This inspection took place on 20 August 2018 and was announced. We informed the registered provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day and we wanted to make sure the people who lived there would be in when we visited.

The service was last inspected in March 2016 and was rated good. At this inspection we found the service remained good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Ash Tree House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It accommodates up to five people with a learning disability in one adapted building. At the time of our inspection five people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

Risks to people were assessed and actions taken to reduce the chances of them occurring. The premises were clean and tidy and the provider had effective infection control processes in place. Plans were in place to support people in emergency situations. People were safeguarded from abuse. Medicines were managed safely. There were enough staff at the service to keep people safe. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

People’s support needs and preferences were assessed before they started using the service to ensure Ash Tree House could provide the care they needed. Staff were supported with regular training, supervision and appraisal. 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. People were supported with food and nutrition. Staff at the service worked closely with a range of healthcare professionals to monitor and promote people’s health. The premises had been adapted for the safety and comfort of the people living there.

People spoke positively about staff at the service and said they received caring support. Throughout the inspection we saw staff providing kind and compassionate care. Staff were supported to maintain their independence and live as full a life as possible. People were treated with dignity and respect. People were supported to access advocacy services where needed.

People received personalised support based on their assessed needs and preferences. Support plans were regularly reviewed to ensure they reflected people’s current support needs. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints. At the time of our inspection nobody at the service was receiving end of life care. Policies and procedures were in place to arrange this should it be needed.

The provider and registered manager carried out several quality assurance audits of the service to monitor and improve standards. Feedback was sough

We inspected Ash Tree House on 16 March 2016. This was an announced inspection. We informed the registered provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day; we wanted to make sure the people who lived there would be in when we visited.

Ash Tree House is situated in a residential area of Grangetown, Middlesbrough. The service is a residential care home that provides care and support for up to three people with a learning disability. There are three flats within the property all with bedroom, kitchen facilities and en-suite bathroom. There is a communal lounge/diner and a kitchen and office on the ground floor as well as one flat. The additional two flats are on the first floor.

The service 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.

People who used the service told us they felt safe. Staff were able to tell us about different types of abuse and were aware of the action they should take if abuse was suspected. There were systems and processes in place to keep people safe. Appropriate checks of the building and maintenance systems were undertaken.

Each person had an assessment of their individual needs which identified any risks. Risk assessments were in place to reduce the risks identified and covered areas such smoking, going out in the community, choking and behaviour that challenged. Person centred plans were developed with people who used the service to identify how they wished to be supported and looked after.

Staff told us that they felt supported by the registered manager, deputy managers and the registered provider. There was a regular programme of monthly staff supervision in place and appraisals took place on an annual basis. Records of supervision were detailed and showed the registered manager and the deputy managers discussed with staff their performance and development needs.

Staff had been trained and had the skills and knowledge to support the people they cared for. People told us and we observed there were enough staff on duty to provide support and ensure that their needs were met. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

People told us they were happy and well looked after. There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion and humour, were patient and gave encouragement to people.

We saw that people were involved in planning the menus and were provided with a choice of healthy food and drinks. People were also involved in shopping for and cooking the foods they had chosen. Staff had undertaken nutritional screening to identify specific risks in relation to people’s nutrition.

People were supported to maintain good health and had access to healthcare professionals and services. People had a hospital passport. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and th