The inspection took place on 7 and 8 June 2016 and was unannounced. Ashdale is registered to provide accommodation and support to four people with learning disabilities. It does not provide nursing care. At the time of the inspection there were four people living there. 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. The registered manager had returned to the service in January 2016 following a period of planned absence. During their absence the service had been managed by another registered manager.
Staff had undertaken training in safeguarding adults and understood their role in relation to keeping people safe from the risk of abuse. Where safeguarding incidents had occurred these had been correctly reported to the relevant authorities and action taken to minimise the risk of re-occurrence for people.
Risks to people had been assessed and measures were in place to manage them. Staff understood the risks to each person and ensured these were managed whilst promoting people’s right to be independent. When incidents took place the registered manager reviewed them and took any required action to ensure the person’s future safety.
There had been difficulties staffing the service but there were now sufficient staff. The registered manager had recruited new staff. Action had been taken by the registered manager to ensure people received a level of consistency through the use of the same agency staff whilst new staff were being recruited. People were safe as new staff were required to undertake relevant recruitment checks to ensure their suitability for their role.
There were processes in place to ensure people’s medicines were ordered and stored safely and that their administration was documented. Staff had undertaken training to enable them to administer people’s daily medicines. However, a person required emergency medication to be administered to them on occasions. Not all staff had undertaken this training, as the training that had been arranged for them had to be cancelled at short notice. The provider re-arranged this training during the inspection and the registered manager ensured that in the interim a trained member of staff was rostered at all times in the event the medication needed to be administered. The arrangements that had been in place had not been sufficiently robust to ensure this person’s safety but the registered manager and provider did subsequently take the required action.
Staff received an appropriate induction to their role which included regular supervision when they commenced work with the provider. Staff continued to receive regular supervision in their role following their probationary period. Staff were provided with relevant training. People were cared for by suitably trained and well supported staff.
People’s relatives told us they had been consulted about decisions that their loved ones lacked the capacity to make for themselves. Deprivation of Liberty Safeguards (DoLS) applications had been made for all people as required. Two people’s Mental Capacity Act 2005 assessments which underpinned these applications were not available for review at the inspection. However, the registered manager took immediate action to provide them.
Staff understood people’s dietary needs and had access to relevant written guidance. People’s weight was monitored and where required professional advice was sought. People enjoyed their mealtimes which were a sociable occasion.
People’s records demonstrated they were supported by staff to see a range of health care professionals. In addition people had been reviewed by the provider’s internal behavioural support team where required. People were supported by staff to access health care services.
Relatives told us staff were caring towards people. Staff were observed to interact in a kind and caring manner with people. Staff had access to relevant guidance about how to communicate with people, which they followed.
People were supported by staff to make their own decisions wherever possible. People were involved in the weekly meal planning and were encouraged to exercise choice in their lives.
Staff were observed to treat people with dignity and respect. Staff supported people appropriately to ensure their privacy was maintained when their care was provided.
People’s relatives were involved in the planning and reviewing of their care on their behalf. Staff had a good knowledge of each person’s care needs and interests. People were encouraged to be independent where possible. Staff supported people to attend a range of activities and to maintain regular contact with their families.
There was a complaints process. People were encouraged at their monthly meetings with staff to express their feelings about living at the service and staff understood their role in supporting people to raise any issues.
Staff applied the provider’s values in their work with people. People were supported by staff who understood the processes to enable them to speak out if required.
People’s relatives and staff told us the service was well-led. The registered manager was visible and supportive to the staff team.
Processes were in place to seek feedback on the quality of the service provided. Various aspects of the service were audited both internally and by the operations manager and the provider’s central audit team. Where areas had been identified as requiring improvement, actions had been taken to address these for people.