Ashurst

Ashurst is a small ‘care home’ providing accommodation to up to 5 people who require nursing or personal care. The service provides support to young people with complex mental health needs. At the time of our inspection there were 3 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support: People were supported by staff who had a strong understanding of how to promote people’s independence. Staff supported people to work towards achieving their goals by working in accordance with robust care plans. People told us they felt supported by staff and the management team. People were able to personalise their rooms with personal items important to them; the provider also provided a budget to people so they could choose how their rooms were decorated. The provider consistently reviewed and reflected on the approach staff took in supporting people during times of anxiety and distress to inform continuous improvement.

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.

Right Care: People received support from external healthcare professionals when needed and this was requested in a timely manner. People felt safe at the service and staff’s presence was noted throughout our inspection visit. People’s care and support was tailored around their preferences. Staff had a good understanding of safeguarding and support was provided to people safely. People’s medicines were administered safely; however, record keeping needed improvement. We have made a recommendation relating to medication records.

Right Culture: The provider ensured a person centred approach to care planning, support and care was promoted throughout the service. People’s protected characteristics were considered at all times. The provider had worked proactively with local safeguarding professionals to ensure they were meeting the requirements to share safeguarding incidents in line with local and national guidance and legislation. We observed evidence of reflective work being carried out. The provider had quality assurance systems in place which ensured checks within the service were completed regularly. However, audits were not always consistent with our findings at this inspection. Staff induction records contained significant gaps. We have made a recommendation in relation to governance systems and staff induction records.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 7 January 2022).

Why we inspected

We received information which highlighted a review of risk management and service governance was needed. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same.

We found no evidence during this inspection that people were at risk of harm. Please see the safe, effective and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashurst on our website at www.cqc.org.uk.

Recommendations

We have found areas where the provider needs to make improvements. We have made recommendations related to medication recording systems, induction records and audits. Please see the safe, effective and well-led sections of this report.

People’s experience of using this service and what we found

Concerns had been raised about the staffing levels at the service, following a number of staff, including the registered manager, leaving their employment. This was currently being addressed by prompt and appropriate actions to recruit appropriately skilled and suitable staff. In the interim the service was being overseen and supported by the senior management team. Numbers were sufficient, due to bank and regular agency staff being utilized.

There had been some concerns around training. A thorough induction process was in place, and there was a comprehensive on-going training programme to help ensure staff maintained the required level of skills and abilities required.

Risk management had been flagged as a concern. Procedures for managing risks were robust and the service ensured risks were monitored, managed and reviewed regularly. Risk assessments were very detailed and included triggers and early warning signs for staff to be aware of. There was clear evidence that the young people were involved in all aspects of their care and support. All required infection control and prevention measures were in place.

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.

Staff were clear about their roles and responsibilities and were able to explain their duties. The quality of service provision was checked regularly via a robust auditing system, governance reports and responses. The provider was open to continuous learning and improvement.

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 the service was good (published 7 January 2022).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing, training, risk management and governance. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashurst is a residential care home which provides support and rehabilitation for up to five young people with complex mental health needs. At the time of the inspection there were three young people being supported at the home. The home is located in the area of Heaton in Bolton. The young people are supported by a team of residential and clinical staff.

People’s experience of using this service and what we found

People were safeguarded from the risk of abuse. Staff had completed appropriate safeguarding training and the young people felt safe. There were systems in place to monitor and manage risk within the home. All the young people had comprehensive risk management plans with all relevant information included. Medicines were managed safely and a number of checks were in place to help ensure they remained safe. All required infection prevention and control measures were in place.

Staff were recruited safely and there were sufficient staff to meet people’s needs. Staff were supported via a thorough induction, an on-going training programme and very extensive management and clinical support.

The culture at the home was positive and inclusive. People’s needs were thoroughly assessed and care plans included appropriate health and personal information. This was reviewed and updated regularly. Staff worked with other agencies and professionals to ensure the young people’s needs were met appropriately. The young people were treated with respect and compassion by all staff. They were supported to be as independent as possible and to express their views and wishes about their care and treatment.

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.

People’s individual communication methods were understood and supported by staff. The young people were supported to maintain healthy relationships and to follow their interests and hobbies.

The provider had quality assurance systems in place and the results of these were analysed to inform continual improvement to service provision.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 30 March 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns around risk management within the service. We, therefore, brought forward the inspection to look at these risks.

Although the young people were at risk of harm, due to their complex mental health needs, these risks were mitigated appropriately. Please see the Safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.