About the service:

Ashington House is a residential care home that provides personal care and accommodation for up to six people some of whom have learning and physical disabilities and autism. At the time of this inspection five people were receiving support from this service.

People's experience of using this service:

Staff were aware of people’s communication needs and knew what people were saying when they used their body language. However, people’s communication aids required updating which the registered manager agreed to implement immediately.

Risks to people's health and safety were sufficiently identified and assessed which guided staff on how to mitigate the potential risks to people. Staffs’ employment history was appropriately checked before they were employed by the service. People had support to manage their medicines safely. Staff were aware of the actions they had to take should they notice people being at risk of harm or when incidents and accidents took place.

Staff were provided with opportunities to update their knowledge and skills in all areas required for their role, including the Mental Capacity Act 2005 (MCA) which they applied in practice as necessary.

People’s health needs were assessed and they had the necessary support to attend their health appointments when needed. Staff assisted people with their meal preparations and ensured that people had their meals not rushed.

Personal information about people was kept safely. Staff were kind to people and respectful of their privacy. Strategies were in place to support people in the decision-making process.

People’s care records were person-centred and individualised. People were encouraged to raise concerns when they had any so that the staff team could address them accordingly. Staff supported people to have conversations about their wishes at the end of their lives.

Everyone involved in people’s care told us that the registered manager was caring and led by example. Quality assurance processes were in place to monitor the service delivery. There were shared responsibilities between the staff team to ensure good care for people.

Rating at last inspection:

At the last inspection on 9 December 2016, the service was given a rating of Good in all key questions.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspection will be planned in line with our re-inspection programme. If any concerning information is received, we may inspect the service sooner.

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

This inspection took place on 9 December 2016 and was unannounced. Ashington House is a residential care home for up to six adults with learning disabilities. The home has two floors with one wheelchair accessible bedroom on the ground floor and one of the six bedrooms is used to provide respite care. At the time of our inspection, five people were using the service. At the last comprehensive inspection in November 2014, this service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

Since our last comprehensive inspection the provider had made some improvements, most notably to the ways in which they managed the risk of people developing pressure ulcers. At the time of our inspection the service was meeting all relevant fundamental standards.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs and promoted their independence. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. Medicines were managed safely.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was designed and adapted to meet people’s individual needs.

People received a variety of nutritious food that met their individual needs. They received the support they needed to stay healthy and to access healthcare services.

Staff knew people well and had developed positive caring relationships with them. They knew how to communicate information in ways that people understood, which helped enable people to make choices about their care. Staff supported people to take pride in their personal appearance and provided care in a way that promoted people’s dignity and independence.

People received personalised support that was responsive to their individual needs. Staff were aware of people's needs, goals, abilities, likes and dislikes. People received support to maintain contact with their families and to meet their religious and cultural needs. People took part in a range of individual and group activities to suit their abilities and interests.

The service had a complaints procedure and this was available in an accessible format. The provider also routinely gathered feedback from people and their representatives through surveys. They used feedback alongside their own audits and quality checks to continually assess, monitor and improve the quality of the service. The service had a clear vision and values and demonstrated an inclusive and empowering culture where people were involved in the day to day running of the service.

Further information is in the detailed findings in the main body of the report.

At the last comprehensive inspection of this service on 27 November 2014 a breach of legal requirements was found. This was because the service was not managing risks in relation to pressure ulcers well. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashington House on our website at www.cqc.org.uk

Ashington House provides accommodation and personal care for up to six people with learning disabilities or autism. On the day of our visit there were six people living in the home.

The home had a registered 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. You can read a summary of our findings from both inspections below.

At this inspection we found the registered manager had put in place the necessary improvements in relation to pressure ulcer risk management. This meant the person’s risk of developing pressure ulcers was reduced. The registered manager had liaised with a district nurse to produce a risk assessment and clear guidelines which staff followed to reduce the risk of pressure ulcers. Staff had attended training on pressure ulcer management. Equipment to help reduce the risk had also been provided and was being used appropriately.

People were supported in promoting their independence and community involvement and, with the support of the care staff, were able to express their views and were involved in making decisions about their care and treatment. We observed the interaction between care workers and people and found that the care workers had a thorough understanding of people's needs. We looked at staff records and found that there were clear policies on respect and dignity and that these themes were covered during induction and other training events.

Staff demonstrated good knowledge of individual's needs and how best to meet them. We saw that there were varied activities for people, both in the local community and at various clubs or day centres. People's needs were assessed and care and support was planned and delivered in line with their individual care plan. We looked at every person's care records and saw that care plans were developed from assessments and using information from relatives and placing social workers. These care plans were then recorded in such a way that they expressed people's support needs from the perspective of the individual.

The manager was able to demonstrate that the care team had undergone training in safeguarding people from abuse and that this training was updated at regular intervals. There were also clear policies and procedures in place and the manager was aware of the contact details of all the local authorities who had placing contracts with the service.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. We saw that questionnaires and surveys were sent to relatives and local authorities and that the service had received positive feedback from those questionnaires. One local authority commented "No complaints whatsoever". A relative commented that the staff team were very caring and did a good job.

We gathered evidence of people's experiences of the service by observing activities, reviewing surveys and complaints and speaking with placing social workers. We observed some good interactions between staff and people who use the service. Staff demonstrated good knowledge of people's needs and how to meet them. People looked comfortable and relaxed with staff. People who use the service had access to various activities and outings to meet their social and leisure needs.

One person told us that they were happy living at the home, saying "I have all I need in my bedroom", they told us that staff provided the care and support they needed and "helped and listened". Two people told us that they were settled and were seen to be happy and relaxed with staff in the lounge during our visit.

Care plans were seen to be person centred. The care and support was in line with placing social workers expectations. There were no current safeguarding concerns and placing social workers we spoke with said the manager and staff were approachable and they felt confident any issues they raised would be dealt with quickly.

This inspection took place on 27 November 2014 and was unannounced. When we last visited the home on 20 November 2013 we found the service was meeting the regulations we looked at.

Ashington House provides accommodation and personal care for up to six people with learning disabilities or autism. On the day of our visit there were five people living in the home. 

The home had a registered 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.

Risk were generally managed well except risks in regards to the management and prevention of pressure ulcers. This was a breach of the regulation in relation to the care and welfare of people using the service. You can see what action we told the provider to take at the back of the full version of the report.

Care plans and risk assessments were in place with regards to other risks such as moving and handling. People’s care plans reflected these assessed needs and staff had a good understanding of people’s individual needs and preferences. Staff treated people with kindness and compassion, dignity and respect and people and their representatives were involved in decisions about their care.

Staff had a good understanding of how to recognise abuse and how to help protect people from the risk of abuse.

The premises and equipment used to support people were safe as a range of health and safety checks were carried out regularly, including the water, electrical and fire systems.

There were enough staff employed to meet people’s needs. Recruitment procedures were robust and made sure that only people who were deemed suitable worked within the home. Staff were supported to carry out their roles with effective induction, supervision and training. 

Medicines management in the home was safe. Only senior staff, who had been assessed as competent, administered medicines, and checking procedures were in place to make sure medicines were given as prescribed.

Accidents and incidents were reviewed to identify patterns and provide the right support to people.

Staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The service was meeting the requirements of the DoLS. The registered manager had assessed whether people required DoLS and made the necessary applications. In this way people’s rights in relation to this were recognised, respected and promoted.

People were supported effectively to meet their needs, including their health needs. Staff supported people who had specialist needs in relation to eating and their diet, as well as those who were at risk of malnutrition and dehydration. People were provided with a choice of food and drink, and were supported to eat when required. Staff made referrals to specialists when necessary and followed their guidance. People were supported to access health services, such as the GP, dentist and optician as necessary. 

People were kept stimulated as they were provided with a range of activities they were interested in. 

People using the service, their representatives and staff were encouraged to give feedback about the service they received and make suggestions to improve it. People knew how to make complaints and there was an effective system in place to review complaints and suggestions made by people and their relatives, to ensure learning took place. 

The service was well-led as the registered manager and staff understood their roles well and a culture of support, openness and transparency was in place. A range of audits were in place for the provider to monitor the standards of service people received in the home.