This inspection took place on 28 September 2017 and was unannounced. Ashbourne House is registered to provide accommodation and personal care for up to 17 people. At the time of our visit there were 15 people living at the service.

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.

At our last inspection in June 2016 we rated the service overall as Requires Improvement. At that inspection we found a breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not appropriate procedures for the administration and recording of PRN (as required) medicines. We also found that although improvements had been made since the inspection of August 2015 and previous breaches had been met we had to be satisfied that these would be sustained over time.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. Staff had completed nationally recognised qualifications in health and social care and others were in the process of completing this.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them those living at the service felt ‘valued and happy’.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions a process of best interest decision making had been followed that was consistent with the principles of the Mental Capacity Act 2005 (MCA). The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff embraced new initiatives with the support of the registered manager and deputy. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.

The provider and registered manager had implemented a programme of ‘planned growth’ that was being well managed and they were committed to continuous improvement. An increase in the provider’s oversight meant that a significant number

We carried out a comprehensive inspection of Ashbourne House on 20 and 21 August 2015. Following this inspection, we served a Warning Notice for a breach of Regulation 13 of the Health and Social Care Act 2008 relating to Safeguarding service users from abuse and improper treatment. In addition to this, we also found an additional nine breaches of nine other regulations of the Health and Social Care Act 2008 during that inspection.

Following the inspection the home was placed into special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Ashbourne House' on our website at www.cqc.org.uk

Following the inspection in August 2015 the provider wrote to us to say what they would do to meet the legal requirements. We undertook another comprehensive inspection on 1 June 2016 to check the provider was meeting the legal requirements for the regulations which they had breached. At this inspection the provider had made sufficient improvements to be removed from special measures.

Ashbourne House is a 17 bed residential home for older people that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 12 people living at the service.

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.

There were not appropriate procedures for the administration and recording of PRN (as required) medicines.

Daily records did not always accurately reflect the care given to people.

The home was generally clean however improvement was required in the level of cleanliness and the inappropriate storage of cleaning materials within the laundry room.

People’s needs were regularly assessed and resulting care plans provided practical guidance to staff on how people were to be supported. Care plans were personalised and contained individual information and references to people’s daily lives.

There were enough staff to meet people’s needs. Staff demonstrated a detailed knowledge of people’s needs. They had received training to support people to be safe and respond to their care needs. Training did not however include specific training to support all care staff to recognise and meet the needs of people Staff were aware of the service’s safeguarding and whistle-blowing policy and procedures.

The provider had quality monitoring systems in place which were used to bring about improvements to the service.

Training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) had been provided to staff. DoLS aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Staff were knowledgeable about the protection of people’s rights. The service had ensured that best interest decisions were undertaken when people lacked the mental capacity to make decisions an

During a CQC inspection on 10 May 2013 we found Ashbourne House non -compliant in outcomes relating to the care and welfare of people who use services, supporting workers and assessing and monitoring the quality of service provision. Following the inspection we asked the provider for an action plan to address the non-compliance we had found.

We re-examined the outstanding outcomes during an inspection on 17 November 2013. People we spoke with were happy living in the home. People told us “they look after me very well” and “we get a first class service”. We also found that action had been taken to address the identified shortfalls.

We re-examined the outcome where we previously identified non-compliance. We found that appropriate action had been taken to address the identified shortfalls.

We spoke with six people who lived in the home, two visitors to the home, three members of staff, the registered manager and the provider. We examined records, minutes of meetings and survey results. People told us "It’s very friendly here I have no complaints" and "they go out of their way to please us".

The care plans we saw provided basic details of people's needs and were not person centred.The information in people’s risk assessments were generic and did not clearly define the risk to individuals and measures required to ensure their health and safety.

The provider had effective systems in place to deal with safeguarding incidents. Staff received safeguarding training which was updated annually. Safeguarding and complaints information was displayed in the home for the staff and people to refer to.

The provider’s infection control procedures did not meet the recommended guidelines for the prevention and control of infection within the home.

Staff did not receive appropriate professional development supervisions and annual appraisals.

The provider did not have effective quality assurance systems in place to monitor the performance of the home.

This inspection was to look at the actions the home had taken in response to our inspection of 24th April 2012. As a result of that inspection we took enforcement action because the provider was not meeting essential standards.

We issued warning notices which told the provider they had to take action by 30th June in relation to Outcome 4 Care and welfare of people who use services, Outcome 12 Requirements relating to workers, Outcome 14 Supporting staff and Outcome 16 Assessing and monitoring the quality of service provision.

We received an action plan from the provider on 1st June telling us the actions they were taking as a result of our enforcement action.

This visit was to look at the actions taken to date and make a judgement whether the provider was now meeting essential standards. We did not talk to individuals as part of this visit our focus was looking at evidence in the form of systems, procedures and records.

We found that the provider had addressed the areas of concerns and put in place systems, policies and procedures to make sure that the practice of the home meets the required standard. Importantly recruitment, training of staff and care systems particularly the management of risk had improved. We noted that there were areas such as quality assurance audits that had not taken place and we will look at these as part of our next inspection.

We spoke with six people who told us they liked living at the home and staff met their needs. One person told us "the staff look after me well". However, other evidence did not support this. We found care records did not reflect the individual needs of the people and lacked assessment of risks.

The home provided recreational activities for people. On the day we visited an exercise class took place in the lounge and people were invited to join in with the gentle exercise routines, which were set to appropriate music.

We also observed a hairdresser present on the day that we visited. People who lived at the service were clearly enjoying having their hair done and chatting to the hair dresser.

People told us they could choose how they lived their lives in the home. They also commented on the politeness of staff.

All of the people who used the service that we spoke with told us they felt safe living in the home.

We found that the home lacked systems to assess and monitor the quality of the service. We found that staff had not received training in the last year and one new member of staff had not received training at all. We found that recruitment checks had not been completed for two members of staff who had been employed since January 2011.

We carried out this inspection on 20 and 21 August 2015 and it was unannounced. When Ashbourne House was last inspected in November 2013 there were no breaches of the legal requirements identified.

Ashbourne House is a 17 bed residential home for older people that provides accommodation for persons who require nursing or personal care. At the time of our inspection there were 12 people living at the service.

The overall rating for this service is ‘Inadequate' and therefore 

the service is in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was 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.

On the day of inspection the registered manager was on annual leave. The home was represented by a senior member of staff.

The home was not suitably safe and clean. The hygiene practices of staff did not meet the Department of Health guidance for the prevention and detection of infection.

The administration of medicines was not in line with best practice.

The provider had not made appropriate arrangements to identify and respond to allegations of abuse. Staff were not aware of the provider’s safeguarding policy and how to respond to actual or suspected abuse to keep people safe. The provider had also failed to act appropriately in reporting potential abuse to the local authority safeguarding team.

The provider did not operate safe and effective recruitment procedures to ensure only suitable staff were employed at the service.

There were not sufficient numbers of staff to support people safely.

We saw that appropriate action was not taken in response to unsafe incidents, including steps to reduce the risk of them reoccurring.

Staff did not have a good understanding of the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards (DoLS). The registered manager had not made applications for DoLS where they had been required. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Staff appraisals and supervisions were not undertaken as planned and the registered managerfailed to monitor and feedback on staff performance.

The provider did not have a system to monitor records made by staff or records that related to the management of the service.

The provider failed to ensure that people sustained good health by the means of providing nutritious food and sufficient drinks to people.

We observed occasions where people’s care and dignity were compromised. People were not given choices in their daily routines.

People were not supported in promoting their independence through activities and community involvement.

Care was not consistently person centred. Care plans were not personalised and did not contain unique individual information and references to people’s daily lives.

Risk assessments did not always reflect actions required to reduce risks to people.

Statutory notifications had not been made to the Commission for notifiable incidents.

The systems in place for monitoring quality and safety were not sufficient to ensure that the risks to people were identified and managed.

Staff felt that their views and concerns would be listened to but were not confident these would be acted upon.

We found ten breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report