Archived: Ashwood House - Norwich

About the service

Ashwood House - Norwich is a residential care home providing personal care to up to 7 adults with a learning disability or autistic people. The service accommodates 5 people in the main house with a shared communal lounge and kitchen. Accommodation for a further 2 people is provided in two self-contained flats.

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

Right 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.

Right Care: Care records were detailed and personalised ensuring people were supported in a consistent approach from staff. People’s dignity, privacy and human rights were being upheld. People were treated as individuals and were able to express themselves how they chose. Staff training ensured they had the necessary skills, knowledge and expertise to safely meet people’s needs.

Right Culture: Leadership at the service had now become imbedded and ensured staff were clear on their expectations. People knew who the manager was and was happy engaging with them and would seek them out if they had a concern. People were empowered to lead meaningful lives and advocate for themselves wherever possible.

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 requires improvement (published 29 April 2022)

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashwood House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Ashwood House - Norwich is a residential care home providing personal care to up to seven adults with a learning disability or autistic people. There were seven people living there at the time of this inspection. The service accommodates five people in the main house with a shared communal lounge and kitchen. Accommodation for a further two people is provided in two self-contained flats.

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

Based on our review of safe, responsive, and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture.

Right support

The model of care did not maximise people's choice, control and independence. The ability to provide person-centred care was compromised due to poor care planning, poor communication and poor consultation with relevant people, including relatives. The systems in place to promote person-centred support were not being utilised effectively. This included in relation to planning activities and maintaining important relationships.

Right Care

People were not receiving care that helped ensure risks to them and others were identified, assessed, and actions taken in response. Further work was required to ensure people were effectively supported with distressed behaviour and communication. Medicines were not always managed safely which placed people at an increased risk. People were not being supported by a robust incident reporting and management system. This included ensuring safeguarding concerns were identified and incidents drove learning and improvement. Serious concerns were identified with the governance systems in place. The systems in place had failed to ensure improvements in the quality of the service had been made. People’s safety was compromised by ineffective and absent systems regarding the monitoring and mitigation of risk.

Right culture

People were not being supported by a service with effective governance that fostered a person-centred, open and inclusive culture.

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 requires improvement (published 11 September 2021). 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. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines management and the management of the service. A decision was made for us to inspect and examine those risks. The information received raised concerns on how the service was applying the principles of Right support right care right culture. We assessed the application of these principles during this inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, person-centred care, and good governance.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. This includes working with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashwood House - Norwich is a residential care home providing personal care to up to seven younger adults with a learning disability, sensory impairment, physical disability or mental health condition. There were seven people living there at the time of this inspection. The service accommodates five people in the main house with a shared communal lounge and kitchen. Accommodation for a further two people is provided in two self-contained flats.

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

The person-centred and quality care that people received had been failed by the provider’s lack of governance systems. This meant there was no effective and accurate oversight, assessment and review system being used. Two concurrent care planning systems were in place running the risk that neither were fully reliable or effective. Important information was either not being captured at provider level or potentially being missed by staff.

Whilst some audits were being completed to assess and monitor the service, we had doubts about their integrity and effectiveness. This was because we saw some records had been pre-populated and others which had been amended. Furthermore, the audits that were in place had either not identified the concerns we found at this inspection or failed to rectify them.

Improvements in the care and support people received was noticeable at this inspection and people’s human rights were being better supported. Although not all risks had been identified and recorded as required, they were mitigated to some degree in practice however improvements are needed in this area.

People received care from staff who were motivated, skilled and knowledgeable, and understood their needs. Staff had received regular support and training and had been safely recruited. Medicines were managed safely. Staff understood their responsibilities around protecting people from the risk of abuse and improper treatment. They knew people’s needs well.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the Safe and Well-led key questions, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service had been registered prior to the guidance however it met the key characteristics due to its small size, position in the community and homely environment. People received person-centred care that concentrated on their strengths, and a proactive and integrated approach had been adopted.

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 requires improvement (published 05 January 2021) and there were multiple breaches of regulations. We imposed conditions on the provider’s registration which meant they had to submit monthly reports explaining the improvements they were making.

At this inspection, whilst we found some improvements, further development is required, and the provider remains in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns about the provider’s governance systems and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains as requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Some of the concerns raised on the day of our inspection site visit were actioned immediately by the provider, such as the removal of accessible ladders and dirty shower drains. However, further risks remain that require the provider’s attention.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashwood House - Norwich on our website at www.cqc.org.uk.

Enforcement

This inspection evidenced that some improvements had been made and that two breaches of regulations found at the previous inspection had been met. However, the provider continued to be in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The previous inspection, completed in July 2020, also found a breach to this regulation and as a result, we imposed conditions on the provider’s registration. This action will remain in place.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashwood House-Norwich is a residential care home providing personal care to up seven people with learning disabilities, autism and mental health conditions. At the time of the inspection seven people were living in the service. The service accommodates five people in the main house with a shared communal lounge and kitchen. Accommodation for a further two people is provided in two self-contained flats. The service had been registered prior to Registering the Right support, however it met key characteristics due to its small size, position in the local community, and homely environment.

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

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support because restrictive practices were not fully assessed and kept under review.

Systems were not in place to ensure restrictive practices were fully assessed and kept under review. Systems around the management and review of restraint were not operating effectively. Whilst most safeguarding concerns were reported we found incidents where some were not. This compromised the oversight and ability of external agencies to monitor and respond to potential safeguarding concerns.

Risks to people were not always identified and assessed. Actions to mitigate risk had not always been taken. The provider had not acted to assure themselves that staff had the skills and competency to support people with moving and handling tasks. No thorough analysis of incidents was occurring overall in the service which took account of patterns and trends to prevent reoccurrence.

A robust framework for quality monitoring and improvement was not in place. There was lack of provider oversight of the service and this also impacted on the ability of the service to make improvements. We found some instances where people’s written information was not accurate or omitted.

Some incidents that had taken place in the service raised some concerns about their being a closed culture. By a closed culture we mean a poor culture that can lead to harm, which can include human rights breaches such as abuse. However, people, relatives, and staff spoke positively about the service and of the support provided. Staff ensured there was regular contact and involvement with relatives. There were systems in place to ensure people’s views and opinions were listened to. The management team were open and receptive to feedback. Where we identified issues at this inspection the management team took responsive action to address concerns which included working collaboratively with other agencies.

Medicines were managed safely, and people received these as prescribed. We identified areas of good practice in relation to infection control and management, this included the service’s response to Covid-19. Following incidents that occurred in the service, these were reviewed and discussed with staff as part of a learning response.

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 April 2019)

Why we inspected

The inspection was prompted in part by concerns relating to a notification of an incident which could have resulted in serious harm to staff and people using the service. The information CQC received about the incident indicated concerns about the management of distressed behaviours for people who use the service. Subsequent conversations with the service also identified concerns about the management of risk in relation to Covid-19. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

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

Following our inspection, the provider took immediate action to address some of the issues identified. This is detailed within the safe and well led sections of this report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashwood House-Norwich on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safeguarding services users from risk of abuse, safe care and treatment, and good governance.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ People and their relatives made positive comments about the care provided at Ashwood House. Comments included, “I have peace of mind as [person] is totally looked after. I can’t express how happy I am with the care,” and, “I am quite happy with it all.” One person said, “It’s my home. I like living here.”

¿ People received care and support from a stable staff team who knew them extremely well.

¿ Care was delivered in a person-centred way based on people’s preferences.

¿ Staff encouraged people to be as independent as possible.

¿ Risks people were exposed to were assessed and measures were put in place to minimise them.

¿ People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way.

¿ People were involved in their care and support and staff respected their privacy and dignity.

¿ Staff had a good understanding of people’s needs, preferences, histories, and routines.

¿ People received appropriate support to maintain their health and to achieve good health outcomes.

¿ Opportunities were offered and enabled people to take part in a wide range of activities which met their individual choice and preferences. This enabled people to achieve positive outcomes and a good quality of life.

¿ Staff felt listened to and valued and they felt involved in the development of the service.

¿ The service was well managed and systems were in place to check the quality of the care provided.

Rating at last inspection: Good (report published 12 April 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Ashwood House is a service that provides accommodation for up to seven people. It offers residential care for adults with a learning disability, autistic spectrum, people who have been detained under the Mental Health Act 1983, people with mental health issues, sensory impairment and people with a physical disability. On the day of our inspection seven people were permanently living in the service. This inspection took place on 2 March 2016 and was unannounced.

The service had a registered manager (‘the 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.’

People living in the service were safe and benefited from the support of sufficient numbers of staff, who were well trained, supported and felt valued in their work.

Staff and the management team understood their responsibilities in safeguarding people from harm. When appropriate they contacted the local authority to report concerns. The home knew how to support people’s needs without restricting their freedom.

Appropriate recruitment procedures were followed and pre-employment checks were carried out to ensure staff were suitable to work with people receiving care and support. There was a robust induction programme for new staff.

Medicines were managed and administered safely in the home and people received their medicines as the prescriber had intended.

Staff were skilled and motivated to support and care for people. Staff also knew people and their needs well. All staff received appropriate training and were supported well by the manager.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us that some people living in the home did not have capacity to make certain decisions for themselves. The manager had appropriately made DoLS referrals to the local authority because they were restricting some people’s freedoms in order to keep them safe.

People had enough to eat and drink and the staff who prepared food provided good quality food and catered for individual preferences. People also had access to the community on a daily basis and often had meals out.

People had regular access to healthcare professionals and were supported to attend appointments. Staff managed people’s health appointments and made appropriate health and social care referrals.

All staff at the service were caring and supportive and treated people as individuals. The care provided was sensitive and person centred and people’s privacy, dignity and wishes were consistently respected. Friends and relatives were welcome to visit as and when they wished and people were supported to be as independent as possible.

People appeared happy living in Ashwood House and their interests were encouraged and supported by staff. There was a positive atmosphere in the service and people were supported to have regular access to the community if they wanted to. People were also involved in planning their care.

There was an open and positive culture at Ashwood House. People using the service and their relatives were given opportunities to raise issues about the quality of the care provided. Relatives knew how to make a complaint if needed.

The service was being well run and people’s needs were being met appropriately. The manager was approachable and communication between the manager and staff was frequent and effective.

There were a number of systems in place to ensure the quality of the service was regularly monitored and maintained. The provider carried out regular audits to identify areas that needed improvement and an action plan was put in place for the manager to complete.

One person animatedly told us that they had had a 'good day' and indicated that they had been for a drive out. By their gestures and facial expressions, we could see that this was something they had enjoyed.

The people we observed during this inspection were content and relaxed and the interactions we witnessed between staff and people living in the home were consistently warm, friendly and engaging.

There were policies in place to safeguard people living in this home and the manager had kept the Care Quality Commission informed of any notifiable incidents or safeguarding concerns.

We observed that medication was stored securely in a lockable trolley, with a designated member of staff holding the keys.

When we asked people questions about the staff, we received positive responses either by them saying, 'yes' or by nodding, smiling and giving us a 'thumbs up' gesture. We also saw that people were comfortable in the presence of the staff on duty.