9 September 2020
During an inspection looking at part of the service
Ashford Lodge is a residential care home providing personal care for up to nine people with a learning disability. At the time of the inspection there were seven people using the service. One person lived in an annex on the grounds of the service giving them their own space.
People’s experience of using this service and what we found
People were not always treated in a way which was person- centred or took into account their wishes. Some people were restricted by staff and prevented from having a choice in their day to day activities. A few staff had raised some concerns with the registered manager, however, when these were they had not been acted upon or escalated outside the service
Professional help or guidance had not always been sought when people had unaccounted for lost weight. Fire checks and drills had not been completed in a timely fashion. Risk assessments had not been updated when people’s needs changed. Relatives stated that communication was poor, and they were not always informed of changes in their loved ones needs.
There were not always enough staff to keep people safe and ensure they could go out or take part in activities they enjoyed. Staff did not have regular supervision and told us their views were not listened to. Incidents were not reviewed for learning and had not been shared with relevant professionals or notified to CQC.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The service rarely applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, people had restrictions placed on them for example the times they could watch television. People had limited access to food and were given food staff knew they did not like with no alternative available. Low staff levels restricted people’s ability to go out or take part in activities they enjoyed.
The provider had put in place temporary managers from two of its other services to support the service, after the registered manager recently resigned, identify shortfalls and take action to improve the care people received. The manager had identified the shortfalls found at this inspection and a plan was in place to address them. When action was urgent such as seeking medical advice for people this had been done. The managers were working to challenge poor practice and role model for staff.
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 06 July 2018).
Why we inspected
We received concerns about people being restricted and not having full choice in their lives, a closed culture and a lack of consistent support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
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 improvement. Please see the safe and well led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashford Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches in relation to safeguarding people from abuse and improper treatment and good governance. 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 coronavirus and other infection outbreaks effectively.
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.