Ashby Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashby Lodge can accommodate up to 22 people. Accommodation is based over two floors. The home is situated in the Outwood area of Wakefield within reach of local shops and public transport. At the time of this inspection, 20 people were living at Ashby Lodge.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Our last inspection at Ashby Lodge took place on 15 and 19 May 2017. The service was rated requires improvement overall and we found two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a breach of Regulation 12 Safe care and treatment and Regulation 17 Good governance.

Following the last inspection, we asked the registered provider to send an action plan to show what they would do, and by when, to improve the key questions safe and well led.

This inspection took place on 10 July 2018 and was unannounced. We found sufficient improvements had been made to meet the requirements of Regulations 12 and 17 and we did not identify any further breaches. There had been enough improvements to increase the rating to good in all key questions.

The home was welcoming and friendly. People and relatives spoke positively about the standard of care people received and staff were respectful and caring in their approach.

Staff were aware of their responsibilities in keeping people safe. Systems and processes for the safe management of medicines were in place.

There were robust recruitment procedures and sufficient staff to promote people’s safety. Staff were provided with relevant induction, training and supervision so they could support people effectively overall.

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’s care records contained relevant information to inform staff and were regularly reviewed to ensure they were up to date.

The environment had improved since the last inspection and there was ongoing refurbishment, although we made a recommendation for the ‘far’ lounge to be made more accessible and welcoming to people.

People were confident in reporting concerns to the registered manager and felt they would be listened to. The complaints procedure was displayed prominently, although there had been no complaints recorded.

There was clear communication between staff and families and the registered manager was actively involved in people’s care.

There were quality assurance and audit processes in place to make sure the home was running well, although we recommended the registered manager received more formal support and supervision from the registered provider. Policies and procedures were available to staff to support them in their work.

Ashby Lodge is a small residential care home for up to 22 people, most of whom are elderly. There were 21 people living in the home at the time of the inspection.

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.

The home had a welcoming, friendly atmosphere and people told us they were happy and content living at Ashby Lodge. There had been some recent improvements to the décor and we were advised this work was ongoing.

People said they felt safe and there were routine safety checks carried out. Individual risk assessments for people were in place but were lacking in detail and accuracy.

Staff understood how to ensure people were safeguarded against possible abuse and they knew how to report any concerns.

People said they received their medicines on time, but we found some weaknesses in the management of medicines.

There were regular staff training and supervision opportunities, although staff’s competence was not always monitored robustly.

People enjoyed the meals and the food and drink provision was suitable for people’s needs.

Staff interaction with people was kind and caring and staff knew people well. People were encouraged to retain their independence.

Staff knew people’s individual preferences and these were reflected in the activities provided.

Care records were not maintained with sufficient information for staff to fully understand all aspects of people’s care needs.

People knew how to make a complaint and there was a system for recording complaints and compliments.

People, relatives and staff felt supported by the registered manager and they were confident their views were valued and acted upon. Systems were in place for monitoring the quality of the provision, although these were not always sufficiently robust.

The registered manager was aware of the strengths of the service and the areas to improve.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 30 December 2014 and was unannounced.

There were no breaches of the legal requirements at the last inspection in March 2014.

Ashby Lodge provides accommodation and personal care for up to 22 people. The home is on the main Leeds Road in Outwood and is close to local shops and amenities. There were 20 people living in the home when we visited.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Ashby Lodge was homely and welcoming with a happy atmosphere. There were good relationships between staff and people who lived in the home. Staff were kind and caring with high regard for people’s individual needs.

People’s dignity and rights were promoted and they were treated with respect by staff who understood their individual needs. Staff involved people in their care, supported their independence and promoted person-centred care.

The registered manager had a sound understanding of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff worked well together and communication was effective to ensure people’s needs were met. Staff were recruited appropriately, skilled and knowledgeable about people’s needs and training was ongoing to support staff in their role.

Care records provided sufficient information for staff to be able to support people’s individual needs safely. People engaged in sufficient activities of their choice.

People and their relatives praised the service and the staff. Visiting professionals said communication was effective to ensure people’s needs were met.

Medication was not always given to people as stated on their prescriptions, which meant people may not have received their medicines appropriately.

Systems to monitor and review the quality of the provision were in place and the registered manager was involved in people’s care delivery, maintaining an overview of the service. Improvements to the quality of the service had been made since the last inspection. Not all quality checks were rigorous enough to ensure practice was sound, such as with audits of medications.

Improvements to the quality of the service and the premises had been made since the last inspection. However, improvements were required in the kitchen area with regard to electrical sockets, appliances and food safety.

You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up visit to check the provider had taken action to ensure compliance with outcome 16, assessing and monitoring the quality of the provision. At our previous visit on 21 October 2013, we found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We spoke with the manager and one member of staff and looked at documentation to show how the quality of the provision was regularly assessed and monitored. We had a tour of the environment on the ground floor. We found there had been substantial improvements since our last visit.

This was a follow up visit to check that actions raised at our previous visit had been addressed and the provider had responded to the warning notices we issued.

We spoke with the acting manager, three care staff, one kitchen staff and the maintenance staff. We spoke with three people who lived in the home and one relative.

We found the provider had made some improvements since our last inspection in all areas. We saw premises were clean and appropriately maintained; some rooms had been redecorated. We saw faulty equipment had been replaced and there was an on-going programme for repairs and maintenance.

We saw the acting manager had taken steps to address the issues from our last inspection, which reduced our level of concern.

We were not fully satisfied that there were effective systems in place to assess and monitor the quality of the service provision.

This location was previously inspected in April 2013 and May 2013, where premises were found not to be fit for purpose.

At our last visit we saw some furniture was not suitable for people to use. We discussed this with the provider and the provider said this would be put right.

We received information from the Environmental Health Officer that they had placed a Prohibition Notice under the Health and Safety at Work etc. Act 1974 in respect of bedroom four. This was because the window was unsafe, not securely held in place and had no window restrictors.

We looked at the safety and suitability of the premises. We saw that the décor of the building was not refreshed and maintained. We spoke with three staff, the acting manager and one person who lived there. We saw that standards of cleanliness and hygiene were not maintained in relation to both the premises and the equipment. We saw the provider had not improved furniture for people. We identified further concerns with regard to premises and equipment. Staff that we spoke with said they did not think there was sufficient or suitable equipment to meet the needs of the people who lived there. This meant that people did not benefit from equipment that was safe, comfortable, promoted independence or met their needs.

We saw the provider was failing to ensure the effective management of risks to people’s health, welfare and safety. There were inadequate systems in place to monitor the quality of the service.

This was a follow up visit to our inspection in April 2013. We wanted to make sure that the provider had taken the action necessary to make premises safe and to ensure people's dignity and privacy when using the shower. We also wanted to make sure that the premises had been made suitable with regard to the wet-room and bathing facilities and so we made our visit with the Environmental Health Officer. We saw that the provider had re-furbished the wet-room and installed new tiles and floor surface. The shower had been repositioned to make it easier for people to use. There was a blind up at the window to ensure people's dignity and privacy. The provider had installed a new accessible bath upstairs to give people the choice of whether to have a bath or a shower. We were satisfied that the premises had been improved with regard to bathing facilities, dignity and choice for people living in the home. We spoke with the manager and with staff, who told us that the facilities were much improved.

However, we saw that the provider had not taken any action to address our concerns about one of the fire escapes on the ground floor. This has been referred to the Fire Officer for further advice. We will make a further visit to the home once the Fire Officer has checked the premises. We spoke with the provider and explained our concerns. The provider agreed to take action to address this matter.

We saw positive relationships between people and staff. The atmosphere in the home was homely and friendly and people appeared to be happy and relaxed. People told us "the staff are kind" and they said there were enough staff to meet their needs. Staff showed respect and courtesy to people and they encouraged their independence and choice in most aspects of their care. People's care was discussed with them, although they did not contribute to their care plans.

People told us they liked to engage in activities of their choice, such as reading newspapers, doing crosswords or knitting and crocheting. People say they enjoyed organised activities, such as a sing-song. We spoke with staff and saw that they spent time talking with people about their lives and their interests.

The living areas people used and their personal rooms were adequate. However, although the provider has made alterations to one of the bathrooms, the bathroom facilities were seen to be unsuitable and they did not afford people choice and privacy. Risk assessments of the premises were not in place to ensure the suitability and safety of areas in and around the home.

People we could not communicate with appeared relaxed and comfortable. One person said the staff are very good. Another says ‘the girls are very caring’.

People we could not communicate with were comfortable and well cared for. One person said the staff are very good and they are well cared for.

People we could not communicate with were relaxed and comfortable. One person said they like the new chairs and they are happy with their bedroom.

People we could not communicate with were observed to be relaxed and comfortable. On person says they like the people caring for them and they feel safe.

People we could not communicate with were comfortable and well cared for. One person said they like living in the home and feel they are ‘treated well’.