Ashmount

Ashmount is a care home providing personal and nursing care and support to five people with learning disabilities and autism at the time of the inspection. The home can provide support for up to seven people.

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 received planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

All five people living at the home had learning disabilities and communication impairments. Although we were unable to communicate with people we spoke with three family members who told us they were happy with the care and support their relatives received.

We spent time observing the experience of people and how staff interacted with people. People appeared relaxed and comfortable with staff. Staff interacted well with people and were caring and supportive towards them.

The home had arrangements for keeping people safe from harm. Staff ensured people were safe. Risks to people’s health and wellbeing had been assessed. There was guidance for staff on how to minimise risks to people.

People were safeguarded from the risk of abuse. Staff had received training on how to safeguard people and were aware of the procedures they should follow if they suspected that harm or abuse had occurred.

People received their prescribed medicines safely. Medicines were safely stored and monitored. Staff had received medicines administration training. They worked in partnership with people’s GPs and other health professionals to ensure that people received the correct medicines.

The provider had carried out pre-employment checks to ensure that staff were suitable for their roles in supporting people. There was a sufficient number of staff deployed to meet people’s needs. Additional staffing was provided where people required support to participate in activities.

Staff had received regular training and demonstrated they had the knowledge and skills to support people’s needs. Regular staff supervisions and appraisals had taken place.

The home was clean, tidy and well-furnished. People’s individual safety had been considered in the design and furnishing of the home and garden. Up to date safety checks had been carried out and any essential maintenance concerns had been addressed. Suitable fire safety arrangements were in place.

Staff supported people to eat a healthy diet that was in line with their individual dietary needs and preferences. Guidance and training were provided to support people’s individual eating and drinking needs.

People were supported to remain healthy. Staff had worked in partnership with health professionals to ensure people’s healthcare needs were met.

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 services supported this practice.

Staff provided people with person-centred care and support that met their individual needs and choices. People’s care and support needs were regularly reviewed, and staff were knowledgeable about how they should support these.

Staff supported people to participate in a range of social, therapeutic and community activities which met their individual needs. Family members told us that staff had supported people to successfully participate in new activities.

There was a complaints procedure and family members told us they knew how to complain. Although people were not able to verbally communicate complaints, staff had responded to their behaviours to make improvements.

The home was well managed. There was a transparent and open culture. Management monitored the quality of the services provided via regular audits and checks. Staff told us they felt well supported. Family members consistently praised the information they received, and the support provided to their relatives.

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

Rating at last inspection:

The last rating for this service was Good (published 23 May 2017). The service remains rated as Good.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

This inspection took place on 26 April 2017 and was unannounced.

The home 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 assisted us with our inspection.

We carried out an inspection to Ashmount in March 2016 were we identified breaches of regulation in relation to person-centred care (specifically individualised activities) and record keeping. Following that inspection the registered provider sent us an action plan detailing how they planned to address our concerns. We carried out this inspection to check the registered provider had taken action in line with their action plan. We found huge improvements during this inspection and had no concerns in relation to person-centred care or records.

People were protected from the risk of harm as systems were in place to keep them safe. Risk assessments were completed which identified control measures to mitigate the risks of harm. Accidents and incidents were monitored and action taken to keep people safe. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse.

Evacuation plans had been written for each person, to help support them safely in the event of an emergency. The building was purpose built with suitable fire exits and staff had undergone fire training to help them understand the procedures in the case of an evacuation.

Medicines were managed well and records showed that people received their medicines in accordance with prescription guidance. People were supported to maintain good health and had regular access to a range of healthcare professionals. People were supported to have a nutritious diet and were able to make choices regarding what they had to eat and drink.

There were sufficient staff deployed in the service and staff worked flexibly to meet people’s needs. Prior to starting work at the service recruitment checks were completed to help ensure only suitable staff were employed. Training was provided and regular supervision held for staff to monitor their performance.

People’s legal rights were protected as staff acted in accordance with the Mental Capacity Act 2005. Capacity assessments were completed and where best interest decisions were made relevant people were involved in the decision. People had access to advocates to act on their behalf.

People were supported by staff who showed kindness and care. People’s dignity and privacy was respected by staff and people were able to choose where they spent their time. Staff had a good understanding of people’s communication needs and supported people to make decisions about their care. People were supported to develop and maintain their independent living skills and had access to a range of activities both within and outside of the home to keep them stimulated.

Each person had an individualised support plan in place which detailed their needs and preferences. Staff were knowledgeable about people’s needs and we observed people’s likes and dislikes were respected. People were supported to maintain relationships with people who were important to them.

Feedback on the quality of the service provided was obtained from relatives. Annual surveys showed that relatives were happy with the care provided. A complaints policy was in place and displayed in an easy read format.

Relatives and staff told us they felt the service was well-led and that the registered manager was approachable. Regular audits of the service were completed to monitor the quality of the service provided. Action was taken to address any concerns identified.

There was no registered manager in post. The new manager was in the process of applying to become the 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 and associated Regulations about how the service is run. The new manager assisted us with our inspection on the day.

At our previous inspections in May and August 2015, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of our concerns we placed Ashmount in special measures and have carried out this further fully comprehensive inspection to see if the provider took action to address our concerns. We had received an action plan from the provider following our previous inspections and we reviewed progress against that action plan during this inspection.

This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant the overall rating is now Requires Improvement and we have taken Ashmount out of Special Measures.

Medicines management processes were not always followed by staff but people received the medicines they required when they needed them. Individual risk assessments for people were not always completed for people, however staff knew how to support people and they received safe care and treatment. Accidents and incidents were recorded. However, some information and action in relation to accidents and incidents had not been completed.

Care plans had been reviewed however, we found some inconsistencies in the information they contained. We found more activities were being undertaken by people. However, further improvement is required to ensure activities are individualised and meaningful.

People lived in a clean, hygienic environment and people’s rooms had been refurbished and personalised. People were provided with information on how to make a complaint should they wish to.

There were a sufficient number of staff available to support people and staff were deployed appropriately. Staff had a good understanding of their role in relation to safeguarding and the provider carried out appropriate checks on staff before they started working at Ashmount.

Staff followed legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had been provided with up to date training and the opportunity to meet with their line manager on a regular basis to discuss their work.

People had a choice of meals each day and staff had guidance easily available to them for those people who were at risk of choking. People received appropriate foods and were supported to remain healthy by staff. For example, fresh fruit and foods were available and health care professionals involved when appropriate.

People were made to feel they mattered. Staff interacted with people and listened to them, supporting them to make individual decisions. People were shown dignity and respect by staff. The atmosphere in the home had improved hugely from our last inspection and staff told us they were much happier working at Ashmount.

Quality assurance checks were carried out by staff and the Trust to check the quality of the care provided. Actions arising from these audits were completed.

People and staff were involved in the running of the home and were given the opportunity to give their feedback on the care they received.

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

As part of this inspection we spoke with four people who use the service, the registered manager, one care staff and three relatives of people who used the service. We also reviewed records relating to the management of the service which included, three care plans, daily care records, training and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that the service minimised the risk and the likelihood of abuse by making sure all the policies and procedures to promote safeguarding were in place.

Relatives told us the service kept them informed about people's wellbeing. They told us that they felt people were safe.

We found that where people did not have capacity to consent, the provider acted in accordance with legal requirements in line with the Mental Capacity Act.

There were procedures in place to deal with foreseeable emergencies. We saw that the Trust had an emergency procedures file, which covered such things as fire evacuation, electricity power cuts, gas failure, heating failure, and adverse weather conditions. We also saw the service had followed on from these to plan and record its further contingencies, so that should a situation arise where the building cannot be used, temporally places of safety had been identified so that safe and appropriate care could continue.

We saw that doors and areas that were required to be kept locked to protect people were secure, for example electrical and medicines cupboards.

We saw risk assessments that identified what action should be taken by staff so that risks to people's safety could be minimised.

Is the service effective?

People's health care needs were assessed with them and written in a care plan.

We were greeted by one of the people who used the service who offered us tea and to be involved with their routines. They showed us they could access the kitchen and be supported to have a snack and a drink when they wanted.

Relatives told us they had no complaints about the service people received and they felt they were listened to when they raised any concerns or minor issues.

We saw staff had a good knowledge of peoples' needs and how people liked to be communicated with. We saw that staff demonstrated this through their positive interactions with the people who used the service. For example one person insisted on making tea and having a biscuit every time a visitor arrived. We saw staff support them to do this immediately which followed the guidelines in their care plan.

Is the service caring?

Relatives told us the staff were caring, and that people were well cared for and the service kept them informed about their relative's wellbeing.

We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner.

People's individual person centred care plans also had a section called 'what matters' to the person. For example the care plan showed it mattered to a person that there was sufficient quantity of a certain product and would want to check the levels repeatedly. We saw staff support this on every occasion and show knowledge of how to support them appropriately.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. An example of this would be access to the kitchen unsupervised.

Is the service well led?

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare, but did not have an effective system to regularly assess and monitor the quality of service that people receive. People who used the service, their representatives were not always asked for their views about their care and treatment.

Our visit was unannounced and we found the building fresh and clean and people were treated with respect and dignity.

We were greeted by some of the people who used the service who offered us tea and the opportunity to be involved with their routines. They showed us they could access the kitchen and were supported to have a snack and a drink when they wanted.

We observed that the people who used the service made real choices and confidently directed their day and the day's events according to their current wishes and needs and that staff were responsive to this, as opposed to managing activities only through staff- planned rigid and fixed time events.

We saw that although staff did offer choices and seek consent before offering care and information was included in formats and languages people would understand better so the person's consent would be better informed, we founf that sometimes where people did not have capacity the provider did not always act in accordance with legal requirements.

We found people's needs were assessed and care and treatment was planned and delivered in line with an individual care plan.

We saw that people who used the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises because bedroom doors did not all provide privacy and did not have closing devises. In addition other doors were being wedged open so they could not close to protect people in the event of a fire.

We found that people were given support to make a comment or complaint where they needed assistance. People had their comments or complaints listened to and acted on, without fear that they would be discriminated against for making a complaint.