Background to this inspection
Updated
8 April 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team
Our inspection was completed by two inspectors.
Service and service type
This service provides care and support to people living in a house in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a registered manager. 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. The registered manager was not present on the day of the inspection as they had been on a period of planned leave. Instead we were supported by an interim manager.
Notice of inspection
Our inspection was unannounced.
What we did before the inspection
Our inspection was informed by information we already held about the service. We also checked for feedback we received from members of the public and local authorities. We checked records held by Companies House.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people that used the service. We spoke with the interim manager and three members of staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed two people's care records, three staff personnel files, training and supervisions for staff, audits and other records about the management of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We also received feedback from three relatives.
Updated
8 April 2020
About the service
Ashton provides personal care to six people some who have a learning disability and physical needs. On the day of our inspection six people were receiving care and support.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People were not always protected from the risk of abuse as staff were not following the correct procedures when instances of abuse were suspected. Risks associated with people’s care were not always reviewed appropriately and the processes around the management of medicines was not always undertaken robustly. Accidents and incidents were not always being recorded or analysed to look for trends. The quality assurance was not robust in identifying shortfalls.
There were not always sufficient staff to support people with the one to one activities. There were improvements needed around the updates of care records and ensuring good staff practice. We have made recommendations around this.
People received their medicines when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff received training in relation to their role and told us they were supported by the management team. However, we have recommended staff are provided with Makaton training so that they can communicate with people in a more meaningful way. People and relatives told us that staff were kind, considerate and respectful. We saw examples of this during the inspection. People were supported and encouraged to remain as independent as possible and were involved in decisions around their care. People and relatives knew how to complain and were confident that complaints would be listened to and addressed. People, relatives and staff thought the leadership of the service was effective.
Rating at last inspection
This service was registered with us on 2 May 2019 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about how medicines were being managed and incidents of safeguarding not always being recorded and reported. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.
We have identified breaches in relation to the people not always being safeguarded from abuse, the management of medicines and assessment of risk and the robustness of quality assurance. Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner