Ashley House - Langport

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

At the last inspection we identified a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure staff received sufficient training to enable them to carry out their roles. At this assessment improvements had been made to staff training and the provider was no longer in breach of regulation 18. Staff training had improved. Staff received training to meet the needs of the people they were supporting. Where staff told us they would benefit from additional training, the registered manager told us they would look into this. There were systems in place to manage medicines, we found some shortfalls in how staff were recording medicines. The registered manager was aware of and addressing this. The assessment of risk for a high-risk medicine was not in place, the registered manager confirmed they would complete this. Care records showed risks to people's health were assessed and managed by staff. Staff supported people safely in line with their risk assessments and management plans. There were enough staff available to meet people’s needs. Staff raised some concerns around the deployment of staff, the registered manager was addressing this prior to our assessment and had plans in place. Recruitment systems were in place, we found some gaps in auxiliary staffs’ employment records, which were rectified during the assessment. The provider had systems and processes to manage, follow up and learn from accidents and incidents. Staff told us they knew how to raise concerns and would do so if they were worried about safety or the quality of care. Where restrictions were placed on people’s liberty appropriate referrals were made to authorise this. The provider had systems to prevent and control infections and maintain the safety of equipment and the environment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People lived in a service where there was a culture of learning. One relative told us when asked about the learning culture, “Yes, any concerns are addressed and there is learning."

Staff told us learning was shared amongst the team. One staff member told us, “We have discussions as a team and handovers are used in the morning and evenings to discuss anything, things are passed on.” The registered manager gave examples of how they had identified and shared learning following incidents.

There were processes in place to learn. The registered manager monitored accidents and incidents, to identify possible learning and ensure action had been taken to mitigate individual and service level risks. Learning from accidents and incidents was shared with staff through handovers and staff meetings.

People told us the staff knew and understood what support they required, and they regularly saw professionals such as district nurses and doctors in order to support them.

The registered manager told us they worked in partnership with other professionals to ensure safe systems of care when people move between services.

Health professionals told us the appropriate referrals were made by the registered manager when someone moved into the home, or if their health deteriorated. One health professional told us, “[Name of registered manager] is always engaging and reaches out to the team and has discussions with residents and family members prior to our visits.” Another health professional told us, “It’s a really lovely home, staff are very helpful I have no concerns. Staff have advocated well for people, and in a way that meets their needs.” We received feedback from a health professional relating to information being available when they visited. They told us staff did not always have a “Clear and precise” history of the person. We discussed this with the registered manager who told us they would look into this and take action to address it.

There were systems in place to monitor people’s health. People’s needs were regularly reviewed, and referrals made to external healthcare professionals where required. Daily handover meetings were held and included discussions around people’s health and changing needs. Concerns were escalated where GP or hospital consultations was required. People had hospital documents that could be created via the electronic computer system, in case a person needed to transfer to hospital.

People told us they felt safe in the home and with the staff supporting them. One person told us, “Yes I feel very safe, I can speak to whoever is on [staff].” Another person told us, “There are no problems at all, the staff are really good here."

Staff knew how to recognise and report abuse, including how to report concerns externally. One staff member told us, “I would report anything to [Name of registered manager] and I am happy they would definitely take action, I would also go to [Name of managing director] who is the safeguarding lead. I know I could also go to CQC. I have never had to report anything but definitely would."

We observed people looked relaxed and happy in the company of staff. There was a friendly and welcoming atmosphere in the home.

When safeguarding concerns were reported to the provider or registered manager, they worked with the local authority safeguarding team to investigate and take any actions needed. Training records showed that staff had received safeguarding training. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. Where required, DoLS were either in place or they had been applied for in line with legislation and local practice.

People were involved in a monthly review of their care plans and risk assessments through the 'resident of the day’ process. Risks to people were detailed in their care records and people confirmed staff supported them where required to be independent whilst still managing any risks. One person told us, “I don’t think I am at risk of having a fall, I have a mat here [sensor mat on the floor] just in case.” People confirmed they had access to call bell pendants, should they need to summon staff. People were supported to move freely around the home and there were no unnecessary restrictions on them.

Staff told us they understood people’s risk assessments and care plans and how to support people safely. They also told us they were made aware of any changes to people’s plans when changes were required.

During the assessment site visit we observed people being supported in line with their care plans and risk assessments, for example when supporting people in line with their eating and drinking risk guidelines.

There was a system in place to ensure risks to people were assessed and mitigated. Care plans were in place, and where people were at risk of harm, assessments were carried out. Risk assessments had been completed for areas such as mobility, falls, moving and handling, skin damage and Personal Emergency Evacuation Plan (PEEPS). A generic risk assessment was in place relating to the risk of falls on the stairs and control measures were in place. The registered manager told us they would complete individual risk assessments for people using the stairs where required.

People and their relatives did not raise any concerns relating to the environment. They felt the home was well maintained.

Staff did not raise any concerns about the quality or safety of the equipment they used. The registered manager and maintenance staff told us about the systems in place to make sure the building and equipment was safe. This included regular checks and servicing by outside contractors on areas such as the fire system and moving and handling equipment.

We observed the environment and equipment was well maintained. Fire equipment and signage was in place.

Regular checks of the environment and equipment took place. These included a range of internal and external checks in place covering fire, water temperatures, legionella, lifting equipment, gas, electric and window restrictors. We found 1 shower which was running higher than the recommended safe temperature, the registered manager told us people only ever used the shower with staff support. The maintenance person showed us there was a manual restrictor on the water temperature which would prevent it from reaching an unsafe temperature. The registered manager confirmed that they would complete a risk assessment for people using the shower detailing the control measures in place. An external fire service visit had been completed, there were some ongoing recommendations made. The service was working with the fire service to resolve these. There was an environmental risk assessment in place that covered all areas of the home including the stairs, stair lift, kitchen and boiler room.

People and their relatives told us there were enough staff available to support people and meet their needs. One person told us, “Yes, staff are always walking past, and they check in.” A relative told us, “There always seem to be a lot of staff, there are a core element of permanent staff and some agency.”

Staff told us there were enough staff available to meet people’s needs. One staff member told us, “Yes, shifts are covered, we do use some agency and use the same ones, they form relationships and are familiar faces, the residents like that.” However, staff told us at times they had to cover other staff’s roles, such as cleaning due to there being some staff vacancies. The registered manager was aware of this and had a plan in place to address it. One staff member told us, “We have a couple of new staff starting soon and we will be on track then, we use some agency, the same staff.” We received some mixed feedback from staff regarding the training they received. One staff member told us, “I think we have enough training, we get regular updates” One staff member felt they would benefit from further training in end of life care, and another commented they would like more mental health training. We discussed this with the registered manager who described the training staff received in both of these subjects. They confirmed they would speak to staff to ascertain any additional support or training they may need.

We observed there were enough staff available to meet people’s needs. Call bells were answered promptly during our site visit.

At the last inspection we identified a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure staff received sufficient training to enable them to carry out their roles. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 18. There was a training programme in place. Staff had received training in areas such as, first aid awareness, medication management, infection prevention and control, moving and handling and safeguarding. Staff received additional training to meet people’s needs such as diabetes and supporting people living with dementia. A system was in place to ensure safe recruitment of staff. Safe recruitment checks and documents were in place for care staff. We found some gaps in the employment of auxiliary staff, 1 staff member did not have a full employment history recorded, and another 2 staff only had 1 reference on their files. The registered manager addressed this during the assessment. There were systems in place to ensure there were enough staff available to meet people’s needs. Staff rotas were completed by the registered manager, and they had recently reviewed their staffing arrangements to cover staff vacancies.

People and relatives told us the home was clean. One relative told us, “It’s always really clean here, the cleaning staff are wonderful.”

Staff confirmed they had infection prevention control training and access to enough personal protective equipment (PPE). Staff were able to tell us how they used PPE in accordance with best practice guidance.

We observed the home was clean and free from any malodors. However, the laundry room was cluttered which meant it could be difficult to clean. This was addressed during the assessment. New shelving was put up and items were removed from the area.

There were infection prevention and control (IPC) procedures in place. This included a cleaning schedule and records. Staff attended IPC training and had access to enough suitable PPE. The home, however, did not have a specific IPC risk assessment detailing the control measures in place. An IPC risk assessment was completed by the registered manager during the assessment.

People told us they were happy with how staff supported them with their medicines. One person told us, “I get my tablets around the same time every day and staff explain to me what they are.” Another person commented, “I know what I am taking, and I am happy with that.”

Staff told us they had medicines training, and their competencies were assessed to ensure they were competent to administer medicines. The registered manager told us they were working with the staff team around areas of improvements. This included creams and ointments not being dated when they were opened and gaps in the topical medication administration records (MARs).

There were appropriate arrangements for the ordering, storage, and disposal of medicines. There were systems in place to ensure the safe administration of people’s medicines. This included medicines profiles, guidance for staff and medicines administration records (MARs). Some people were prescribed ‘as required’ medicines (PRN). We found 1 instance where a protocol was not in place for 1 person’s medicines. The registered manager completed this during the assessment. Some people were prescribed creams and ointments. These were not always dated when opened to inform staff when they should be disposed. Staff did not always sign the MAR to indicate these creams had been applied, they did however sign the person’s electronic record to indicate this. We discussed this with the registered manager who told us they had identified this, and they were working with the staff to make improvements. We found 1 example where a risk assessment had not been completed for a person who was taking a medicine that was deemed high risk. We discussed this with the registered manager who told us they would implement this during the assessment.