Ash Lea House provides accommodation and personal care for up to 14 people with a learning disability. The home is situated on the outskirts of Alfreton and has good access to local shops and public amenities. There were 12 people living at the home on the day of our inspection.

We inspected this service on 17 May 2018. The inspection was unannounced. At our previous inspection on 3 February 2017 we rated the service as requires improvement. This was because we identified specific concerns with how safeguarding concerns were managed; how people were supported to maintain their health and how effective the quality monitoring systems were. The provider sent us an action plan which stated how and when they would make improvements to meet the legal requirements. On this inspection visit we saw improvements had been made.

There was a registered manager in post. 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.

People were now protected from the risks of abuse because staff understood where harm may have occurred and took action when people were at risk of harm. Staff supported people to understand any risks to prevent avoidable harm. Where people were concerned about their safety they knew who to speak with.

People kept their medicines in their bedroom and were helped to understand what their medicines were for. Staff knew why people needed medicines and when these should be taken. Staffing was organised flexibly to enable people to be involved with activities and do the things they enjoyed. People had opportunities to be involved with a variety of activities and could choose how to spend their time.

People had food and drink that they liked and specialist diets were catered for. People’s health and wellbeing needs were monitored and they were supported to attend health appointments and screening programmes as required.

People had positive relationships with the staff who were caring and treated them with respect and kindness. People liked the staff who supported them and had developed good relationships with them. People maintained relationships with their families and friends who were invited to join in activities with them.

There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint. Staff listened to people’s views about their care and they were able to influence the development of the service.

People were consulted regarding their preferences and interests and these were incorporated into their support plan to ensure they were supported to lead the life they wanted to. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People made decisions about their care and staff helped them to understand the information they needed to make any decisions. Staff sought people’s consent before they provided care and they were helped to make decisions which were in their best interests. Where people’s liberty was restricted, this had been done lawfully to safeguard them.

The registered manager and provider understood their legal responsibilities and kept up to date with relevant changes. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

We inspected the service on 30 November 2016. The inspection was unannounced. Ash Lea House provides accommodation for up to 14 people with a learning disability. It is located in Alfreton, Derbyshire. On the day of our inspection 13 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

People may not be supported in the safest way by staff because possible concerns to their safety were not reported to ensure people were protected from avoidable harm. Risks in relation to people’s daily life were not always assessed so plans could be made to protect them from harm.

People were not always supported by enough staff to ensure they received care and support when they needed it.

Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions for themselves. People were not subjected to any restraint or unlawful restriction.

People did not receive the support they needed to monitor and ensure their healthcare needs were met. They were provided with support to maintain sufficient nutritional intake.

People lived in a service where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People’s care and support was not planned in a clear way that took into account all their needs and aspirations. People had opportunities to participate in social and community based activities, although plans made were not always followed through. People were confident that any concerns or complaints would be listened to and acted upon.

People who used the service, relatives and staff had opportunities to give their views on how the service was run. Systems followed to monitor and improve the quality of the service provided did not identify all of the areas where improvements were required.

On the day of this inspection there were 13 people living at Ash Lea House. We spoke with four people who lived at the home. We also spoke with the manager and three other members of staff. We looked at written records, which included people's care records, medication systems and quality assurance documentation.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

Is the home safe?

The accommodation was warm, clean and properly maintained. People were protected by safe recruitment practices.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the home effective?

People we spoke with were satisfied with the care and support they received. No one raised any concerns with us. This was consistent with mostly positive feedback reported in the provider's own annual quality assurance survey.

People were cared for by staff who were properly trained and supported to develop professionally. People were treated with respect and were encouraged to promote their independence. People were given information and support to help them understand the care and support available to them.

Is the home caring?

We spoke with four people who lived at the home. Due to their communication needs we were not able to have extended conversations with them. One person said to us, "I love it here; I'm going into town with staff later." Another person said, "I like all the staff."

We witnessed the care and attention people received from staff. All interactions we saw were respectful, encouraging and friendly. There was a relaxed atmosphere throughout the home and a good rapport between staff and the people who lived there.

Is the home responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements. Care plans and risk assessments were informative, up to date and regularly reviewed.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns about the service.

Is the home well led?

Staff said that they felt well supported by the manager, there was a good team ethic and they were able do their jobs safely. The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

There were 14 people living at Ash Lea House at the time of our inspection. We spoke with two people about the care they received. Everyone we spoke with gave us positive feedback about their care, one person said, “I am very happy here, it’s my home now. The staff are nice and we have birthday parties.”

We found that the provider was working well with other services to ensure that people were protected from harm when moving to or from Ash Lea House. People were supported to visit the home before moving in and staff employed in the home were encouraged to visit people and get to know them ease any worries or anxieties they may have.

We observed that people were being care for in a clean, hygienic environment. One person said, “The cleaning lady does a very good job here as there’s a lot of us to clean up after.” We did note however that some areas of the home were in need of redecoration or repair. A redecoration and improvement plan had been put into place in November 2012 which was due to be completed in November 2013.

We found that appropriate and consistent staffing levels were maintained for the majority of the time. We did note that occasional shifts had not been covered, although this was usually when other members of staff had not attended a planned shift due to sickness. The provider was in the process of recruiting additional staff at the time of our visit.

We spoke with five people living at Ash Lea House. They told us “I like going out to do things” and “I have done more things myself since coming here”.

Everyone we spoke with felt that staff were mostly nice. One person told us “staff are ok, I particularly get on with (the deputy manager)”.

The people we spoke with were able to explain what they would do if they had any complaints. One person said “I had some problems but I spoke to (the manager) and they helped sort things out”.