Ash House

On this page

• 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

We identified a breach of the legal regulations. Systems and processes were not always effective to ensure people were provided with safe care and treatment. There was limited evidence of a learning culture. Accidents and incidents were not always reviewed in a timely way, so learning could be promptly shared with the wider staff team. There had been no effective oversight by the provider to identify any trends or patterns so they could support the manager in mitigating emerging risks. Where risks associated with people’s health and wellbeing had been identified, records contained detailed information about how staff should manage these risks. However, records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring of risks to take place. The provider had policies and processes in place to safeguard people from abuse and potential harm. However, records did not contain enough information about the actions staff had taken to safeguard people. Two unexplained injuries had not been investigated to identify the cause and determine if a safeguarding referral to the local authority was needed. The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, Right care, Right culture. Overall, medicines were managed safely. However, some processes to support good medicines practices were not being consistently followed. There were enough staff to provide safe care and treatment. Staff were recruited safely. Pre employment processes included reference and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us communication regarding accidents and incidents needed to improve. Some relatives were not confident they were always informed about accidents and incidents. When relatives were informed, outcomes were not always shared. One relative told us, "The family want feedback and learning from incidents, and to have more involvement [in the overall management of accidents and incidents."

Staff understood their responsibility to be open and honest and told us they understood the importance of reporting and recording accidents and incidents. One staff member told us, "We record accidents and incident forms. We have a tray to put the forms in for the manager to review. After an incident we can talk it through but it has been a long time since I have been involved." Another staff member told us, "I fill out accident reports if there are any injuries. I always report it first." Although staff understood their responsibilities, this was not always reflected in staff practice. The interim manager and area manager told us accidents and incidents had not been recorded in line with the providers expectations and confirmed staff had not always completed these records in enough detail to enable an effective review.

There was limited evidence of a learning culture. Accidents and incidents were not always reviewed in a timely, so learning could be promptly shared with the wider staff team. There had been no effective oversight by the provider to identify any trends or patterns so they could support the manager in mitigating emerging risks. The provider required accidents and incidents to be recorded on an accident and incident form, and then transferred onto an electronic system to enable an effective review and analysis by the provider. During the 3 months prior to our assessment, a significant number of accidents and incidents had not been entered onto the electronic system. This meant there had been no effective oversight by the provider to identify any trends or patterns at individual or service level so they could support the manager in mitigating emerging risks. Where accident and incident records had been completed, they were incomplete and contained significant gaps in information. There was no evidence these had been reviewed to ensure action had been taken to mitigate individual risks to people's health and well-being. Where staff had used breakaway techniques to keep themselves and others safe, records were not detailed in describing the use of the interventions or their effectiveness. There was no reflection or oversight after the use of breakaway techniques to support staff learning, identify where changes could be made to develop more effective strategies and to understand the meaning of the person's behaviour. Both the interim manager and area manager confirmed this was not in line with the provider’s policies and procedures.

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.

Although relatives did not raise concerns of people's physical safety, most relatives raised concerns about people’s personal and emotional needs not being consistently met. One relative told us they felt a person looked 'neglected' when they saw them. Another relative commented, "I don’t think any staff will actually harm [person]. But they might not give them a drink. [Person] was trying to drink out of bottle, but nothing was coming out. Staff sat there drinking tea."

Staff understood their safeguarding responsibilities and knew what action to take if they thought a person was at risk of potential harm. Staff told us, "I wouldn’t hesitate and go to management. If it was my child I would be devastated. If anyone was being neglected or not being given the right care, even if laundry [was] not getting done, I will raise it". Another told us, "Safeguarding is ensuring the people we support [and their] rights are protected. Involving them in everything we do. Protecting them from any harm and abuse."

During the on-site part of our assessment we spent time with people and the staff team. People appeared relaxed and comfortable with the staff members supporting them. One person greeted new members of staff coming on duty with handshakes and ‘fist bumps’ and appeared pleased to see them.

The provider had policies and processes to safeguard people from abuse and potential harm. However, incident reports did not contain enough information about the actions staff had taken to safeguard people. Two unexplained injuries had not been investigated to identify the cause and determine if a safeguarding referral to the local authority was needed. The interim and area manager confirmed the provider’s safeguarding processes had not been followed. Ineffective management of accident and incident reports meant the provider could not be assured safeguarding incidents would be identified, reported and managed in a timely way. Where people had restrictions in their care plans, applications had been made to the authorising authority to seek agreement for depriving people of their liberty. We found no unlawful restrictions in people's care and there were no legal conditions where authorisations to deprive people of their liberty had been granted.

Relatives felt improved communication between them and the service would mean a more holistic approach to risk management. One relative told us, “Staff do not communicate around this area, family have to ask if they want to know anything.” Another relative told us how they had raised concerns with the interim manager because they were worried risks related to a person's health were not being met. Other relatives described limited involvement in developing strategies to minimise risks to people’s emotional and mental wellbeing.

Staff knew people well and understood risks involved with people’s care. All staff described restraint being a last resort and talked about proactive strategies in supporting people. One staff member told us, “We focus on preventative strategies. Our priority is to de-escalate situations before they get out of hand.” Another staff member told us, “Everyone has de-escalation plans, and we should be catching those red flags before it gets to the point of restraint. Which I think we are good at. We have always identified early warning signs.” Staff told us they took blood sugar tests twice daily for a person who required blood glucose levels monitored due to their diagnosis of diabetes. However, this knowledge was not always shown in staff everyday practices as staff had now always completed important records to show safe risk management.

People living at Ash House have their own individual flats within the care home. We were therefore only able to carry out limited observations as some people did not wish to have visitors. However, we saw staff had identified 1 person’s increasing levels of distress and they responded appropriately to ensure the person’s emotional wellbeing was maintained. Another person’s routine was important to them. Staff supported the person in accordance with their preferences to minimise the risks of their levels of distress increasing. Although we did not observe any evidence risks were not being managed, records did not always support the observed staff practice.

Where risks associated with people’s health and wellbeing had been identified, records contained detailed information about how staff should manage these risks. However, records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring of risks to take place. For example, in relation to diabetes care. One person's care plan directed staff to take their blood glucose recordings twice daily. This was not always completed. Another person required their seizures to be recorded to enable an effective review by clinicians. This was not always completed. It was not always clear if healthcare professional advice was being followed in regards to people's eating and drinking as monitoring charts lacked detail. Some people had complex conditions which required very careful and considered care planning to minimise the likelihood of distress. Care plans provided information for staff on how to support people at times of distress to keep the person and others safe. However, records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring of risks to take place. This included incident reports when people had demonstrated their distress which put them or other people at risk. These incidents did not always show staff had supported people in line with their care plan.

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

Relatives told us people's staffing requirements were maintained. However, they felt staff would benefit from further training to support their understanding of people’s individual needs and provide consistency in practice. For example, 1 relative told us how staff had not identified a person's level of distress and acted accordingly. Another relative told us how a staff member had not identified a person needed a drink.

Staff told us there were enough staff to keep people safe and any short-term sickness was covered. Staff were confident people's assessed staffing requirements were always maintained. One staff member told us, "There is enough staff employed. If staff call in sick, other staff will cover. People are never left on their own." Another staff member told us, "There is enough staff. People always have the right number of staff. The (interim) manager will come and do the shift themselves." Staff felt they had received appropriate training for their role. Staff told us how the provider's training around reducing physical intervention gave them confidence to do their jobs well. One staff member told us, "I am confident when people show behaviours and that is as a result of good training and the length of time I have worked with people." Staff told us the provider followed safe recruitment procedures and that they were not able to start their employment until their DBS had been received.

There were enough staff to provide safe care and support. Staff were visible within the home and were available to support people’s individual needs. People had the support of at least 1 member of staff during the day. When people had allocated hours for support from 2 staff, this was provided as outlined in their support plans. There were enough staff to support people to do the things they wanted to do inside their home and within their local community. We observed positive staff engagement and interactions with people. Staff knew people well and appeared skilled in their approach and reacted to changes in people's behaviour quickly.

Records showed people's assessed staffing needs were met. Most staff had completed all of the provider's training requirements. Where some training was out of date, this had been planned following our assessment. Records showed staff could contact senior members of staff out of hours if needed using the providers 'on-call' process. Staff were recruited safely. Pre employment systems included reference and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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 and relatives did not raise any direct concerns about the administration of people's medicines. However, some relatives were not confident any issues around people taking their medicines or about any medication screening checks would be effectively communicated to them.

Staff told us they had received training and felt confident to administer people’s medicines. Comments included, "I give medicines. I have had training. I feel confident to give medicines. They [deputy manager] watched me last summer. They observed me to make sure I was doing it right" and, "I am trained. We have observations under the guidance of someone else. Also online training and competency assessments. Now I am very familiar with giving out medicines."

Overall, medicines were managed safely. However, some processes to support good medicines practices were not being consistently followed. For example, staff signing sheets had not always been completed and medication support plans had not always been updated to reflect what medicines people were currently prescribed. We checked 4 people’s MAR charts and found most had been completed accurately to demonstrate people had received their medicines as prescribed. However, there were gaps on one person’s MAR where staff had not signed to confirm their night time medicines had been given. Stock checks provided assurance this was a recording error rather than evidence the person had not been given their medicines. Some people needed medicines on an 'as required' (PRN) basis to treat short term conditions such as anxiety or distress. There was detailed guidance linked to people’s positive behaviour support plans to inform staff when these medicines should be considered. However, the provider could not evidence a clear rationale for the administration of one person’s PRN medicines. Staff had not completed sufficiently detailed records to show this medicine had been given as a last resort. People had regular reviews of their medicines to ensure they were on the most effective medicines to support their conditions.