Ashville House

Ashville House is a residential care home which provides support for up to 3 people needing personal care and mental health support. The home is an adapted terraced house in a residential area. At the time of our inspection there were 3 people using the service.

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

During this inspection recruitment records were not accurate or easily accessible. We found disclosure and barring service checks were not always up to date and references were missing in one recruitment file.

We were not assured people were being supported to receive medicines on an as required basis appropriately, as medicine administration records were not accurate and there was no protocol to explain when people should receive them.

Staff training was not up to date, we were not assured the registered manager had effective oversight to manage staff training to ensure they completed their learning before expiry. Staff were not receiving regular supervision support. This meant we had concerns staff did not have up to date knowledge to support people at the home.

Quality assurance was not effective in the home audits, were not being completed for medicines and recruitment checklist audits were not accurate.

Equality and diversity was not always understood by staff where people were at risk of being discriminated against. We have made a recommendation about equality and diversity.

People were supported to have enough to eat and drink but choices were not always respected.

We have made a recommendation about nutrition and hydration.

People, relatives and staff views were not always gathered within the home to drive improvement.

We have made a recommendation about engagement with people, relatives, staff and health professionals.

There were enough staff to support people at the home and people told us they felt safe living there. People’s other prescribed medicines was administered safely.

People’s risk were assessed and measures put in place to reduce the risk of harm. Staff knew people’s risks and how to keep them safe. Staff knew their safeguarding responsibilities despite not receiving up to date training in the area. The home was clean and infection was managed well within the home.

Consent to care and treatment was requested before care began and staff asked people for their permission before providing personal care support.

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.

The home worked well with health professionals to ensure they received prompt care and support and the registered manger found ways to support a comfortable experience for people when medical procedures were being carried out.

The home was warmly decorated and people could personalise their rooms as they wished. The home was accessible for people living there with access to a small garden.

People told us staff were kind and caring. Staff were patient with people and treated people with respect. Privacy and dignity was respected within the home and staff encouraged people’s independence.

People’s care plans were personalised to reflect their preferences and people’s communication needs were met. People were able to enjoy different activities and supported to travel abroad. Systems were in place to respond to people’s complaints.

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 29 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to the safe management of medicines, safe recruitment, staffing and good governance.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People were supported in a creative way to stay active when national restrictions prevented access to their normal range of activities.

People were supported to maintain their relationships with friends and family where they wished to do so. One person had re-established contact with a family member during the COVID-19 pandemic.

Staff knew and followed national guidance around infection prevention and control which ensured people were safe from the risks of infection.

Ashville House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashville House accommodates three people in an adapted terraced house. People living in the home had mental health needs.

There was a registered manager 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.

The provider had systems in place to ensure people were safeguarded from abuse and avoidable harm. There were robust risk assessments in place and people’s medicines were managed in a way that ensured they received them safely. There were enough staff who had been recruited in a way that ensured they were suitable to work in a care setting. The home was clean and free from mal-odour. When incidents occurred the provider took action to prevent recurrence and ensured lessons were learnt.

People’s needs and choices were assessed and care plans focussed on developing skills and independence. Staff received the training and support they needed to perform their roles. People told us they liked the food and we saw people were supported to eat a varied and nutritious diet. Staff worked with other organisations and healthcare services to ensure people’s needs were met. Adaptations were made to the building where this was required to meet people’s needs. People were supported to make their own decisions and the service was working within the principles of the Mental Capacity Act 2005.

People told us the staff were kind and compassionate and we saw positive interactions between staff and people living in the home. People’s relationships, religious beliefs and cultural background were taken into account and people received support that reflected their beliefs and cultural background. People’s privacy was respected and they told us their dignity was respected.

People received personalised care and records showed people’s care plans were updated when their needs changed. People were supported to attend a range of activities of their choosing. People knew how to make complaints and there was a clear system in place for responding to complaints. The provider had policies in place to ensure people received appropriate end of life care should the need arise.

People and staff spoke highly of the registered manager and told us she demonstrated person centred values. There were clear systems in place to ensure the quality and safety of the service were maintained. The provider and registered manager had a plan to ensure the service was sustainable and stayed up to date with best practice guidance.

Ashville House is a residential care home providing accommodation and personal care to up to three people with mental health needs. At the time of our inspection two people lived in the home. 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.

People told us they felt safe living in the home. People had robust risk assessments in place to mitigate against identified risks and staff had a good understanding of the safeguarding adults process. Staff knew how to raise concerns and the registered manager understood their responsibilities.

Staff recruitment practices ensured that suitable staff were employed. Staff received appropriate training to carry out their roles and told us they were well supported by the registered manager.

The service supported people with their medicines and this was managed safely.

People were supported in line with the principles of the Mental Capacity Act (MCA) 2005. Staff demonstrated they understood application of the MCA.

Records showed that people provided consent to their care and were involved in planning and reviewing the support they received. People's preferences regarding their care, including their health, nutrition and hydration needs were clearly documented. People were supported to access healthcare services and follow the advice of healthcare professionals.

Staff demonstrated a caring attitude. People living in the home and staff had positive, strong relationships. Care plans were highly personalised and were written in a way that reflected the people's communication style.

Support was adapted to support people's changing needs as required.

There was a complaints policy in place. This worked alongside formal and informal meetings to enable people to provide feedback about the service. The service responded to and acted upon feedback they received.

The registered manager was supportive of staff who told us they enjoyed their jobs. The registered manager was highly visible and people and staff told us they found her approachable. There were appropriate systems in place to monitor the quality of the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt comfortable at the home. Relatives we spoke to told us the care the family member received was very good. The home made relevant adjustments to people's rooms so that they could receive personal care safely. For example, they installed a toilet and washing facilities for one individual. Staff knew how to respond to challenging behaviour if it presented itself and put in place guidance to manage this type of behaviour in people's care plans.

Recruitment practice was safe and thorough, as we saw evidence that staff had provided two references and had cleared disclosure and barring service checks to enable them to work with vulnerable people.

Is the service effective?

People were encouraged to be independent where they were able to. We saw that people's care plans were person centred and focussed on people's goals and objectives. Staff knew peoples preferences and worked with them on a one to one basis to support them in daily tasks. For example, supporting people to do laundry or with personal care as this helped people be involved with their own personal development. The home worked with people to give them positive health results. We saw evidence how the home had reduced the number of cigarettes people smoked by providing support on how to stop and by encouraging a healthier lifestyle.

Is the service caring?

We spoke to the two people living at the home and they both said they liked living at the home. One person said "I like all the staff here; they make me feel very comfortable." Someone explained how after a personal bereavement, the home helped them through it and helped calm them, which showed how the service cared for them.

A relative explained how they got on well with all the staff and saw that their family member got on well with them too. A member of staff was always visible to support people and we saw that staff responded to people whenever they asked a question.

Is the service responsive?

The home encouraged people to maintain family relationships and where people did not have family, they encouraged people to be social.

People had a choice of what to eat while the home balanced people's choice by offering healthy food and drink options at meal times.

The home reviewed people's needs annually and they documented people's daily activities in log books and communicated any important information during handovers.

Is the service well led?

The home had a registered manager and a deputy to support the leadership in the service. Relatives, staff and people at the service knew who to speak to if they needed support or had any concerns.

People using the home, their relatives and friends involved with the service completed an annual satisfaction survey. Professionals were also encouraged to give feedback so the home could learn and improve on the service provided.

Daily checks on people's rooms and daily health and safety checks were carried out. These helped the home identify any problems that needed to be addressed quickly.

During our visit we saw that staff treated people with dignity and respect. We saw they were knowledgeable about people's needs and preferences, were observed to treat people as individuals and care was delivered in a personalised way.

People that we spoke with were positive about the staff team and comments included, 'staff are good people," "I trust them" and "if I was unhappy I would tell staff who would get in touch with the right people."

Staff we spoke to understood how to support people and assist them to make appropriate choices with their preferences for care and support delivered in accordance with their wishes. They told us they felt supported by the manager, had regular team meetings and access to appropriate training.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires, periodic and annual reviews, care coordination meetings and both group and one to one discussions. We saw notes of meetings and results of satisfaction surveys which showed that people's views were listened to and taken into account and that people were happy with the care provided.

We saw that there were effective safeguarding procedures in place and staff were aware of the processes to report and escalate any concerns both internally and with other agencies.

There were enough staff at the timer of inspection to ensure that peoples needs were met and that if an emetgency arose the staffing levels were suffiecient to enable staff to take timely action. Staff told us that they felt confident and capable of dealing with any emergency situations.

There were safeguarding procedures in place and staff were aware of the reporting and escalation of any concerns. The service had quality assurance and monitoring arrangements in place and the service had implemented changes where appropriate.

We saw results of satisfaction surveys and incident reporting which showed that people were happy with their care and that their views were listened to and taken into account.

The medical notes of people using the service were securely stored and kept current.