Ashingdon Hall

Ashingdon Hall is a residential care home providing the regulated activity of accommodation and personal care to up to 28 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 6 people living on the Residential Suite and 8 people living on the Dementia Suite.

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

Not all risks to people's safety and wellbeing were identified and recorded. Where these were recorded there was not enough detail as to how the risks posed should be mitigated. Personal Emergency Evacuation Plans were not sufficiently detailed and contained inaccurate information. The provider’s processes and procedures to protect people from abuse was not robust. Suitable arrangements were not in place to safeguard people’s financial arrangements. People were not always protected by the prevention and control of infection.

The key requirements of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] were not being followed. 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. Not all staff employed at the service had attained up to date mandatory or specialist training relating to the needs of the people they supported. Newly employed staff had not received a formal induction or supervision. We could not be assured all people using the service had a sufficient fluid intake to maintain their hydration needs.

People’s privacy and dignity was not always promoted and respected. Not all care plans were up-to-date or reflective of people's current care needs. People using the service and their relatives were not involved in developing their care plan. Where people were at the end of their life, care plans did not reflect their individual preferences and wishes relating to how they would like their care to be delivered. We did not see enough evidence of how the Accessible Information Standard [AIS] had been applied to meet peoples’ communication needs. People were not routinely supported to engage in social activities. The provider’s arrangements to manage concerns and complaints were not robust.

The leadership, management and governance arrangements did not provide assurance the service was well-led. Governance and quality assurance arrangements were not reliable or effective in identifying shortfalls in the service. There was no robust audit and governance arrangements in place to effectively monitor the service. Not all conditions imposed on the provider’s registration were complied with. There was little evidence of sustained improvement and learning from events to improve the service and make the required improvements.

Staff felt supported and valued. Sufficient staff were deployed to meet people's care and support needs. Appropriate checks were completed before a new member of staff started working at the service. People were supported to receive their medicines safely. People were supported to access healthcare services and support as needed. People felt supported and treated with care and kindness. Arrangements were now in place for gathering relatives’ views about the quality of service provided.

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 inadequate (Published August 2023)

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, the management of risk, staff training, induction and supervision, consent, dignity and respect 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.

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 therefore remains 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 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.

Ashingdon Hall is a residential care home providing the regulated activity of accommodation and personal care to up to 28 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 7 people living on the Residential Unit and 10 people living on the Dementia Suite.

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

Not all people using the service had a care plan detailing all of their care and support needs. Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people's needs. Where information was recorded this was not always accurate or up to date. Information relating to people's individual risks was not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the safe use of medicines. Recruitment practices and procedures were not reliable or safe. There were gaps in training and development for staff and staff supervision was not consistent. Lessons were not learnt, and improvements made when things went wrong.

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 in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The premises did not meet people's needs, particularly for people living with dementia. We have made a recommendation about this.

People were not supported or enabled to take part in regular social activities that met their needs. The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. There was a lack of understanding of the risks and issues and the potential impact on people using the service.

People and their relatives told us they were treated with care and kindness. People were protected by the prevention and control of infection. The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed.

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 23 November 2018)

Why we inspected

The inspection was prompted in part due to concerns received about the lack of care planning, risk and medicines management, staff training and poor recruitment practices and procedures. A decision was made for us to inspect and examine those risks.

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 see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to person-centred care, consent, risk and medicines management, lack of staff training and induction, recruitment practices and procedures and governance and quality assurance.

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

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.

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.

We found the following examples of good practice.

The registered manager was following the government's guidance on whole home testing for people and staff. This included using rapid and weekly testing for staff.

Staff had received training on working during the pandemic in relation to COVID-19 and had received training in the correct use of personal protective equipment (PPE), hand hygiene and infection control awareness.

There was clear guidance and signage in the service to help prompt staff to safely work whilst minimising the spread of infection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of our inspection the registered manager had just left the service. The provider had recently appointed a day manager to oversee the day to day running of the service. Another manager who was the registered manager for another of the providers services was in the process of applying to become the registered manager. The other service was quite local and they would visit Ashingdon Hall frequently. In the report we will refer to the day manager as ‘day manager’ and the prospective registered manager as ‘manager’.

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 service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them.

Risk assessments were thorough and personalised. However, we did identify two risks that had not been fully explored within care plans. The manager actioned this immediately and sent us the information required following the inspection. The service had just acquired an electronic care planning and scheduling system and paper care plans and risk assessments were in the process of being uploaded to the electronic system.

Staffing levels were meeting the needs of the people who used the service. Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. Recruitment practices were safe and records confirmed this.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly. However, on the day of inspection the manager had identified an error and following this inspection they sent us full details of the actions they had taken.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and these were provided in line with their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Positive relationships were formed between staff and the people who used the service and staff demonstrated how they knew the people they cared for well. People who used the service and their relatives told us staff were caring and treated them with respect.

Care plans were detailed and contained relevant information about people who used the service and their needs such as their preferences and communication needs. Concerns and complaints were listened to and records confirmed this.

People who used the service, their relatives and staff spoke highly of the management team and told us they felt supported. Quality assurance practices were taking place regularly.

Further information is in the detailed findings below

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Ashingdon Hall provides accommodation and personal care without nursing for up to 18 persons some of whom may be living with dementia. At the time of our inspection 15 people were living at the service.

The service had a registered manager. 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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was up-to-date with the law regarding DoLS and made referrals appropriately.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse, mental health team and palliative care nurse.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service and in the community. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The manager and provider held regular meetings with people and their relatives and used questionnaires to gain feedback. The manager carried out quality monitoring to help ensure the service was running effectively and to make improvements.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service our identity was checked and we were asked to sign the visitor's book. This meant that staff took appropriate actions to ensure that people were protected from others who may not have the right to access their home. People said that they felt safe and comfortable living in Ashingdon Hall. One person told us, 'If I ever have anything I am not happy about I would tell the staff and they sort it out for me.'

Staff had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been given the information that they needed to ensure that people were cared for safely. The records showed that health and safety checks had been carried out and that any issues had been dealt with appropriately. This showed that the service was safe.

Is the service effective?

People told us that they felt that the service met their needs. One person who used the service said, 'This is the best home in the area, the food is home cooked and the staff are all lovely.' Another person who used the service said, 'The staff are all good and they help me when I need the help.'

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. We saw that the care records had been reviewed and updated. This meant that staff had up to date information about how to meet people's needs.

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully, and they were caring and courteous in their manner. People told us that the staff were very caring. One person said, 'It is lovely here, the staff care about me, they are all so nice.' Another person said, 'All of the staff are lovely, they all treat me well.'

Staff had a good knowledge of people's likes and dislikes. People told us that the staff treated them respectfully. People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by kind and caring staff and that their personal preferences had been met.

Is the service responsive?

People told us that they had plenty to do. One person said, 'I don't get bored as there is plenty of life in this house.' People had participated in activities both in the home and outside in the local community. People told us that staff responded to their needs appropriately.

People were supported to see other professionals such as a general practitioner, community dentist, chiropodist, optician, and district nurse. This showed that people's general health care needs were considered and that the service was responsive to people's changing needs.

Is the service well-led?

We saw from the records viewed that the service worked well with other agencies. Review and health records showed that the service made sure that people received their care in a joined up way. The service's quality assurance system included regular discussions with people who used the service. This ensured that people's changing needs and preferences were always taken into account. The service was in the process of making improvements to its quality assurance system. A new questionnaire was being devised to enable the service to capture the views of all people involved in a person's care.

Other systems and processes such as the medication system and the care planning processes had been checked to ensure that they were still working well. There were a number of recent compliments praising the service and its staff. The complaints procedure was clear and time limited and people told us that they knew how to complain. The manager told us that the service had not received any complaints. This showed that there was an effective quality assurance system in place and that the service was well-led.

We talked with one relative of a person using the service. They told us that their relative liked living at Ashingdon Hall.

We talked with five staff who told us they felt supported in their work.

We found that the provider had reviewed their systems in place for assessing and monitoring the quality of the service. We found that some improvements were needed in relation to assessment and care planning.

We saw that care and support was well planned and delivered and that risks to the health, safety and welfare of people were identified and managed.

There were sufficient staff employed at the service to meet the needs of people and staff were aware of their responsibilities to keep people safe and how to report any concerns.

There were effective arrangements for regularly assessing and improving the quality and safety of services provided at Ashingdon Hall.