Ashcott House provides a residential care service for seven people with a learning disability. At the time of this unannounced comprehensive inspection of 20 October 2017 there were seven people using the service.

At the last inspection of 20 October 2015 the service was rated Good. At this inspection we found the service remained Good.

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 service continued to provide a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse and with their medicines. Staff were available when people needed assistance and the recruitment of staff was done safely.

People were cared for by staff who were trained and supported to meet their needs. 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. Systems were in place to assess and meet people’s dietary and health needs.

Staff had good relationships with people who used the service. People were involved in making decisions about their care and support.

People received care and support which was planned and delivered to meet their specific needs. People were supported to participate in meaningful activities. A complaints procedure was in place.

The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below.

Ashcott House provides accommodation and personal care for up to seven people with learning disabilities.

There were seven people living in the service when we inspected on 21 October 2015. This was an unannounced 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.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

There were procedures in place which guided staff in safeguarding the people who used the service from the potential risk of abuse. Staff understood the actions they should take if they were concerned about people’s safety. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were enough staff to meet people’s needs and staff were available when people needed assistance. Recruitment checks were made on staff to ensure people were supported by staff who were suitable to work in the service. Staff were trained and supported to meet the needs of the people who used the service.

People, or their representatives, were involved in making decisions about their care and support. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). People’s care plans had been tailored to the individual and contained information including how they communicated and their ability to make decisions.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People’s nutritional needs were being assessed and met.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service’s quality assurance system identified shortfalls and these were addressed. As a result the quality of the service continued to improve.

Our previous inspection of 9 June 2014 found that there were shortfalls in staff supervision, people's care records and medication. The provider wrote to us to tell us about the actions they had taken to address these shortfalls. The purpose of this inspection was to check that the improvements had been made.

We spoke with four people who used the service, the manager, the provider and two staff members. We looked at four people's care records and staff training and supervision records and records relating to the medication management in the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I am happy." Another person said, "I like living here, I am going out today."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Staff were provided with the training and support that they needed to meet people's needs in a safe and effective manner.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had taken action to address the shortfalls identified at our previous inspection. They had reviewed policies and procedures and advice provided to staff to reduce the risks of the shortfalls happening again. As a result the quality of the service had improved.

Since our last inspection a new manager had started working in the service. They told us that they were in the process of making a registered manager application with us.

Prior to our inspection we received information from the local authority safeguarding team, who are responsible for investigating safeguarding concerns. This information told us that there were concerns regarding the safe management of medication in the service. As part of this inspection we assessed if people’s medicines were being managed.

We spoke with seven people who used the service. We also spoke with two staff members and the area manager. We looked at four people's care records. Other records viewed included staff training and supervision records, meeting minutes and medication administration records (MAR). We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. One person said, "I would tell the staff if something was wrong."

There were enough staff on duty to meet the needs of the people living in the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been submitted, staff had been trained to understand when an application should be made, and how to submit one. We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

During our inspection we found that records did not show that medicines were always being given to people as intended by prescribers. We noted some good information available about people’s medicines but some medicine profiles were inaccurate. There was inadequate risk assessment for a person self-administering some of their medicines and there was a lack of records about the administration of medicines given hidden in food to a person that assured us their medicines were always being given in their best interests and appropriately. We noted that all care staff authorised to handle and administer people’s medicines had received training but not all had been more recently assessed as competent to undertake medicine-related tasks. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy living in the service. One person said, "It is very good." Another person said, "We have fun, I like it here."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, there were shortfalls identified in the records. Even though the records were reviewed and updated, they were not done promptly when there had been a change in people's needs to ensure that staff were provided with up to date information about how people's needs were to be met. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff had been provided with the training that they needed to meet the needs of the people who used the service.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, "They (staff) check that I am ok." Another person said, "I like them (staff)."

Our observations and discussions with staff showed that the staff were knowledgeable about people's individual needs and how they were met. Staff offered people choices throughout our inspection, including what they ate and drink and what they did during the day. We saw that the staff listened and acted on what people said.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community. People were supported to maintain relationships with their friends and relatives.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. There was no registered manager in the service. The most current manager had recently left the service. The area manager advised that they undertook the day to day management of the service and that they had recently recruited a new manager.

Staff had not been provided with the supervision and appraisal that was identified in the service's own staff handbook. This meant that staff were not provided with the opportunity to discuss the way that they worked and to receive feedback on their work practice. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff and the area manager told us about the proposed changes to the service, which was split into two, The Bungalow and The House. The plans were that The Bungalow would remain as a care home and The House would provide supported living by the provider's domiciliary care service.

People spoken with and the minutes of house meetings showed that they were consulted about the proposed changes in the service, asked for their views about the service they were provided with and that their comments were listened to and acted on.

At the time of our inspection the provider was in the process of making changes at the service, the building will be separated in two. The bungalow will continue to provide accommodation for persons who require personal care to five people. The main building will become a supported living house where the remainder of the people will live.

We talked with five of the people who used the service, they told us that they liked living there. People also told us that they got on well with the staff that supported them to go out to do their personal shopping, to follow their favourite activities and to be part of the local community. One person told us that the staff were, “… good people, very friendly and kind.”

We observed that the staff were attentive to people’s needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff sought people’s agreement before providing any support or assistance.

We spoke with three staff members, they told us they were supported through supervision and that they believed they were trained sufficiently to support people with learning disabilities in all aspects of their lives.

We also saw that the provider had systems in place to deal with complaints made about the service and that people who used the service were supported to make a complaint if they wanted to.

We spoke with six of the 12 people who used the service who told us that they were happy living in the service. One person said, "I am okay here." Another person said, "I love it here, we are just like a family."

One person told us about how they had worked with a staff member on their care plan. They said, "I told (staff member) what I want and they wrote it down."

People told us about how their health care needs were met. One person said, "I am going to see the doctor today for a health check."

People told us that they were happy with the redecoration and refurbishment in the service. One person said, "I like the new shower." Another person said, "We chose the colours between us."

People told us that the service was kept clean and that they assisted the staff in the chores in the service. One person said, "I keep my bedroom clean and I ask the staff when I need help." Another person said, "I load the dishwasher."

We spoke with seven people who used the service. All people were preparing to go to a sports day and they told us about how they were going to win.

People told us that they were happy with the service they were provided with. One person said "I like living here." Another said "I like it as well, the staff help me." Four people told us that the staff treated them well. Someone else said "I am treated good." Another person said "I like the staff." Another person said "I have got a new keyworker, (staff member) is nice."

People said that the staff listened and acted on what they said. Comments made by people included "I choose what I want to eat,” "I pick what I want" and "They (staff) let me choose."

People told us about the activities that they enjoyed and their comments included "I go out on my own," "I've got lots to do," "I went on holiday, it was good" and "I choose where I want to go." Another person showed us the information that they had brought back from their holiday. We asked them if they had enjoyed it and they said "Yes."

During a visit to the home we were unable to directly communication with many people living at Ashcott House but people who were able to communicate with us told us they “liked” living at the home and that they were “very happy”.

We spent some time observing the care being provided and were able to see that people looked happy and content, they were engaged in activities and that staff were caring and friendly.