Ashley Court Care Limited

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• 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

Our rating for this key question has changed to requires improvement. The service was not always safe. We identified 1 breach of the legal regulations. People did not always receive safe care as care plans were not always in place, or reflective of people’s current needs. Action was not always taken following incidents, which resulted in the home not always having a positive learning culture. People received their regular medicines as prescribed however improvements were needed to ensure guidance was in place when people had ‘as required medicines’. Improvements to manage stock medicines in the home was needed to ensure this was effective and accurate. There were enough suitably recruited staff available to offer support to people when needed.

This service scored 62 (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 Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

People felt safe living in the home and raised no concerns. One person told us, “They help me to have a shower. I feel safe with the staff because they know what they are doing when they shower me. The staff have helped me get my confidence back. They take their time with me”.

Some staff were not always aware of people’s individual risks and how these were managed. This placed people at risk of significant harm. For example, a staff member told us that a person who was at risk of falls understood their risks and independently mobilised, where as another staff member told us this person needed to be supervised when they were mobilising upstairs. Staff told us another person remained in bed as they were not always safe when they got up, however the deputy manager told us this person regularly got up out of bed. We also received differing views from staff about how they managed people’s needs when they became distressed. This meant there was a risk that people’s risks associated with periods of distress were not managed consistently and effectively. Staff were however able to tell us how people’s risks associated with choking and diabetes in a consistent manner. The registered manager who was also the provider, acknowledged this was an area they were currently working on. They told us care plans and risks assessments were in place for people. These were reviewed when needed or as and when something changed. They told us the local authority had identified areas of improvement through their visit and there was an action plan in place they were working towards. The registered manager explained they were in the process of transferring information to an online system for care records.

We saw that people’s risks were not always managed in accordance with their planned care. For example, 1 person who was at risk of falls and needed a walking aid to mobilise independently walking up the stairs without this aid. This placed this person at an increased risk of falls. We also saw that some people’s risks were managed in accordance with their care plans. For example, we saw another person receive a diet in line with their assessed needs.

The systems in place to keep people safe were not effective and left people at risk of potential harm. When incidents had occurred in the home, risk reviews were not always taking place. For example, a person had fallen, medical advice was sought however no further action had been taken following this. The care plan and risk assessment had not been reviewed and was not reflective of this incident. Other care plans and risk assessments lacked detail and guidance and were not always reflective of people’s current needs. For example, a person who was on a specialist diet did not have the correct consistency of drink documented in their care plan, placing them at risk of choking. When people were nursed in bed or on pressure relieving mattresses there were no care plans, risk assessments or reference to this equipment recorded in their care files. When people had displayed periods of emotional distress, there was not always guidance in place to show how staff would support them during these times. Records did not always show people received pressure relief in line with their care plans. This meant we could not be assured that people’s risks relating to their skin were being managed safely.

People were happy with the environment. One person said, “All the environment is very good. I just love it here.”

The registered manager told us there were areas of the home they had identified that were in need of redecoration or repair, they told us “We are looking at some of the older areas and decorating some of these areas, refreshing them up.” They confirmed there was no action plan that set out which specific areas were planned for redecorating. The registered manager told us areas for decoration was prioritised according to need. The registered manager told us the maintenance team monitored the safety of the environment and completed checks on call bells, fire safety and equipment. Staff we spoke with raised no concerns with the environment and felt the home and equipment was safe to use.

We observed there was a strong smell of urine on the upper floor in the home which was unpleasant. There were aerosol cans stored on radiators, which were hot to touch in a downstairs bathroom, posing a fire risk. We also saw some equipment was stored which may pose as a trip hazard, for example a hoover was stored in a communal hallway and not locked away. A mobility aid and wheelchair were also stored, blocking an exit of the building. The home was generally clean. In the ‘older’ side of the building, we saw there were areas that were in need of repair. For example, there was some areas to flooring that were raised and some of the walls were stained. During our site visit we saw other areas of the home were out of use and being decorated.

The maintenance team completed regular checks of the environment and equipment. However, we could not be assured these were always effective as we observed concerns including the storage of equipment. Where areas of improvement had been identified and recorded, we saw these had been actioned. There was a system in place to ensure staff could share information with the maintenance team if they identified concerns.

People were happy with the staff that supported them and felt there were enough of them available. Although one person said they sometimes felt rushed when care tasks were being completed, they said, “If I use my buzzer though they come straight away.” Another person said, “There is enough staff, they have always got the time to chat with me. They take their time with me. There is plenty of staff.” Another person felt staff were well trained.

Both leaders and staff felt there were enough staff available to support people safely. The registered manager told us there was a staffing tool in place that was used to ensure there were enough staff available for people. They told us all people’s needs were assessed through the care planning/dependency process; however, they confirmed when people had low needs this was not then added to the dependency part of the tool to calculate the scoring. This meant this tool was not always reflective of people’s needs. The registered manager explained to us the process to ensure staff were safely recruited. Staff told us they received training and felt it helped them to support people. One staff member told us, “All my training is online and up to date, it’s a good base to help people.”

We saw there were enough staff available for people and they did not have to wait for support. However, we saw there were more staff available during our site visit than what the deputy manager and records told us were needed. When people used their call bells staff answered these in a timely way. Staff were available to support people when they requested support in the communal areas throughout our site visit.

Although we observed there were enough staff available to support people during our site visit, we could not be assured the dependency tool used was effective. Assessments were completed for people to determine their dependency levels. However, as we found care plans and risk assessments were not always in place, up to date and reflective of people’s current needs, we could not be assured these scores were accurate. Furthermore, there were 2 parts to the tool and when people’s needs were ‘low’ the registered manager had not completed the calculation part of the tool, to ensure their holistic needs were fully considered. Staff had received training to ensure they had the skills and knowledge to support people. This included mandatory training and training that was specific to people’s individual needs. We reviewed the training matrix, and this confirmed staffs training was mostly up to date. Staff had received the relevant pre-employment checks before they could start working in the home to ensure they were safe to do so.

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

People were happy with how their medicines were managed. One person told us, “I get my medication every day.” Another person said, “They bring me tablets when I need them usually when I’m in pain.”

Staff told us they received training and had their competency checked before they started to administer medicines to people. They told us they were happy to administer medicines and felt safe to do so. The registered manager told us there were some concerns with the electronic system and sometimes this did not sync correctly. However, if this occurred staff could manually input medicines administration. This meant the stock of medicines was sometimes inaccurate. They confirmed this had not been documented or recorded as part of the medicines audit.

The medicines administration records (MAR) we viewed showed us people received their regular medicines when required. People who had ‘as required’ medicines did not always have guidance in place to show staff when these should be administered. This placed people at risk of not receiving these medicines when needed. We found 2 people’s stock for ‘as required’ medicines was inaccurate. We therefore could not be assured people had received these medicines as prescribed