Ash House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a breach of the legal regulations. The provider's systems and processes had failed to monitor and mitigate risks relating to the health, safety and well-being of people living at Ash House. Accident and incident reports were not consistently completed to show people had received support in accordance with their risk management plans. Where accident and incident reports had been completed, they had not been consistently reviewed to mitigate the chance of reoccurrence or analysed to identify any patterns or trends. Audits and checks had failed to identify gaps in risk management tools to ensure people were provided with safe care and treatment. There had been a period of managerial instability at the home. At the time of our assessment, there was no registered manager in post. A registered manager from 1 of the provider’s other services had taken over interim day to day managerial responsibility to oversee the home. However, they had also retained their registered manager responsibilities for the safety and quality of care delivery at the other service. Although overall we received positive feedback about the interim manager, all relatives expressed concern over effective communication and did not always feel involved in people's care.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Following significant changes within the management and staff team at Ash House, the acting manager explained how they had prioritised building a positive and inclusive culture within the service. They acknowledged that recent events had impacted on staff morale and it was their primary objective to build a staff team who worked together to ensure people received the best standards of care. One staff member reflected on the culture at the home and explained how this had not always been positive. However, they were confident this had, and continued to improve.

The provider identified the culture within Ash House had not always promoted an open, inclusive and person-centred service. Actions from a safeguarding investigation had been introduced to support staff practice to ensure it aligned with the provider’s vision of ‘delivering exceptional care and support’. This included increased observations of staff practice, spot checks, individual staff supervision meetings and team meetings. However, this remained a work in progress as records showed some staff supervisions remained outstanding and spot checks of staff practice at night had not been recorded to inform learning. Records did not always contain language reflecting an open and inclusive culture. The area manager assured us this would be addressed through further training and support.

Staff were very positive about the interim manager. Comments included, “[Interim manager] is excellent. They are so hardworking and driven. They are inspiring. I have learnt a lot from them,” and, “I have been working with [interim manager] since I started with Lifeways. They are the reason I stay. They make me feel comfortable at work, treats us as professionals, is visible here and is very professional." Another staff member commented, "They are the glue that keeps us all together. They are absolutely amazing." However, staff were not as positive about the senior leaders. Comments included, “The first time I met the area manager was last year. It seems like they (area manager’s) leave a trail of chaos to be honest but then it reflects bad on us as whatever change the area manager has made, it is us that gets it in the neck,” “I don’t really know the senior leadership team. The area manager has been and I have seen them in passing but don’t know them” and, “The provider I don’t really know.” Staff talked about the impact of the instability of management within the home. Comments included, “It has been a rollercoaster. The service users have an idea and if there is no management, they pick up on it. Sometimes the guidance is missing” and, “The management structure is difficult as there is such a high turnover of managers."

At the time of our assessment, there was no registered manager in post. A registered manager from 1 of the provider’s other services had taken over interim day to day managerial responsibility to oversee the home. However, they had also retained their registered manager responsibilities for the safety and quality of care delivery at the other service. The interim manager was clearly committed to providing high standards of care but acknowledged they did not have time to complete some aspects of their managerial role. Records showed on the week of our assessment visit, the interim manager had worked 7 days, including 2 days supporting people to cover shortfalls in the staff rota. Whilst working support shifts enabled the interim manager to have a good understanding of the challenges faced by staff, this did not embody a positive provider culture of supporting the interim manager’s wellbeing. Records also showed other staff were working very long hours without the government recommended breaks between shifts. This was a particular concern because of the complex support people needed when they became distressed. The provider's representatives assured us increased monitoring of the rota would be implemented to ensure staff had the recommended breaks when they volunteered to pick up additional hours at work. The provider had appointed a new manager for Ash House who was going through recruitment checks at the time of our assessment.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider's representatives explained there was a clear governance and accountability structure at Ash House where any identified risks were escalated and action would be taken to resolve. However, this structure was not reflected in what we found during the on-site assessment. Although the provider's representatives told us a variety of support mechanisms had been actioned at the home, such as the allocation of a quality compliance manager, these had not been effective in driving the required improvements. The area manager told us they did not have access to enable them to have oversight of accidents and incidents. The interim manager acknowledged the challenges of managing 2 of the provider's homes which meant some actions to ensure effective governance had not been completed in a timely way.

The provider carried out regular audits and checks and was working through a service improvement plan to address areas for improvement. However, systems to monitor people's health and wellbeing required more day-to-day scrutiny. Important records were not always detailed enough to demonstrate people received the right levels of care and safe practices were followed. This included accident and incident reports which were not consistently completed to show people had received support in accordance with their risk management plans. For approximately 3 months prior to our assessment visit, accident and incident reports had not been consistently reviewed or analysed. This meant risk management plans were not effective as changes in people’s needs were not reflected. Staff needed more guidance to ensure they had the confidence and motivation to check the quality of their own work and that of their peers. Poor record keeping was not always challenged or reported.

Relatives consistently spoke of the negative impact of constant changes in management, a lack of communication and wanting to feel more involved in their family member’s care. Two relatives specifically mentioned they were not always involved or consulted in changes to care plans or changes made by other healthcare professionals. One relative told us that communication with the management needed to improve because they felt they needed to keep, “Chasing for more information.” Another relative told us, “The service is constantly changing management so we would like to see consistency in management and staffing."

The area manager and interim manager told us they were working with the local authority against their quality improvement plan. They explained they were liaising regularly with the commissioners to drive forward improvements. The interim manager explained how they were working with one person's relative to improve outcomes for that person. The interim manager acknowledged that reflective practice and learning had not always been completed following interventions during incidents in accordance with the provider's policies and procedures and physical intervention training.

We spoke with 3 healthcare professionals about how well the provider worked in partnership with them to improve outcomes for people living at Ash House. All of these healthcare professionals shared concerns about the instability of management at Ash House. They explained the lack of consistent leadership had been an on-going concern for over 12 months and gave examples of how this had impacted the continuous improvement of the home. One healthcare professional told us, "My main overall concern for this service is leadership. They’ve had interim support from managers at other services or new managers that have left very early resulting in them having to restart their actions on their service improvement plan several times and not progressing."

People were referred to other healthcare professionals both externally and within the provider group and their advice incorporated into people's care and risk management plans. Where staff required advice or clarification about people’s healthcare needs, records evidenced this had been sought. However, documentation and records did not always evidence how effective that advice was.

Staff told us information and learning was shared with them through handover and regular team meetings. One staff member reflected on an incident that occurred in the home where things had not been managed well and told us what had been put in place to ensure it did not happen again. The interim manager and area manager understood the provider's process for reviewing and analysing accidents and incidents but confirmed this had not always been done.

The provider’s processes to ensure continuous learning, innovation and improvement across the organisation and the local system were not always effective. Slow progress had been made with the service improvement plan and improvements were not always embedded or sustained. The provider's system for ensuring the health, safety and welfare of people had been ineffective because important records had not been reviewed. This put people at potential risk of harm. Reviews, reflective practice or root cause analyses had not always been completed for accidents and incidents with actions to prevent reoccurrence. Reflective practice enables individuals and teams to 'step back' from their work and to learn from experience to drive forward improvements.