Ashwood Care achieved a Good rating across all five key questions at this April 2018 inspection, having fully remediated breaches of Regulations 17, 18 and 19 identified in 2017. The only areas for improvement were minor inconsistencies in MAR sheet completion and quality assurance recording, both of which were addressed by the registered manager during the inspection itself.
Concerns (2)
moderate
Medication management
: “there were some inconsistencies in the recording such as gaps being left on the MAR sheets when medication was not required”
minorRecord keeping: “whilst the quality assurance system was adequate we noted that it would benefit from additional information being recorded in a more consistent format”
Strengths
· Robust recruitment processes including DBS checks, two references and ID verification for all new staff
· Staff received induction, Care Certificate enrolment, regular supervision, direct observations approximately four times yearly, and annual appraisals
· Electronic call monitoring system enabled real-time visibility of visit start and finish times
· Person-centred care plans written in people's own words detailing individual preferences, routines and needs
· Responsive leadership: issues identified during inspection (badge size, MAR gaps) were addressed with immediate effect
Ashwood Care was rated Requires Improvement overall following its first inspection since 2015 registration, with breaches of Regulations 17, 18 and 19 identified around governance, staff supervision/training, and recruitment checks. The service demonstrated genuine caring relationships and adequate staffing levels, but was undermined by a dual-registered manager unable to delegate, absent quality assurance systems, and a warning notice issued for good governance failures.
Concerns (9)
criticalStaffing levels: “references on nine of the files viewed were not provided from the person's previous employer...recruitment process was poor and there was considerable risk to people”
criticalGovernance: “A warning notice for regulation 17 was issued to the provider...provider did not have systems and processes in place to assess, monitor and improve the quality, safety of the service.”
criticalSupervision / appraisal: “Two senior staff spoken with told us they had never received supervision or support meetings. One carer said 'Supervisions, they are non-existent'”
moderateStaff training: “not all established staff had been provided with some of the refresher training...refresher training rota had not been updated due to an administrative error”
moderateMedication management: “five of the ten MAR looked at did not fully identify when medication commenced or ceased as the dates were missing from the MAR sheets viewed”
moderateLeadership: “registered manager was responsible for managing two separate agencies without being able to delegate some of her duties...unable to ensure the service was run in the best interests”
moderateIncident learning: “completion of these audit checks was not recorded at all. This oversight had increased the risk that problems might not be quickly identified and resolved.”
minorComplaints handling: “One person said they had made a complaint about times of calls but said 'they did nothing about it'...Not everybody felt able to make a complaint.”
minorMissed or late visits: “any missed calls were identified by word of mouth...One person told us that their carer had not arrived for the tea time call and no one had contacted her”
Strengths
· People consistently reported feeling safe and well cared for, with staff praised for kindness and genuine affection
· Sufficient staffing levels maintained to complete planned visits in a timely manner with appropriate travel time between calls
· Risk assessments and home safety checklists were in place for each person using the service
· Staff demonstrated good knowledge of safeguarding, whistleblowing procedures, and how to report abuse
· People were treated with dignity and respect; staff understood individual preferences, likes and dislikes
Quality-Statement breakdown (16)
safe: Fit and proper persons employed (Regulation 19)Requires improvement
safe: Safeguarding people from abuse and improper treatmentGood
safe: Medicines managementRequires improvement
safe: Staffing levels and visit reliabilityGood
safe: Risk assessment and business continuityRequires improvement
effective: Staff supervision and appraisal (Regulation 18)Requires improvement
effective: Staff training and developmentRequires improvement
effective: Mental Capacity Act and consentGood
effective: Nutrition, hydration and healthcare accessGood
caring: Dignity, respect and person-centred careGood
caring: Communication with people and familiesGood
responsive: Care planning and responsiveness to changing needsGood