Ashton Court Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment, we have identified breaches in relation to safe care and treatment, safeguarding, and staffing. We assessed 5 quality statements in the safe key question and found areas of good practice and concerns. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. There were enough staff to support people with their needs. Managers reviewed staffing levels regularly to make sure there were always enough staff. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable would be employed to support people at the service. Safety risks to people were managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. The home was kept clean, and staff used personal protective equipment (like gloves) as needed. People and staff felt able to raise concerns. However, we found that processes were not always in place to ensure allegations of abuse were referred in a timely way to the local safeguarding team. Staff were not suitably trained to ensure they could do their role safely. People felt that the agency staff knew them less well than the permanent staff. There were issues with deprivation of liberty safeguard (DoLs) including where some DoLs had expired and had not been re-applied for in a timely way. Medicines were not always managed safely. We have asked the provider for an action plan in response to our concerns.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and staff were seen to have positive relationships. We did not observe any signs of abuse at the service.

People told us that they felt safe at the service. One person said they felt safe and added, "I am sure if I brought my worries up to one of the staff, they would deal with it or pass it to someone who can.”

The service did not have a clear safeguarding policy for staff to follow. The policy referred to legislation from 2008. However, legislation relating to safeguarding has been updated in 2014 (with the implementation of the Care Act). The policy also did not include all types of abuse, nor did it give clear guidance on which local agency to contact in the event of an allegation. Staff had recorded 3 incidents where people living at the service had physically threatened, or physically hit another person. These are incidents of physical abuse to a vulnerable person and should be investigated and referred to the local authority safeguarding team promptly. The incidents occurring between 3 and 4 months ago; no investigations or referrals had yet occurred. It was concerning that these incidents had not been already acted upon. Some people had a deprivation of liberty safeguards (DoLs). This is a legally authorised restriction on a person’s freedom, due to their ability to make decisions about their living arrangements. It was not clear in people’s care planning documentation that a person was affected by DoLs, how the restriction affected them, or how staff could best support this authorisation. The management team had already identified this and explained it was in their action plan to improve the record keeping at the service. Records showed that some people's DoLs authorisations had expired and not been re-applied. For example, one had expired 4 years ago. This meant the affected person’s rights had been unlawfully restricted for 4 years. The provider had recently recognised this error and made updated referrals. However, it was concerning that such a large time period had lapsed without a re-application.

Staff told us they had no concerns about abuse occurring at the service. Staff knew how to report concerns to the senior management team and had confidence that any concerns would be acted on. Staff also knew how to whistle-blow to external agencies, if they felt sufficient action was not being taken.

Staff understood people's needs and how to support people to stay safe. One staff member said, "If someone feels unsafe walking, we would walk with them. [Name] doesn’t feel safe walking but will do if you support them. Some people can't walk safely, but we know who needs a hoist and have been trained to use it safely."

People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical and social needs. Staff then knew how to support people to manage risk. For example, one person’s mental health diagnosis meant they could easily become agitated and distressed. Staff had clear guidance on how to best support the person, to reduce their anxiety. We saw staff follow this care plan guidance effectively. Staff kept clear records on what support was offered to people. This included keeping records on how often people were supported to reposition. This meant people regularly moved and so reduced the risk of pressure related skin damage. Incidents were recorded by staff, and then reviewed to ensure suitable action was taken to prevent re-occurrence. For example, one person had fallen over, and staff reviewed the incident record and approached the GP for a review of the person’s medicines.

We saw people were supported by staff in a safe way. For example, someone needed to use a hoist to move position. Staff effectively and safely used this equipment.

People told us staff involved them in planning their care. They said staff also knew how to support them in a safe way. One person's memory meant they struggled to be involved with making decisions about their care. Their relative said, “I have seen her care plan and am happy it covers all her needs."

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building, to provide timely support to people.

People told us that there were enough skilled staff to support them safely. A relative told us, "There appears to be enough staff and they have been very helpful. Recently I have been helping [relative] get to the loo but here the carers take over which is nice. The staff seem well trained." On occasion, the service did employ agency staff. People told us that the agency staff were not as good quality as the permanent staff as they did not know people's needs as well.

The management team told us they used a calculation tool to assess how many staff were needed to meet people’s needs. Management told us they felt there was enough staff with the right skill mix to support people safely. Staff told us there was enough staff to meet people’s need. Staff felt they had received appropriate training relevant to their role and supported by the management team.

The provider recorded each staff members completed training module and date onto an excel spreadsheet. The spreadsheet showed that not all staff had received the required training to deliver safe care. For example, 88 percent of staff had not completed end of life training, 75 percent of the staff had not completed tissue viability training and 58 percent of the staff had not completed falls awareness training. This meant we not assured staff were appropriately trained to do their role safely. There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Safe recruitment processes were followed. For example, previous employers were contacted to give references. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people.

Staff had good knowledge of how to keep the service clean and prevent people from catching infections. One staff member said "Some people caught COVID-19. It was managed well. They isolated in their rooms and there was plenty of protective equipment for staff to support them safely."

There were clear processes and policies, to ensure the environment was kept clean and hygienic. However, 53 percent of the staff team had not received training in infection control, this includes how to put on protective equipment and how to keep people safe in the event of an infection outbreak. This meant that not all staff were appropriately trained to ensure people were kept safe in event of an infection outbreak.

People told us that the home was consistently kept to a clean standard, and that staff would always support them using suitable personal protective equipment. This kept them safe from the spread of infection. One person said, "they always wear gloves and aprons when they shower me. The home is always clean and never smells”.

The home was clean and hygienic. We saw that staff had access to personal protective equipment (such as gloves) throughout the home. This allowed them to support people in a hygienic way.

Medicines were not always managed safely. The service did not have safe and effective systems to ensure medicines were managed safely. For example, a person was prescribed a controlled drug Midazolam (used to manage anxiety), the medicines records showed a stock balance of 7 injections. However, in the medicines box there was 8 injections. This placed people at increased risk of not receiving their medication safely. Opened liquid medications which included information about how long they could be used for, had not always been labelled with the date they were opened. For example, liquid Paracetamol (used to treat pain) were being administered to people without staff knowing when they had been opened. This meant people are at risk of not receiving their medication safely. People did not always receive their prescribed medicines as directed. For example, a person had been prescribed Laxido (used to manage constipation) to be administered daily. However, the date on the pharmacy dispensing label was 16 January 2024. This means we were not assured the person had their medicines as prescribed. Medicines audits had been completed but had not identified all areas of risk and concern. This meant there were no effective oversight to ensure medicines were managed safely. This placed people at risk of harm. Staff had completed training, however from what we had seen during our site assessment we were not assured staff were competent after completing the training.

People told us that staff supported them well with their medicines. One person said, "my medication is always on time and if I need any pain killers for anything I can ask for them."

Staff told us they had received relevant training and competency assessment to ensure medicines were administrated safely. Staff were able to explain how they supported people to take their medicines safely. One staff member said, “We check the MAR (medicines administration record) and the medicine label to ensure they match and then administer the medicines. We make sure they have swallowed the medicines and then sign to say they have had them.” However, due to the concerns we saw during our onsite assessment we are not assured that staff were competent to manage and administer medicines safely.