This inspection took place on 10 June 2016 and was unannounced. Ashingham House is a privately owned service providing care and support for up to ten people with different learning disabilities. People may also have behaviours that challenge and communication needs. There were nine people living at the service at the time of the inspection. The service is a large detached property set in its own grounds in a rural area. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The
service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.
There was a registered manager working at the service and they were supported by a deputy manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We carried out an unannounced comprehensive inspection of this service on 30 March 2015. Three breaches of regulations were found. We issued requirement notices relating to, safeguarding service users from abuse, person centre care and dignity and respect. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had fully met the regulations.
Safeguarding procedures were in place to keep people safe from harm. The registered manager had taken steps to make sure that people were safeguarded from abuse and protected from the risk of harm. People told us and indicated they felt safe at the service; and if they had any concerns, they were confident these would be addressed quickly by the registered manager or the deputy manager. The staff had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. This was a shortfall at the last inspection. The breach in the regulation had now been met.
Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. Each person had a care plan which was personal to them and that they or their representative had been involved in writing. The care plans contained the information needed to make sure staff had guidance and information to care and support people in the way that suited them best.
At the last inspection physical interventions being carried out by staff were not approved and did not match service user’s direct support needs. This was a shortfall. The breach in the regulation had now been met. There were plans in place for behaviours that challenge and positive behaviour support techniques had been put in place, which were successful and the incidences of behaviours had reduced.
People were now empowered to have as much control and independence as possible. How people received there medicines had been changed since the last inspection. Each person had a medicine cabinet in their bedrooms and staff gave them their medicines in a way they preferred and suited them best. People were supported to be as independent as possible and their dignity was respected when they were given their medicines and in all other areas of their care. This was a shortfall at the last inspection and the breach in the regulation had been met.
People who were not able to use speech to communicate were given different choices about the meals they received. People were being supported to develop their decision making skills to promote their independence and have more control. This was a shortfall at the last inspection. The breach in the regulation had now been met. People were offered and received a balanced and healthy diet. People looked healthy and had a wide range of foods available. When people were not eating well the staff made sure they were seen by dieticians and their doctor.
People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People knew who their key worker was. Staff were caring and respected people’s privacy and dignity. People received the individual care and support they needed to keep them as safe as possible. People were involved in activities which they enjoyed.
Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. The registered manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements as a result.
Staff assumed people had capacity and respected the straightforward decisions they made on a day to day basis. When people needed help or could not make a particular decision on their own, staff supported them. Decisions were made in people's best interests. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that people had applications granted to deprive them of their liberty to make sure they were kept as safe as possible.
Staff had the support they needed to make sure they could care safely and effectively for people. Staff had received regular one to one meetings with a senior member of staff. Staff had completed induction training when they first started to work at the service and had gone on to complete other training provided by the company. The training records were up to date and reflected the amount of training the staff had received. There were regular staff meetings. Staff said they could go to the registered manager at any time and they would be listened to.
A system of recruitment checks was in place to ensure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to.
The complaints procedure was on display in a format that was accessible to people. Feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that the service was well led and that the management team were supportive and approachable. They said there was a culture of openness within Ashingham House which allowed them to suggest new ideas which were often acted on. Quality assurance systems were consistently applied. Audits and health and safety checks were carried out.