About the service Ashgale House is a residential care home providing personal care to 14 people. The home provides care and support for people living with learning disabilities who may have autism and additional physical disabilities. The home also provided a respite service for people. At the time of the inspection there were eight people using the service, none of whom were receiving respite care.
The care home had been registered before Registering the Right Support (2015) and other best practice guidance had been developed. Registering the Right support ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.
The care home is a large house in a residential area, located close to a range of community amenities and facilities. It is registered to provide care and support for up to 14 people. This is larger than current Registering the Right Support standards and other best practice guidance. However, at the time of the inspection there were only eight people using the service. The building design of two floors with bedrooms, kitchen facilities and communal areas on both floors enabled people to be cared for individually and in smaller groups when fully occupied. This mitigated any negative impact that may occur from accommodating more people than current best practice guidance for a similar service.
People’s experience of using this service and what we found
Quality monitoring systems including audits and checks of the environment and other areas of the service were not always fully effective in identifying shortfalls and for driving improvement. Some checks had not been carried out within the provider’s timescales. Whilst it was not evident this had any significant impact on people, it did not show that a fully effective governance system was in operation.
Records did not show that regular written analysis of incidents, accidents and complaints had taken place to identify any patterns and trends and to help prevent similar events being repeated.
There were gaps in people’s care monitoring records. This could mean that people received ineffective care due to a lack of up to date, accurate information about people’s needs. This had not been identified by senior staff.
Improvements were needed in some areas of medicines management and administration to ensure that people always received their prescribed medicines safely.
People did not always have the opportunity to take part in a range of personalised meaningful activities to keep themselves stimulated and minimise the risk of social isolation.
Staff received the training and support to enable them to carry out their roles competently. Sometimes refresher training had not been completed within the provider’s timescales.
Feedback from people’s relatives was mixed. Some relatives provided positive feedback about the care people received. Others told us that communication between them and staff about people’s needs and progress could be improved.
Some healthcare and social care professionals told us that staff had not always understood people’s communication and behaviour needs, so engagement between some people and staff was ineffective.
The service applied some principles and values of Registering the Right Support and other best practice guidance. People were provided with choices and involved as far as they were able to be in decisions to do with their care. However, it was not evident that all the people using the service had the opportunity to frequently spend time out and about in the local community.
Staff knew what their responsibilities were in relation to keeping people safe. Recent action had been taken by management staff to better protect people from the risks of harm, abuse and discrimination.
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.
The provider had systems in place to manage and resolve complaints.
People had a choice of meals, snacks and drinks. People received the support they needed to access healthcare services.
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 22 November 2017). The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.
We have made a recommendation about developing and improving the opportunities for people to take part in a range of personalised meaningful activities.
Why we inspected
This comprehensive inspection was brought forward due in part to concerns received about some areas of the service, including, medicines, moving and handling, reporting of incidents and staff engagement with people.
Enforcement
We have identified breaches in relation to the management and administration of medicines and governance. Please see the action we have told the provider to take at the end of this report.
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.