Ashview

About the service

Ashview is a residential care home providing personal care to 12 people at the time of the inspection. The service can support up to 13 people with a learning disability and autistic people.

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

The provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The provider did not focus on people’s strengths or promote what they could do, so people had a fulfilling and meaningful everyday life.

People were not supported to achieve their aspirations and goals.

People did not benefit from an interactive and stimulating environment. People were not always supported by staff to pursue their interests.

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 policies and systems in the service did not support this practice.

People were not always supported with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

The provider had not ensured staff were appropriately skilled to meet people's needs and keep them safe.

People’s care, treatment and support plans did not reflect their range of needs or promote their wellbeing and enjoyment of life.

People’s care was not focused on their quality of life and was not delivered in line with best practice.

People’s care was not always dignified or respectful.

Right Culture

People were not always supported by staff who understood best practice in relation to the wide range of strengths, needs or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.

The provider had not ensured people’s wishes, needs and rights were placed at the heart of everything they did. The provider had not created a culture of improvement and inclusivity.

People and those important to them, were not involved in planning their care.

The provider had not effectively monitored and evaluated the quality and safety of the support provided to people.

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 requires improvement (18 July 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also received information of concern about management oversight at the service and the quality and safety of the care people received.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. We also assessed whether the service was applying the principles of Right support, right care, right culture.

We have found evidence the provider needs to make improvements. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, staff training, person-centred care, treating people with dignity and respect, supporting people's nutritional needs, management oversight and requirements relating to the registered manager.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

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.

About the service

Ashview is a residential care home providing personal care to nine people at the time of the inspection. The service can support up to 13 people with a learning disability and autistic people.

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

The provider was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

Staff supported people with their medicines in a way that promoted their independence; however, information about people’s medicines was not always accurately documented.

People were supported to make decisions and staff communicated with people in ways that met their needs. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

The provider had not always ensured staff were appropriately skilled to meet people’s needs and keep them safe.

The provider had not always completed all relevant recruitment checks prior to staff starting work. We have made a recommendation about safe staff recruitment.

Staff understood how to protect people from poor care and abuse and how to recognise and report any concerns.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

The provider did not have effective systems in place to monitor the quality and safety of the service. For example, we found concerns with the provider’s oversight of staff training and medicines management.

People’s care documentation had not always been reviewed to ensure it reflected their current needs and preferences.

People were not always supported to engage in meaningful activities and their care plans did not always accurately reflect their future goals and aspirations.

People and those important to them, were involved in planning their care; however, we received some mixed feedback about how well the provider communicated with others.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 3 March 2021) and there were breaches of regulation.

At this inspection enough improvement had not been made and the provider was still in breach of regulations and the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections

Why we inspected

We carried out an unannounced inspection of this service on 27 January 2021. Breaches of legal requirements were found. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve the safety of people’s care and the oversight of the service.

We undertook this focused inspection to follow up on the action we told the provider to take at the last inspection. We also assessed whether the service was applying the principles of Right support, right care, right culture.

This report only covers our findings in relation to the Key Questions of Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashview on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the 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 will take further action if needed.

We have identified breaches in relation to staff training and management oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashview is a ‘care home’. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Ashview accommodates up to 13 people who may have a learning disability, in one adapted building. At the time of our inspection, eight people were using the service.

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

Staff did not always follow the provider’s COVID-19 policy or government infection and protection guidelines. This posed a risk of staff transferring infection.

Quality assurance arrangements and governance systems were in place to assess, monitor and improve the quality of the service. However, we found the quality assurance monitoring had not been completed or had been ineffective in identifying and managing concerns.

People’s medicines were managed safely. However, where people had been prescribed medicines that were taken when required, guidance for staff had not always been provided.

Peoples risks in relation to their health care needs had been assessed and were being managed safely.

People and staff were encouraged to share their views through regular meetings. Staff felt able to raise concerns with the management.

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 30/01/2018).

Why we inspected

This was a planned inspection based on the previous rating and partly prompted by concerns reported by the service in relation to people's safety. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashview on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the 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 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.

We have identified breaches in relation to safe care and treatment and governance at this inspection.

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.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress.

We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

This inspection took place on 15 January 2018. The inspection was unannounced, this meant the staff and provider did not know we would be visiting.

At the last inspection on 7 October 2015, the service was rated ‘Good’. At this inspection we found that the service remained good.

A registered manager was in post. 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.

We found that improvements needed to be made to the outdoor area to ensure that this was accessible, and that the décor within the service would benefit from being updated. We have recommended that the provider updates the décor and external areas of the service, and ensures that people are involved with these decisions.

People spoke positively about the service and told us they were listened to by staff that were kind and caring towards them. People told us that they felt safe and staff understood what abuse was. They knew what steps they should take to protect people and keep them safe. Risks to people’s daily life had been assessed and contained detailed information to ensure people were kept safe from harm.

Checks were undertaken on staff suitability for the role and there were sufficient numbers of staff available to meet people’s needs in a safe way. However, we did find that when staff did not turn up to work that this had an impact on people and staff. We have made a recommendation to increase and maintain consistent staffing levels.

There were adequate systems in place for the safe administration of medication and people received their medicines as prescribed.

Staff received an induction to prepare them for their role and additional training was provided to support their learning and development. The manager assessed staff’s competency to ensure that staff had understood the training and were able to put it into practice.

Staff had understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who lived in the home were positive about the quality of the food and our observations were that people enjoyed their meals. People had meaningful activities offered to them but when staff did not turn up to work this prevented them from going out from time to time.

Care plans were written holistically and reflected people’s needs. Information about people’s health and support needs were available to people in a way that they understood. Assistive technology enabled people to speak with staff and share their views.

No complaints about the service had been received over the last 12 month, but systems were in place so that if a complaint was made, this would be appropriately investigated.

There were systems in place to drive improvement and audits were carried out on a regular basis, which looked at the quality of the service people received. The registered manager had a clear oversight of the service.

We found that staff had been well trained and saw that they had a good understanding of people's individual needs. People were treated respectfully, their individuality and diversity understood. People enjoyed good levels of activity and were able to access the local community.

We found that the provider consulted with people and families and also monitored the service to ensure that standards would be maintained.

All of the people that we spoke with either indicated or told us that they were happy. One person said, 'It's good here, I like the staff and we do lots of things. I go on holidays and went to Blackpool this year.'

We looked at a sample of care files and found them to be detailed and informative. They had been regularly reviewed and updated to reflect any changes. We found that staff had been trained and had received regular updates in their training. Staff told us that they felt well supported to do their work.

The records showed that regular quality assurance surveys had been undertaken. The manager had carried out regular audits and the provider visited monthly to check on the quality of the service.