We inspected Ashdale House on 17 and 20 December 2018. The inspection was unannounced and undertaken by three inspectors each day. We undertook this unannounced comprehensive inspection because of concerns that had been raised about the service. We looked at all aspects of the service and checked that the service was meeting legal requirements.

Ashdale 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. Ashdale House provides accommodation for up to 11 people with complex learning disabilities, in one adapted building. At the time of the inspection there were 10 people living at the home.

The care service had been designed, developed and registered before ‘Registering the Right Support’ and other best practice guidance was published. However, the registered manager was working to ensure that developments were 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 at the service. 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.

We previously carried out an inspection at Ashdale House in January 2017 where we rated the service Good, but we had asked the provider to make improvements in relation to their quality assurance processes and records.

At this inspection we rated the service ‘Requires Improvement’. We found improvements were needed to ensure there was an adequate process for assessing and monitoring the quality of the services provided and to ensure that records were accurate and complete.

The provider has been rated ‘Inadequate’ twice and ‘Requires Improvement’ twice in the well led key questions and we have determined they are not meeting the regulation in relation to Governance because of this.

Improvements were needed to ensure staff worked within the principles of the Mental Capacity Act 2005. Improvements had been made to the training programme. However, further time and commitment was needed to ensure these changes were fully embedded into practice.

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

People were supported by staff who were kind and caring. They treated them with kindness, understanding and patience. Staff knew people well. They were able to tell us about people’s support needs, choices and preferences. People were supported to make their own decisions and choices throughout the day and their privacy and dignity were respected.

The registered manager was well thought of and supportive to people and staff. They were working hard to improve the culture at the home and develop the service.

People received support that was person-centred and met their individual needs and choices. They took part in a range of activities that were specific to them and they enjoyed. Each person had an individualised activity plan that they followed each day. Those who wished to, took part in group activities at the home.

Staff had a good understanding of the risks associated with the people they looked after. There were risk assessments that provided guidance. Staff understood how to safeguard people from the risk of abuse and discrimination and understood their own responsibility in reporting concerns. Systems were in place to ensure medicines were ordered, stored, given and disposed of safely. There were enough staf

We undertook an unannounced inspection at Ashdale House on 16 and 17 January 2017 to check that the provider had made improvements to previous concerns and to confirm that legal requirements had been met.

We had carried out an inspection on the 3 December 2014 to follow up on concerns identified to us. We found the provider had not met the regulations in relation to safe recruitment of staff, supporting staff, quality assurance and records. A further unannounced inspection and took place on 14 and 25 September 2015 where we found improvements were still required in relation to quality assurance and records. We also found improvements were required in relation to the safe management of medicines. The provider sent us an action plan and told us they would address these issues by 30 December 2015.

We undertook another inspection on 13 and 14 June 2016 where we found improvements had been made however not all legal requirements had been met in relation to quality assurance and people’s records. We met with the provider and registered manager to discuss our concerns and issued them with a Warning Notice in relation to records and quality assurance. A Warning Notice is part of our enforcement powers. It informs the provider that we may take further action if they do not comply with the notice. It also gives the provider a timescale within which they must comply.

We also placed the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. Services in special measures are kept under review and 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. At this inspection we found significant improvements had taken place and the service is no longer in 'special measures'.

Ashdale House provides support and accommodation for up to 11 young people who are living with a learning disability, autism and mental health issues. Ten people lived at the home at the time of our inspection and all required some assistance, including personal care and support to go out. People had a range of care needs, including limited vision and hearing; and some could show behaviour which may challenge themselves and others. Some were verbally unable to share their experience of life in the home because of their learning disability.

The home was a converted older building, with bedrooms on four floors, there was a lift to enable people to access all parts of the home. There was a secure rear garden where people could spend time outside.

There is a registered manager at the home. 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.

We found significant improvements had taken place since our last inspection. The registered manager was aware of where improvements were required and was working to ensure these were made and embedded into everyday practice. There was a system to assess the quality of the service provided and this had improved since our previous inspection. However, the audit system had not identified the lack of ‘as required’ (PRN) protocols and guidance in relation to topical creams. This did not impact of people because staff had a good knowledge of their care and support needs.

People’s care plans and risk assessments were detailed, they reflected their needs and daily notes showed what support people had received throughout the day.

Staff knew people well and had a good understanding of their personal histories, likes and dislikes and individual needs. They were committed to ensuring people were happy and enjoyed their life. Staff unde

We undertook an unannounced inspection at Ashdale House on 13 and 14 June 2016 to check that the provider had made improvements to previous concerns and to confirm that legal requirements had been met.

We had carried out an inspection on the 3 December 2014 to follow up on concerns identified to us. We found the provider had not met the regulations in relation to safe recruitment of staff, supporting staff, quality assurance and records. A further unannounced inspection and took place on 14 and 25 September 2015 where we found improvements were still required in relation to quality assurance and records. We also found improvements were required in relation to the safe management of medicines. The provider sent us an action plan and told us they would address these issues by 30 December 2015.

At this inspection we found improvements had been made however not all legal requirements had been met.

Ashdale House provides support and accommodation for up to 11 young people who are living with a learning disability, autism and mental health issues. Ten people lived at the home at the time of our inspection and all required some assistance, including personal care and support to go out. People had a range of care needs, including limited vision and hearing; and some could show behaviour which may challenge themselves and others. Some were verbally unable to share their experience of life in the home because of their learning disability.

The home was a converted older building, with bedrooms on four floors, there was a lift to enable people to access all parts of the home. There was a secure rear garden where people were able to spend time outside.

The home has been without a registered manager since January 2015. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. There was a manager at the home who told us they were in the process of applying to become registered manager.

At the time of this inspection the local authority had a safeguarding plan in place in relation to previous concerns. There was also an embargo on admissions to the home pending improvements in records.

At this inspection we found care plans where information did not reflect people’s current support needs and other care plans did not include the level of detail staff may require to provide people with the appropriate level of support. The audit systems had not ensured that actions identified at the last inspections had been addressed. The systems to assess the quality of the service provided were not always effective and had not identified the shortfalls we found. We found some areas of the home were not clean, this included some people’s en-suites and skirting boards in the kitchen.

Staff knew people well and they had a good understanding of their personal histories, likes and dislikes and individual needs. They were committed to ensuring people enjoyed their life at Ashdale House. People were given choices about what they would like to do each day. We observed staff supporting people appropriately throughout the inspection.

People’s medicines were stored, administered and disposed of and managed safely. People received their medicines when they needed them in a way that suited their individual preferences.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk. There were enough staff working each day to ensure people’s needs were met in a way that met their individual needs. The recruitment procedure ensured only staff suitable to work at the home were employed. Staff received the training and support they needed to ensure they had the appropriate knowledge and skills to look after peopl

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We saw that people had risk assessments in place which identified what support they required.

There were enough staff to support people, however appropriate recruitment checks had not always been completed.

People had been cared for in an environment that was safe. We saw that regular electrical and gas servicing took place. There were regular checks for call bells, fire alarms, hoists and lift.

Staff were able to tell us about their understanding of abuse. Although staff understood how to report their concerns within the service, they did not know how to report concerns to external professionals.

It was clear from our observations and from speaking with staff that they knew people and understood their care and support needs.

Is the service effective?

We observed staff seeking people’s consent prior to providing any support or care.

Mental capacity assessments and deprivation of liberty safeguarding assessments had been undertaken appropriately when required.

Staff received regular training and updates. However, staff had not received regular supervision.

Is the service caring?

People were supported by staff that knew them well.

We saw that staff were kind and gave appropriate support and encouragement to people.

Is the service responsive?

People’s needs had been assessed. However, these had not all been reviewed regularly and did not reflect the current needs of people.

Is the service well-led?

There was a registered manager in post. However this person was not currently working at the home.

Staff told us there was always someone within the company who they could approach for support.

We used a number of different methods to help us understand the experiences of people who used the service. People had complex needs, which meant they were not able to tell us their experiences. However, those that spoke to use said they had enjoyed their lunch and were looking forward to the party that evening.

Staff said they asked people for their consent before they provided support. We found evidence that people were encouraged to make choices and observed staff treated people with respect and dignity.

We examined two care plans and found that they were based on people’s individual support needs. The care workers we spoke with demonstrated a good understanding of people's needs and how these were met.

The systems for the management of medicines were appropriate.

Safeguarding procedures and policies were in place and the home used them as required to ensure people’s safety.

We reviewed the systems used to support staff, including supervision and training.

Complaint policies and procedures were in place, and staff said people were encouraged to discuss the support they received.

We used a number of different methods to help us understand the experiences of the people using the service, because they had complex needs which meant some were unable to tell us their experiences. We observed staff supporting people living in Ashdale House, we looked at documents and spoke with people who used the service, the care workers and the deputy manager.

We visited the home and were introduced to seven of the 10 people who used the service. People who were able to speak with us said they were happy living in Ashdale House and that the staff were “very nice." We observed that staff were mindful of people’s individual methods of communication and were respectful when offering support.

We contacted three relatives after the inspection They said Ashdale House offered the care that people needed. They told us that the care workers supported people to be independent and make choices, whilst ensuring they were safe.

We looked at two care plans and found them to be person centred, with relevant risk assessments and guidelines for staff to follow.

We looked at the procedures for the ordering, storage and administration of medicines. We found that the systems in place were appropriate.

We looked at the staff rotas and found the number of staff on duty were sufficient to meet the needs of the people who used the service

A quality monitoring system was in place to ensure that a good standard of support was offered by the service.

One person living at Ashdale House told us that they had recently been on holiday and “had a great time”. Other people were looking forward to going away on holiday on the afternoon of our visit. People spoke positively about the activities they liked doing and one person said that they had really enjoyed a recent pub lunch. People said they liked their bedrooms and had decorated them how they wanted, but one person indicated that they would like to have their own key to their room.

People who commission this service said that they had a good relationship with the management at Ashdale House and that they had no concerns about the way care was being delivered.

Ashdale House provides support and accommodation for up to 11 young people with learning disabilities, autism and mental health issues. There were 10 people living in the home during the inspection and all required some assistance with looking after themselves, including personal care and support in the community. People had a range of care needs, including limited vision and hearing; and some could show behaviour which may challenge and most were verbally unable to share their experience of life in the home because of their learning disability.

The home was a converted older building, with bedrooms on four floors, there was a lift to enable people to access all parts of the home and a secure garden to the rear for people to spend time outside if they wished.

The home has been without a registered manager since January 2015. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.’ A manager had been appointed just prior to the inspection. They told us they would be applying to register as the manager of the home with CQC.

This inspection took place on the 14 and 25 September 2015 and was unannounced

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements in records. At the last inspection on 3 December 2014 we found areas that needed improvement included staff recruitment, supporting staff, quality assurance and record keeping. We received an action plan stating the improvements would be in place by the end of June 2015, and then we had further information that this date would have to be extended. We found that some improvements had been made, but additional work was needed.

The quality monitoring and assessing system used by the provider to review the support provided at the home was not effective. It had not identified the issues found during this inspection, including gaps in medicine records and, that care plans did not reflect people’s specific needs and they had not been reviewed and updated as people’s needs changed.

People were able to choose what they ate and where, with many eating outside the home, but there was no system in place to ensure people’s diet was nutritious and varied.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished, although staff had identified they may not have been specific to people’s needs and alternative activities had been arranged.

The staffing levels were appropriate to the needs of people living in the home and pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies if they had any concerns. People said they were comfortable and felt safe and, relatives felt people were safe.

Training and updates were mandatory for all staff, including safeguarding people, awareness of learning disabilities and management of challenging behaviour. Staff said the training was good and helped them to understand people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the manager was approachable and they felt they could be involved in developing the service to ensure people had the support they needed and wanted. Relatives said the manager seemed very nice and they hoped the service would improve with good leadership.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.