Ashleigh House

Ashleigh House provides accommodation and personal care for people with a learning disability and autistic people. The service is registered to support up to nine people, there were eight people living at Ashleigh House at the time of our inspection. The new management team were continuing to take steps to create a more domestic and homely feel.

People’s experience of using this service and what we found

Since the last inspection, staffing levels had significantly increased to enable people to be supported in a more person-centred way. People were better 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 now supported this practice. The provider needs to continue to take steps to embed and sustain these improvements. Please see the Effective, Responsive and Well-Led sections of this full report which identify how the service needs to continue to develop.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The new registered manager was continuing to develop and improve the quality of support against their own action plan since taking over the running of the service. The outcomes for people were continuing to better reflect the principles of this guidance of providing; right support, right care, and right culture. The registered manager demonstrated a good understanding about what further action was required to further improve people’s support. In order to embed and sustain improvements we have made a recommendation that the provider seeks support from a reputable source in respect of developing the strategic and independent monitoring of the service.

Right support:

• Model of care and setting maximises people’s choice, control and independence

The registered manager was continuing to coach and mentor staff to develop their understanding of people’s needs and support them in a more personalised way. Staffing levels had been significantly increased across both day and night and this had improved both the quality and safety of people’s lives.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Care was continuing to become more person-centred and better promoted people’s dignity, privacy and human rights. People’s individual needs were now recognised, and diversity celebrated. Staff had a better understanding about people’s emotional needs and the link between their anxiety and behaviours.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The new registered manager had continued the creating a more open and transparent culture which promoted learning from incidents and accidents through the process of reflective practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last comprehensive inspection rated the service as Inadequate (reported published 7 May 2020) and there were multiple breaches of regulation. We carried out a focused inspection (report published 16 October 2020) where we found the management team had made improvements to the service in line with their action plan. A further targeted inspection (report published 21 January 2021) confirmed these improvements were ongoing.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on actions that the provider told us had been taken to improve the service.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

Follow up

We will continue to work alongside the provider and local authority to monitor their progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashleigh House is registered to provide accommodation and personal care for up to nine people with physical and learning disabilities including Autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance, however the new management team had begun to take steps to create a more domestic and homely feel. Since the last inspection, people had been actively supported to start personalising their rooms and communal areas.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The registered manager was continuing to develop and improve the quality of support against their own action plan since taking over the running of the service. The outcomes for people were starting to better reflect the principles of this guidance of providing; right support, right care, and right culture. The registered manager demonstrated a good understanding about what further action was required to further improve people’s support.

Right support:

• The registered manager was continuing to coach and mentor staff to develop their understanding of people’s needs and support them in a more personalised way.

Right care:

• Care was beginning to become more person-centred and better promoted people’s dignity, privacy and human rights. People’s individual needs were recognised, and diversity celebrated. The registered manager had introduced ways of encouraging staff and people to explore each other’s cultures, beliefs and religions in an inclusive way.

Right culture:

• The registered manager continued to work hard to develop a more open and transparent culture which promoted learning and reflective practice.

Despite concerns that had been raised, we found that people were being supported safely and staffing levels were sufficient to meet people's needs. The atmosphere within the service was relaxed and people were happily engaged in their own individual activities. Staff morale was good and care staff reported that they felt well supported by the registered manager who was continuing to make improvements to the culture and ethos of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last comprehensive inspection rated the service as Inadequate (reported published 7 May 2020). We carried out a focused inspection (report published 16 October 2020) where we found the management team had made improvements to the service in line with their action plan.

At this inspection we found improvements had continued to be made and embedded across the service.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safety and management of the service. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. You can read the report from our previous inspections, by selecting the ‘all reports’ link for Ashleigh House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information 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.

Ashleigh House is registered to provide accommodation and personal care for up to nine people with physical and learning disabilities including Autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance, however the new management team had begun to take steps to create a more domestic and homely feel. Since the last inspection, people had been actively supported to start personalising their rooms and communal areas.

People’s experience of using this service and what we found

People had greater choice and control of their lives and staff were beginning to support in a less restrictive way and promote their best interests. The outcomes for people showed signs of reflecting the principles and values of Registering the Right Support.

People were better safeguarded because management and staff now understood what constituted abuse and how to protect them from harm. Risks to people were assessed and managed in a way which gave people access to more meaningful lives.

The culture of the service was improving, and support was moving towards a more person-centred approach. The restrictions imposed by the COVID-19 pandemic had curtailed people’s access to many activities, but staff had worked more creatively to support people appropriately within the service.

There was now a strong leadership team within the service that were working hard to effectively coach and constructively challenge staff practices. Staffing levels had been increased and maintained at a level that kept people safe and engaged. Shortfalls in recruitment practices had been addressed.

Medicines were now being given as prescribed with better systems to continually monitor safe management.

There were formal systems in place to monitor the quality and safety of the service. A key priority since the last inspection had been responding to the infection risks posed by the pandemic and these had been managed well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 7th May 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the new management team were working hard to address the breaches in regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in March 2020 where multiple breaches of legal requirements were found.

We undertook this focused inspection to check the provider had followed their action plan and to confirm the breaches in regulations had been addressed. This report only covers our findings in relation to the Safe and Well-led key questions which contained the most serious requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashleigh House on our website at www.cqc.org.uk.

Follow up

As we only looked at two key questions, the overall rating for this service is still ‘Inadequate’ and the service remains in ‘special measures’. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took in to account the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what action was necessary and proportionate to keep people safe at Ashleigh House.

We will now request an action plan from the provider to understand what they will do to continue to improve the standards of quality and safety. We will then continue to monitor the service closely and work with our partner agencies to ensure people are safeguarded. We will re-inspect the service to ensure the service continues to make significant improvements to the care that people receive.

Ashleigh House is registered to provide accommodation and personal care for up to nine people with physical and learning disabilities including Autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance and no steps had been taken to create a domestic and homely feel. Bedrooms had not been personalised and communal areas were sparsely decorated.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People were not always treated fully engaged with or treated as partners in their own care.

A lack of understanding by both management and staff in relation to safeguarding people placed them at risk of abuse. Concerns raised during the inspection have led to ongoing safeguarding investigations. People did not always receive support that promoted their privacy and dignity.

The service lacked a positive culture and people were not at the heart of the service they received. Support was task focused and emphasis was placed on managing people as a collective rather than enabling them to lead individual and meaningful lives. People had limited access to activities that developed their skills and independence.

There was an absence of strong leadership to effectively coach and constructively challenge staff practices. This coupled with a lack of staff training meant that staff did not have the necessary skills and experience to deliver support in line with best practice.

Staffing levels were insufficient to meet people’s individual and holistic needs. There was a lack of clarity in respect of people’s one-to-one hours. Recruitment practices failed to adequately assess whether new staff were suitable for their role.

Medicines were not always administered as prescribed. Whilst people were supported to access their doctor when needed, staff did not work appropriately in partnership with other healthcare professionals to meet people’s holistic needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 17 January 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the way people were being treated at the service. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to the provision of person-centred care, treating people with dignity and respect, restrictions on freedom, safe care, safeguarding from abuse, good governance, staff recruitment and training.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor the service closely and work with our partner agencies to ensure people are safeguarded. The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Ashleigh House Residential Care Home registered to provide accommodation and personal care for up to nine people with physical and learning disabilities including autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance. The service comprised of five ground floor bedrooms all with en-suite facilities. There were four further bedrooms on the first floor three of which had en-suite facilities. People were able to use a lounge area as well as dining and activity rooms.

People’s experience of using this service and what we found

People were not always supported in line with their care plans and, on occasions, were closely monitored by staff which was not always necessary. People spent large parts of the day being supervised by staff rather than being supported to be as independent as possible. The registered manager had not considered other ways of supporting people and the service was not always acting in line with its Statement of Purpose. Staffing levels did not always meet the minimum safe levels stated by the registered manager which left some people not receiving the one to one support they required. Whilst there had been no specific safeguarding incidents since the last inspection the system to identify concerns was not clear and potential safeguarding concerns had not been identified. Some staff lacked understanding in some aspects of their role which meant people were ‘managed’ rather than supported by them.

People spent large parts of the day in one area of the home and activities were not meaningful to them in all cases. Staff were seen to be well-intentioned and kind towards people, and feedback from relatives was positive who were happy with the home and how their loved one was supported. However, opportunities to provide person centred care were missed which meant some people were limited in what they did. The quality assurance systems in place had not identified areas for improvement which meant people were restricted unnecessarily at times. Feedback from staff about the registered manager was positive. After the inspection the registered manager told us they had undertaken activities with people later in the day.

The environmental issues identified at the last inspection had been addressed and action taken to help ensure the health and safety of people in relation to this was maintained.

Previous Inspection

The last rating for this service was Inadequate (Report published 13 May 2019.)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor the service closely. The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ashleigh House is a large detached house. It is registered for the support of up to nine people with physical and learning disabilities including autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance. The service comprised of five ground floor bedrooms, three of which had on-suite facilities. There were four further bedrooms on the first floor, three bedrooms had en-suite facilities. Two communal bathrooms were also on the first floor although one of these was not in use at the time of our inspection. People were able to use two lounge areas and a dining room. There was a small outside space with a lawn area and seating.

People’s experience of using this service:

The outcomes for people did not always reflect the principles and values of Registering the Right Support for the following reasons. Most people at the service were non-verbal and poor staff communication methods meant that people did not always have a say in how their care and support was received. People had limited choice and control about their everyday lives.

Some risks people faced were not always identified or acted upon. We found environmental risks that could impact on people’s safety. Sometimes the way the service was designed had a negative impact on people. For example, the positioning of bathrooms and toilets. The provider was undertaking building and maintenance work at the time of our inspection to help make things better for people.

Staff did not always understand or remember the training they had received. Some additional training that may have helped staff meet the needs of people had not been provided. This meant there was a risk that people may not receive the care that was right for them.

Staff told us they felt supported and had regular meetings with the provider to discuss problems or issues. However, some of the recruitment practices for staff were poor and there was a risk that unsuitable staff could be employed to support people.

We were concerned that people were not able to agree to the care they received and the provider's systems meant that people were being deprived of their freedom unlawfully.

We observed people were relaxed in the company of staff and the staff we spoke with knew people well. However, sometimes people did not receive the privacy and dignity they should have.

People had enough food and drink to keep them healthy but they were not able to choose their weekly menu. Instead staff would offer alternatives if people refused the menu choice.

People were not always helped to communicate their needs or be involved in how the service was run. Although guidance had been given to staff about ways to communicate, this was not always followed. Information was not always available to people in a format they could understand.

The provider made regular checks to make sure the service was running well. However, they did not identify the issues we found during our inspection. So, they need to do more work to make sure improvements are made.

Rating at last inspection:

The overall rating at the last inspection was good. Well led was rated as requires improvement. The last inspection report was published on 19 February 2018.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Following an incident, we received information from the local authority regarding concerns about the service. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement:

The service met the characteristics of Inadequate in three key questions of safe, effective and well led and Requires Improvement in caring and responsive. We are considering enforcement action and will report on this when it is completed.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local authority. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We last inspected this service in April 2016 when we rated the service as Good.

There was a registered manager in place, who had taken up their post since our last 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. The registered manager assisted us with our inspection.

People were cared for by staff who knew them and knew their needs. Staff were attentive to people and displayed a kind, caring approach. People seemed relaxed in their environment and were given the opportunity to spend time where they wished and remain as independent as possible. However, we found some records in relation to people needed to be updated. We also found some out of date items in the first aid box and that the service’s complaints policy contained incorrect information.

People were supported by sufficient staff to meet their needs and good recruitment processes were in place to ensure only suitable staff were employed. Risks to people had been identified and as such staff took appropriate steps to help mitigate any risk of harm of injury to people. Staff were aware of their responsibilities in safeguarding people from abuse.

Staff received on-going training, induction and supervision to support them in their roles. Staff were able to describe good infection control processes and we found the environment people lived in was clean and hygienic. Although people’s rooms were not all personalised we found they were comfortable and provided appropriate furniture for people’s needs. People could have privacy if they wished as we found some people had their own keys to their rooms. The environment was suitable for people who have a learning disability and the provider planned to make further improvements in response to people’s needs to improve the quality of the service people received.

People were assessed to see if they had capacity to make specific decisions. In the event that they did not, staff followed the legal requirements in relation to consent. Before people moved into the home a full assessment of their needs was carried out and relatives felt engaged in this process.

People received support from staff who demonstrated a good understanding of people’s communication styles and ensured people received care that focused on their health and wellbeing. People received the medicines prescribed to them and staff sought advice from external professionals to help ensure people received the most appropriate, effective and responsive care.

People had access to the food of their choosing. People’s care records were completed in detail and contained sufficient guidance for staff to understand people’s needs. People had access to a range of individual activities in line with their interests.

Systems were in place to monitor the quality of the service provided and ensure continuous development. People and staff were involved in the running of the home and relatives played an active role. The service had a registered manager who was also the provider. The registered manager was aware of their statutory duties in relation to CQC. Staff felt supported by the registered manager as well as the deputy manager. Staff told us they were happy working at the service and we observed good team work amongst staff.

During our inspection we made one recommendation to the registered provider in relation to records held about people.

The registered manager in post is also the provider. 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 and associated Regulations about how the service is run.

People were protected from abuse because staff were able to recognise the signs of abuse and had undertaken training regarding safeguarding adults.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the provider had good management oversight of the home.

People were encouraged by staff whenever possible to be independent. Staff supported people to keep healthy by providing people with a range of nutritious foods. People who were able to were involved in the menu planning and shopping. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful for people. We heard people chose what they wished to do on the day. For example go for a drive or play ball.

The risk of harm to people was well managed and risk assessments were in place for identified risks. The registered manager logged any accidents and incidents that occurred and staff responded to these by putting measures in please to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (Dolls).

Staff were kind and caring and respected. There were sufficient numbers of staff on duty to meet people’s needs and support their activities. People and staff interaction was relaxed. Staff were aware of people’s needs. They were caring to people and respected their privacy and dignity.

Staff received a good range of training to undertake their roles. This allowed them to carry out their role in an effective and competent way.

The registered manager and deputy manager undertook quality assurance audits to ensure the care provided was of a good standard. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place to support people and keep them safe.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had assess to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas regarding the running of the home.

Our inspection of this care service helped to answer our five questions. Is the service safe? effective?, responsive?, caring?, and well led?.

Below is a summary of what we found when we visited the home on 9 April 2014 and 8 May 2014.

Is the service safe?

People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. The provider had facilitated training for staff with regard to safeguarding vulnerable adults and we saw this was updated yearly. We saw health and safety was monitored and promoted and all appropriate utility checks were in place.

Is the service effective?

People's health and care needs were assessed and people were involved in their care planning as much as they were able. People were able to visit their GP and we saw people also had annual health checks. When people's care need changed these were not always reflected with an appropriate risk assessment and therefore did not protect people receiving care. We have asked the provider to tell us what they are going to do to meet requirements of the law in relation to assessing people's needs and updating risks. Staff supported people to maintain family links and provided transport to enable people to visit family at home or to engage in community participation.

Is the service caring?

Some people who used the service were able to tell us they liked living in the home and the staff were kind. Other people were able to communicated to us with gestures, and the support of staff that they were happy living in the home. We saw staff interacted with people in a kind and sensitive manner. We observed staff encouraged people during lunch to help people eat independently and also provide sensitive support with their personal care.

Is the service responsive?

We saw there was a complaints procedure in place which was available to people who used the service and their relatives. We noted there had been no complaints recorded since CQC's last visit. It was noted that in the event of a complaint being made the provider had made clear provision to ensure this would be responded to in a timely manner. We noted the changing needs of a person who used the service required a move to ground floor accommodation. This was done following a physiotherapy assessment.

We noted the provider was not pro active in assessing and undertaking repairs and maintenance in the home within a reasonable timescale. We did however note the home was in the process of refurbishing a room on the ground floor.

Is the service well-led?

The service had a quality assurance system in place for monitoring and improving the quality of the service. We saw regular auditing of care plans, medication records, health and safety audits, and housekeeping audits were undertaken.

The service worked well with other professional bodies and authorities that have placed people in the home.

Staff told us they liked working in the home and felt they had the training and support required to undertake their roles effectively.