We inspected Ashgrange House on 10 and 11 September 2018. The first day of the inspection was unannounced and undertaken by one inspector. We previously carried out an inspection at Ashgrange House in February 2016 where we rated the service good. We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the service met legal requirements.

Ashgrange 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. Ashgrange House provides accommodation for up to eight people in one adapted building. At the time of the inspection there were seven people living at the home.

The care service has been developed and 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 found improvements were needed to ensure risks to people in relation to their health conditions were safely managed. Improvements were also needed and to ensure information about people’s mental capacity and best interests decision were recorded.

Other risks associated with people’s support and care were well managed. Staff were able to tell us about the risks associated with supporting people and what actions were taken to reduce these risks. There were systems to ensure accidents and incidents were well managed.

Staff understood how to safeguard people from the risk of abuse and discrimination. They were aware of their responsibility for reporting any concerns. There were enough staff, who had been appropriately recruited, working at the home. People received their medicines when they needed them because systems were in place to ensure medicines were ordered, stored, given and disposed of safely.

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. Staff asked for people’s consent before they provided any support.

There was a training programme for staff to help ensure they had the appropriate knowledge and skills to support people. Staff received regular supervision and felt supported by the registered manager. The registered manager was well thought of and supportive to people and staff. People were supported to eat and drink a choice of food that met their individual needs and preferences. They enjoyed going out for meals and this was included in their daily plans.

People’s health and well-being needs were met. Staff supported people to have access to healthcare services when they needed them. They were proactive in ensuring people received the healthcare support they needed.

People received support from staff who knew them well. They were treated them with kindness, respect, understanding and patience. Staff supported people to make their own decisions and choices throughout the day, and maintain their independence. People’s privacy and dignity were respected.

People received support that was person-centred and had been developed, with them, to meet their individual needs and choices. They were supported to communicate in ways that reflected their individual needs. Easy-read information was available for people throughout the home. Staff knew people well and

We carried out an unannounced comprehensive inspection at Ashgrange House on 16 and 17 December 2014 where we found improvements were required in relation to maintaining people’s records and quality assurance. The provider sent us an action plan and told us they would address these issues. We undertook an inspection on 10 and 12 February 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had been made however, further improvements are still required to ensure the changes are fully implemented.

Ashgrange House is a care home that provides accommodation for up to eight people who have a learning disability and require a range of support associated with living with autism and mental health needs. Accommodation comprised of seven individual bedrooms and a single flat. On the day of the inspection there were six people living at the home.

At the time of the inspection there was no registered manager at the home. However there was a manager in post but they had not submitted an application to register with the Care Quality Commission (CQC). 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.

This was an unannounced inspection which took place on 10 and 12 February 2016.

Although there were systems in place to assess the quality of the service provided, these had not identified some of the shortfalls we found in relation to people’s support plans and further improvements are required to ensure they reflected all the support people received and required. The audit system had not identified the lack of ‘as required’ (PRN) guidance for people’s medicines. This did not impact on the care and support people received because staff knew them well.

Staff had a good understanding of people as individuals, their needs, interests and hobbies. They were committed to ensuring people lived happy and enjoyable lives. They worked with people to help them reach their goals and achievements and supported to maintain and improve their independence.

Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. They understood what they needed to do to protect people from the risk of abuse. There were enough staff on duty to ensure people’s needs and choices could be met. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

Staff received the training and supervision they needed to meet the needs of people who lived at Ashgrange House. There was a training and supervision programme in place to ensure staff maintained current knowledge and skills. Staff were aware of the Mental Capacity Act 2005 and how to involve appropriate people in the decision making process if someone lacked capacity to make a decision. People were supported to have access to healthcare services and maintain good health on a day to day basis or when there was a change in their health.

The manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with her at any time and know they would be addressed appropriately. Staff and people spoke positively about the way the service was managed and the open style of management.

We used a number of different methods to help us understand the experiences of people who used the service, because some people who used the service had complex needs which meant they were not able to tell us their experiences. One person told us, "I love it here." We observed staff interacting positively with people.

We examined four care plans and saw evidence that delivery of care was person centred. Care plans and activities were designed and carried out to give people new experiences and independence while keeping them safe.

We found good management processes in place in relation to obtaining, storing, administering and disposing of medicines. Staff administering medication were appropriately trained and gave support to people where required.

Records we examined showed that there were appropriate checks made to ensure the home recruited suitable staff. Staff we spoke with felt well supported and enjoyed working at the home.

We saw that the home was decorated to a good standard. It was homely and designed or adapted as necessary to ensure it was a safe environment for the people living there.

We examined systems and records kept by the home and saw that there were good levels of quality assurance monitoring to maintain standards. These included analysis of satisfaction surveys, feedback from staff meetings and regular reviews of care plans, procedures and practices at the home.

We saw staff listening to people who used the service and responding to them in a polite and courteous way, we also saw that staff supported and gently encouraged people to participate in their planned activities for that day. One person told us that staff had helped her plan a visit to London to see a friend and had supported her on the visit.

People’s needs were assessed and they were consulted and involved in the planning of their care plans and service delivery. People had life history stories that were corroborated with friends and relatives of the people who used the service if they were unable to provide that information.

Staff we spoke to told us that they received regular supervision and that the senior team are available for advice and support. they also told us the senior staff are approachable and very supportive. One person told us "the manager has encouraged them with their professional development by suggesting courses to attend and facilitating their choice. We saw that staff received regular training appropriate to the needs of the people they support.

We saw that people who used the service were able to attend regular group meetings where they were able to put forward their views or concerns regarding a variety of topics such as, menu planning, group social events, the running of the home.

People told us that they liked living at the home. They said that “staff are marvellous” and that they get to spend lots of time with their families. One person informed us that they were going to a valentine’s disco which they were “really looking forward to”. People told us that the registered manager was “very good” and “very kind”.

Ashgrange House is a care home that provides accommodation for up to eight people who have a learning disability and required a range of physical and psychological support. There were seven individual bedrooms and a single flat on the second floor. On the day of the inspection six people lived in the home.

There was a registered manager at the home however this person was no longer working there. A new manager had been appointed three weeks prior to our inspection but had not yet submitted an application to register with the Care Quality Commission (CQC). Throughout this report we will refer to this person as ‘the 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.

This was an unannounced inspection which took place on 16 and 17 December 2014.

Although staff were able to tell us about people’s support needs, choices, personal histories and interests when people’s needs changed not all the information had been recorded in their support plans or was easily accessible. This is to ensure that staff had the guidance they needed to provide consistent care and support.

Audits had not been completed to monitor the quality of care and support people received. These meant areas for improvement were not promptly identified and addressed.

Staff treated people with kindness and patience. People were supported to keep in contact with their family and friends and were given opportunities to take part in activities and hobbies that were meaningful to them. There was a positive and open culture at the home. We observed a caring and relaxed atmosphere.

Care was provided to people by a sufficient number of staff who were trained and supported to keep people safe. Recruitment records contained evidence of appropriate checks on staff to help ensure they were suitable to work at the home.

Staff had received training in how to recognise and report abuse. They told us what procedures they would follow if they had any concerns. Staff told us and records evidenced they received regular training. Staff said they felt supported by the manager.

The manager and staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Medicines were stored, administered and disposed of safely by staff who had been trained to do so. People had access to healthcare professionals when they needed it. This included GP’s, dentists, opticians and psychiatrists.

People had risk assessments in their support plans, these gave information on the identified risk and also gave staff guidance on how any risk could be minimised to protect the person from harm. There was guidance for staff on what action to take and each person had their own personal evacuation and emergency plan.

People were supported to have enough to eat and drink. Nutritional plans contained guidance for staff to help support people eat healthy and nutritious meals.

There was a complaints procedure in place, this was accessible to people and displayed in a pictorial format that was easy for people to understand.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report in relation to the breaches in regulation.