Archived: Ashbury Court

Updated 23 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 6 July 2017 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications received by the Care Quality Commission which a provider is required to send us by law. Notifications are information we receive from the service when significant events happen, like a death or a serious injury. We reviewed information we had received from people’s relatives.

During our inspection we spoke with twelve people living at the service, four people’s relatives and friends, a community nurse, a community matron, the registered manager, the deputy manager and the operations manager and staff. We visited some people’s bedrooms with their permission; we looked at care records and associated risk assessments for five people. We looked at management records including staff recruitment, training and support records, health and safety checks for the building, and staff meeting minutes. We observed the care and support people received. We looked at medicines records and observed people receiving their medicines.

Some people were unable to tell us about their experience of care at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We last inspected Ashbury Court in November 2016 and the service was rated Inadequate. We found that the provider was in breach of a number of regulations. We served three warning notices and told them to take action to make improvements.

Updated 23 September 2017

This inspection was carried out on 4 and 6 July 2017 and was unannounced.

Ashbury Court provides accommodation and personal care for up to 37 older people. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. There were 22 people living at the service at the time of our inspection. The service is situated next door to another care home service run by the same provider. Ashbury Court no longer share staff and management with the other service. The number of people using the service and the complexity of their needs had reduced since our last inspection. No new people had begun using the service since December 2016.

At the last inspection on 30 November and 1 December 2016, we found the service was in breach of six regulations and required the provider to make improvements. The service was rated Inadequate and placed in special measures. The provider sent us information about actions they planned to take to make improvements. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

At this inspection we found some of the necessary improvements had been made, however we found continued breaches of regulations and new breaches of three regulations. Further improvements were required in other areas. People told us staff were kind, however we found that people were not always treated with care and respect.

A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager was supported by an operations manager and a deputy manager. The provider’s oversight of the service had improved however, they had failed to take action to make sure they and the registered manager had made all the necessary improvements. The registered manager had not monitored staff to make sure they had completed tasks correctly. Shortfalls in the practice of some staff had not been identified so they could be addressed. Other checks, such as checks on the building and equipment had been completed and action had been taken to address any shortfalls.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager. However, the registered manager had not always taken action to keep people as safe as possible.

Some people had behaviours that may challenge and did not receive consistent support to manage this. Records of behaviours to help staff and health care professionals plan the support people required were inaccurate. Other records, such as reviews of people’s care were not always accurate. Important information, such as letters from people’s doctors had been removed from their records and had not been used to plan their care.

Changes in people’s health had been recognised and acted on, however there had been a delay in supporting one person to have an injury checked at the hospital. People had been supported to have regular health checks such as eye tests.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people were restricted.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) and supported people to make choices in ways they understood. However, people’s capacity to make specific decisions had not been assessed correctly. People who knew people and their wishes well had been included in making decisions in people’s best interests.

People, their relatives, staff and health care professionals had been asked for their views of the service. This information had not been used by the registered manager to continually improve the service.

The provider’s complaints policy had not been consistently followed. Some people told us they had made complaints but had not received a response to these.

Assessments of people’s needs were now completed consistently and reviewed monthly. Some risks to people had not been assessed and mitigated. There continued to be unsafe medicines practice.

Staff had completed training and were supported to meet people’s needs including keeping them safe in an emergency. Risks identified in the fire risk assessment had been mitigated.

People told us they had enough to do during the day. They were involved in planning and taking part in a range of activities.

CQC had not been notified of two significant events that had happened at the service. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We received the notifications following our inspection.

People no longer had to wait for the care they needed. Sufficient staff were deployed to at all times to meet people’s needs. Safe recruitment procedures were followed for most staff. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

People had privacy and were able to choose the gender of the staff member who supported them.

People told us they liked the food at the service and were able to choose what was on the menu. Meals were prepared to help keep them as healthy as possible.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the reception and on their website.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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