconclusive.”

Records demonstrated accidents and incidents had been reviewed to identify potential safeguarding concerns which had been referred to the local authority. However, records of informal concerns raised by relatives were not formally recorded to determine whether safeguarding referrals were necessary. Further, opportunities to ensure people were consistently safeguarded in relation to their known responses to specific situations were not always taken.

Staff had training about protecting people from abuse and understood their roles and responsibilities. One staff member told us, “Safeguarding is a top priority with the service users, and it is my job to make sure they are safe at all times no matter what.” Another member of staff said, “I would report any concerns even if I was not entirely sure what happened. If I catch a glimpse of something and it gives me that funny feeling in my stomach, I will always report it.” The provider displayed information for staff about how to contact the local authority safeguarding team and report concerns internally. Staff also had training about positive behaviour support and physical intervention to keep people safe.

Where people had restrictions in their care plans, applications had been made to the authorising authority to seek agreement for depriving people of their liberty. We found no unlawful restrictions in people’s care.

The provider did not always work well with people to understand and manage risks.

Feedback from relatives indicated they did not always feel involved and engaged in developing and reviewing risk management strategies. For example, 3 relatives told us suggestions they had made to mitigate risks associated with their family member’s emotional wellbeing had not been actioned. One relative felt improvements could be made in information sharing between staff about the most effective responses to distract people from their anxieties and distress. Some relatives queried how specific incidents had occurred despite risk management strategies in place and described inconsistencies in communication around risk management.

However, risks associated with people’s medical conditions were identified and risk management plans implemented to protect them from the risk of avoidable harm. This included risks in relation to conditions such as epilepsy and diabetes.

Staff told us how they followed care and risk management plans to provide people with safe care. Staff told us they were confident in applying support to people in distress and where restrictive practices were being used, they were proportionate and used as a last resort. One staff member told us that following any restrictive interventions, “We talk it through afterwards between the staff and with the person we have been supporting. We used it recently and talked about it and checked we were okay.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Each person had their own living area which had been adapted to meet their individual needs and preferences. Staff had received fire safety training and information was maintained of the support people needed to evacuate the building in an emergency.

The provider had processes to ensure the premises and equipment were regularly checked and maintained in good order.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

Staffing levels were based on people’s commissioned hours for staff support. Most people had 1 to 1 staff support during the day and some people had 2 to 1 commissioned hours. Staff confirmed identified staffing levels were maintained to ensure people received the level of care identified in their assessment of needs. The provider had recruited new staff which meant they did not have to rely on agency staff to cover shifts. One staff member confirmed, “There’s a lot less agency. [People] had to see so many faces. It’s so, so much better now, [people] have got used to our faces.”

Managers told us rotas were flexible to ensure people had the support they needed to do the things they wanted to do. While relatives did not raise any concerns about staffing levels, some did question whether 2 to 1 staffing levels were being used to ensure the maximum benefit to the person inside the service and out in the local community.

There were processes in place for staff induction and training to ensure staff were competent to provide safe care. The provider’s recruitment processes ensured checks were carried out to ensure the suitability of staff before they started working in the home.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Overall, the home was clean and tidy. There was information available reminding staff about good hand hygiene and the use of personal protective equipment. The provider carried out checks and audits to ensure staff consistently followed good infection control practices.

The provider did not always make sure best practice was maintained in the management of medicines.

Care plans indicated what support people needed with their medicines. However, we identified 1 person’s medication records had not been updated to reflect changes in 1 of their prescribed medicines. Where people were prescribed ‘as required’ medicines to manage pain or at times of distress, there were guidelines in place to inform staff when and in what circumstances they should be administered. However, staff were not consistently recording why 1 person had been administered their ‘as required’ pain relief on the reverse side of the medicine administration record as required. There was no record of whether the medicine had been effective in managing the person’s pain. This meant any patterns in regular pain relief being required might not be identified by other health and social care professionals. Medicines were stored and disposed of safely.

Staff told us they were not allowed to give people their medicines until they had been trained and assessed as competent to do so. People had regular reviews with other healthcare professionals to ensure medicines remained appropriate and effective and to prevent overmedication.