Ashgables 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. Ashgables House accommodates up to 26 people in one adapted building. At the time of our inspection 18 people were living at the home.

This inspection took place on 4 October 2018 and was unannounced. We returned on 5 October 2018 to complete the inspection.

There was a registered manager in post 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 and associated Regulations about how the service is run.

People who used the service were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded promptly to requests for assistance.

People told us they felt safe when receiving care. People were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

Sufficient staff were deployed to meet people’s needs. Staff had the right skills and knowledge to provide the care and support that people needed.

The service was responsive to people’s needs and wishes. People had regular meetings to provide feedback about their care and there was an effective complaints procedure. People were supported to take part in social activities they enjoyed and to keep in contact with friends and family.

Staff demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The management team regularly assessed and monitored the quality of care provided. Feedback from people was encouraged and was used to make improvements to the service. The registered manager had a good understanding of improvements they wanted to make to the service and had plans in place to implement them.

The inspection took place on 6 and 7 July 2017 and was unannounced on the first day.

Ashgables is a residential home providing care, rehabilitation and support for up to 26 people with mental health needs and learning disabilities.

At this inspection there were 24 people living at the service.

At the last inspection, the service was rated Requires Improvement. We found improvement had been made at this inspection.

The service had a new manager in post. They were going through the registration process to become 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.

On the day of the inspection staff were relaxed, and there was a calm, quiet atmosphere. Staff had a clear roles within the service. Information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People’s medicines were not always managed safely. People received their medicines as prescribed, received them on time and understood what they were for however, the service’s policy did not reflect practice at the service and audits were not robust and in line with best practice. Records relating to skin cream required improvement. We also found the systems in place to monitor the use of medicines which require additional storage needed to be more robust. The service acted promptly to make changes to ensure medicine management was in line with best practice. We issued a recommendation in this area.

People were supported by staff that were knowledgeable about the Mental Capacity Act (2005), which ensured they were involved in decisions about their care and their rights were respected. The service followed their processes which protected people’s human rights and liberty. However, records required clarity. The records shown showed the staff had not followed the principles of the MCA and made appropriate applications to restrict people’s liberty from the assessments of capacity.”

People were comfortable with staff supporting them and we observed positive interactions. Care records were in date and personalised. Staff responded quickly when they noted changes to people’s mental or physical well-being contacting the appropriate health professionals for example people’s mental health nurses. People or where appropriate those who mattered to them, were involved in discussions of care needs and how they would like to be supported. People’s preferences for care and treatment were identified and respected.

Staff exhibited a kind and compassionate attitude towards people. Positive, caring relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted and encouraged to live full and active lives. Staff were thoughtful in finding ways to overcome obstacles that restricted people’s independence.

People were supported to maintain good health through regular access to health and social care professionals, such as GPs, mental health nurses, social workers, occupational therapists and physiotherapists.

People we observed were safe and told us they felt safe living at Ashgables. The environment was uncluttered and clear for people to move freely around the home. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Regular fire tests and checks occurred and personal evacuation plans were in place.

People were protected by the service’s safe recruitment practices. Staff underwen

Ashgables provides care for up to 26 people. The home provides care for people with mental health needs and people with learning disabilities. On the day of the inspection there were 21 people living at the service.

The inspection took place on 11 and 12 May 2016 and was unannounced. The inspection was carried out by one inspector. At our last inspection in June 2014, we did not identify any concerns. This was the home’s first rated inspection.

A registered manager was employed by 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. The registered manager was present and approachable throughout our inspection. Staff and people who used the service told us the registered manager was always available if they needed to speak with her and had confidence in her abilities to manage the service. The relatives of people using the service were not available to speak to during the inspection however; positive written feedback was seen about the service from some people’s relatives.

Many of the people currently living at the service have lived there for many years and have developed more specialist healthcare needs often associated with their increasing age. Due to this, in some cases people now require nursing care or care from staff with more specialist training. The service has started to address this and had already liaised with other healthcare professionals for support. They were aware they need to evolve to continue to provide effective support as required by the people living at Ashgables.

Risk assessments were in place but staff did not always have the full knowledge to support people in a way that would keep them safe from harm. Where some risk assessments had been completed there was not always a structured process in place to robustly monitor these risks. However, people told us they felt safe when receiving care and staff had the knowledge and confidence to identify safeguarding concerns and what to do if they were concerned about the safety and well-being of people using the service.

There were sufficient levels of staff and they were seen to be visible for people to call on should they need support. Staff recruitment records showed relevant checks had been completed before staff were employed at the home. These included employment references and Disclosure and Barring Service (DBS) checks. The DBS helps employers to make safer recruitment decisions by providing information about a person’s criminal record and whether they are barred from working with vulnerable adults.

Storage, disposal, ordering, receipt and administration of medicines were well managed.

The home was free from odours and appeared visibly clean with evidence of ongoing cleaning during our inspection.

Staff had completed mandatory training and training updates as required. The registered manager used a training matrix to manage the training needs of the staff team. Staff told us they received the training they required to give people the care they needed. Staff were also supported to carry out their role through regular supervisions (one to one meetings). It was noted however, that for more specific training such as management of people’s specific medical requirements, staff required more training in these areas. We spoke to the registered manager about this and she confirmed that this was something they were aware of and looking into. Further training courses were identified to rectify this during the inspection.

People were able to make specific choices and decisions about their daily life. The registered manager was aware of the legal requirements to ensure decisions were made in people’s best interests and was in the process of ensuring this was be

A single inspector carried out this inspection. 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 is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

This is a summary of what we found-

Is the service safe?

People were treated with respect and dignity by the staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

People were protected from the risks associated with medicines. There were systems in place to ensure the safe storage and administration of medicines.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. Comments included; “they provide everything that I need” and staff provide “excellent care”.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, “I am very well treated by staff”. Staff told us they were able to provide the care that people needed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People using the service, their relatives and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people’s records which indicated they had been consulted over the care they received. This meant that information about people’s preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and other services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We spent part of the day talking with people who lived in the home and with staff. People were happy to see us and some remembered us from our last visit. People were very positive about the care and support they received and in particular about the staff. We observed that people were well cared for. The home had a calm atmosphere and people looked content. People told us they had 'absolutely no complaints'.

We observed that staff were kind, considerate and responsive to people's needs. We looked at the homes recruitment procedures and found that all staff had undergone the appropriate checks to ensure they were safe to work with people. Staff told us they were very satisfied with the induction they had received when they started work at the home.

During our visit we did have concerns around the cleanliness in some areas of the home and around the general maintenance in units one and two. We also highlighted areas with the administration and the quality systems of medicines which needed to be addressed.

We previously carried out an inspection in September 2012 where we found some concerns in relation to maintaining the safety of the environment for people living in the home. We asked the home to make some improvements. We visited the home in November 2012 and found that the home had made the required improvements to maintain a safe environment. We were also told how the home had improved their auditing system to include regular audits of the environment.

We spoke with eight people who use the service and observed others who were unable to verbalise their opinion. They told us that staff were kind and caring. People told us they were supported to make choices and we saw there were a range of activities people could access if they wanted to. One person said, "I am very happy living here". We observed that staff were patient and supported people to be as independent as they were able. Staff told us they felt supported by the management team and were given the appropriate training in order to support people appropriately. We looked at people's care records which evidenced that they were involved in their care. In relation to people living in the home and behaviours which may impact on other people, the home had robust risk assessments in place to promote an environment where people were protected from the risk of abuse.

Although the people receiving services in the home told us they were happy and we saw they were well supported; we found that failure to maintain a safe environment may put people living in the home at risk.

People told us that they were happy with the service they received. They said they liked the staff and had time with their key worker to discuss how they were feeling.

People told us that they went out on a regular basis. Some people had work, college or day centre placements. Other people enjoyed activities at the local leisure centre or trips out to places of interest. A lounge had been turned into a gym and there was a separate activities room. People could use the gym equipment when they wanted to. Some people did activities such as cooking and art and craft within the activities room. People could play games on the games console and use the newly purchased computer.

People told us that they were happy with their general environment. Some areas such as the lounges and the dining rooms had been redecorated. The kitchen had been refurbished. All areas other than the bathrooms were homely and well maintained. The manager told us that the bathrooms were due to be refurbished, as part of the home’s next project. An additional kitchen was also planned in order to enable some people to be more independent within their lifestyle.

Whilst people were comfortable within the home, two people said they did not feel safe around those people who showed challenging behaviour. The manager said that she would look into this. People told us that they felt there were sufficient staff on duty. They said that staff had time to talk to them and also to accompany them on trips and appointments. We saw that people were confident in the company of staff and positive interactions were evident.

People said they would tell the manager or a member of staff if they were not happy about any aspect of the service. They felt staff listened and would sort out any problem they had. People told us that they were encouraged to contribute to the running to the home. They said they were often asked their opinions about the food, social activities and the general home environment. People told us about the holidays they had planned or were planning this year. They said they could give their views at ‘resident’s’ meetings and/or key worker meetings.