The Care Quality Commission (CQC) has dropped the rating for Ashfield Care Homes Limited, a residential care home, from requires improvement to inadequate following inspections in July and August and has placed the service into special measures to protect people.
Ashfield Care Homes Limited cares for up to ten autistic people and people with a learning disability. This inspection was carried out to follow up on the progress of improvements CQC told the provider to make at a previous inspection, around the safety and quality of care at the service.
As well as Ashfield Care Homes Limited’s overall rating dropping from requires improvement to inadequate, so have its ratings for how safe and well-led it is. Effective, caring and responsive weren’t included in this inspection and remain rated as good.
CQC inspectors also issued four warning notices, to focus the home’s attention on making rapid and widespread changes to improve people’s safety and ensure they are receiving person-centred care and support. Two of the warning notices were served to the manager of the service and two to the provider.
CQC has placed the home into special measures, which means it will be kept under close review and re-inspected to check on the progress of improvements.
Rebecca Bauers, CQC’s director for people with a learning disability and autistic people, said:
“When we inspected Ashfield Care Homes Limited, we were concerned to find leaders had still not created a culture that supported the delivery of high-quality care in the service despite us telling them to do so at previous inspections.
“Despite staff having the training, we were concerned they sometimes didn’t understand people’s needs and sensitivities which could help them provide care which was tailored to them to keep people safe and respect their human rights.
“Aspects of institutionalised practices were also in place. For example, when a person asked for a cup of coffee at 10.46 a staff member told them they would make one at 11 o'clock instead, at coffee time, which wasn’t centred on the person’s wishes.
“There were not enough staff to meet peoples’ assessed 1 to 1 support needs. We saw many instances when people were sat in the lounge with no meaningful activity or staff interaction. Activities were often based on staff availability and were often shared experiences rather than individual preferences, such as everyone going to the pub for lunch. The registered manager told us everyone needed support to go out and this could be shared between staff, but we saw staffing levels didn’t enable staff to respond to people‘s requests to go out on their own or be escorted on an individual basis.
“Staff needed permission to administer as required medicines and we saw it was difficult for them to reach managers out of hours. During our second site visit, conducted in the evening, we attempted to call the on-call manager twice between 8pm and 9pm and received no response. Staff weren’t clear on who to escalate to and we had to contact another of the provider's care homes in order to reach someone from management. We were concerned this would mean a delay in a person receiving medicines as required.
“Previously, we had raised concerns about the cleanliness, peeling surfaces and furniture which could create an infection risk. We found limited action had been taken to resolve this, for example the replacement of ripped easy chairs and repainting of some surfaces, but poor and unsafe infection, prevention, and control practices still remained in place.
“Many of these issues we have raised previously to the provider and it’s unacceptable that so many of these issues remain outstanding.
“We’ve issued four warning notices to the provider and the manager to focus their attention on urgently making these improvements. We won’t hesitate to take further action if we’re not assured people are receiving the standard of care they deserve.”
Inspectors also found:
- Despite staff being informed by inspectors, the medicines cabinet was left unlocked, wide open and unattended on at least four occasions during the inspection
- The provider had a series of audits in place for monitoring and assessing the quality and safety of the service. However, they had not identified or addressed the issues found during the inspection
- The home’s environment was cluttered and poorly maintained.
Inspectors also found:
- A pet therapist attended the home regularly and brought small animals such as rabbits and guinea pigs, which people loved
- The staff worked with other partners, such as district nurses, care managers and the wider community.