Ashingham House

We have assessed the service against ‘Right Support, Right Care, Right Culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found staff and leaders were providing people’s support in line with our guidance.

Staff knew how to identify and raise any concerns they had. They had worked with the local authority safeguarding team to protect people from the risk of harm and abuse. Where concerns had been raised regarding staff practice, the provider had followed their processes to protect people from the risk of harm. There was a learning culture at the service and detailed records of accidents and incidents were maintained and analysed to look for patterns and trends. When triggers had been identified staff worked with other professionals to support people to remain calm and live in an environment which was best for them. Staff understood what may cause people distress or anxiety and provided support in ways which avoided these.

We observed people being supported to make choices in ways which were best for them, including using pictures and following the person’s preferred routine. Choices people made were respected, such as what they wished to do during the day and where they wanted to spend their time. When people lacked the capacity to make complex decisions for themselves, decisions were made in their best interests with those who knew the person well, including family members and health care professionals. Staff knew who was legally able to make decisions on people’s behalf. Professionals had complimented the staff on advocating for a person during best interest meetings and how the outcome had improved a person’s life

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives. We observed people were free to move around the building and grounds without restriction and went out with staff when they wished.

Risks to people had been assessed and support had been planned so people could take positive risks, including making hot drinks and cooking. Risks relating to how people used the environment had also been assessed and mitigated to keep everyone safe. Regular checks had been completed on the building and equipment and any shortfalls addressed.

Staff had been recruited safely and checks had been completed to ensure they had the skills to meet people’s needs. New staff completed an induction, which included working alongside experienced staff and completed training. New staff told us they had felt supported by the team as they got to know people’s preferences. Staff had completed the training required to meet people’s needs.

There were enough staff to meet people’s needs. There were several staff vacancies at the time of our assessment. Some had been filled and others were being advertised. The vacancies had not impacted on people's care or ability to access activities and appointments. Vacancies were covered by substantive and agency staff. Agency use was planned in advance and generally the same agency staff worked at the service. Agency staff we spoke with knew people well. We observed all staff had the skills and knowledge to support people in the ways they preferred.

Medicines were managed safely. Staff followed detailed guidance around ‘when required’ medicines, including medicines prescribed to support people remain calm. These were used rarely. When they were needed, the reason for administration was recorded, along with the outcome to ensure they were effective and people were not taking medicines unnecessarily. Medicines were ordered, stored and administered safely.

Leaders completed assessments with people and others who knew them well before they were offered a service. This was to assure themselves staff had the skills to meet people’s needs. They also considered the needs and personalities of other people using the service to make sure people got along well together. When the service could no longer meet people’s needs they worked with people, their relatives and professionals to support people to transition of more appropriate services.

People used nationally recognised tools such as hospital passports, communication passports and Distress and Discomfort Assessment Tools to support them share how they communicated their needs and emotions with healthcare staff. Recognised assessment tools, such as the Malnutrition Universal Screening Tool (MUST), were used to assess people’s health. These tools were also used by local health care professionals which ensured everyone understood the outcomes and the risks to people.

People’s support was reviewed with them and others who knew them well including their relatives. Funding authority representatives were invited but did not always attend. People’s care plans were reviewed with them each month to ensure they remained relevant to their needs and wishes. People, their relatives and staff were regularly asked for their views of the service and this had been used to drive improvements, including changes to the environment.

Staff told us they felt valued and supported by the registered manager and colleagues. The registered manager had a process in place to support staff to develop in their role and most staff were responsible for at least one area of the service, including, medicines, health and safety and infection control.

Regular checks were completed on all areas of the service, including medication checks and checks on the environment and records. Action was planned to address any shortfalls found and checked to ensure actions were complete and effective. A continuous improvement plan was in place. Reviews were completed to ensure improvements had been made and sustained.