The inspection took place on 22 January 2019 and was unannounced. At the last inspection on 12 and 14 December 2017 the service was rated as requires improvement in each key question we inspect against. This was the first inspection to the service since a change of provider. There was no registered manager at the time of the last inspection but one was appointed shortly after our first inspection under the new provider. Six regulatory breaches were identified which included concerns about staffing levels, oversight and management, the care and safety of people using the service, insufficient support and training for staff, insufficient staff recruitment processes and poor person centre planning to ensure people’s needs could be met. The statement of purpose was also out of date. Following this inspection, a report was issued and the provider sent an improvement action plan detailing what actions they had taken. This has been systematically updated and shared with the Care Quality Commission (CQC) and the local authority quality monitoring team who have supported the provider to make the necessary improvements. Since the last inspection another manager was appointed but has subsequently left, a new manager came into post without delay and we have sought additional assurances from the provider about this.

Ashill Lodge 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.

Ashill Lodge provides accommodation and personal care to a maximum of 20 older people, some of whom may be living with dementia. Bedrooms are arranged over two floors with a stair-lift between them. This makes parts of the home unsuitable for, and inaccessible to, people with significant difficulties with their mobility. At the time of our most recent inspection there were seventeen people using the service.

At the time of this inspection there was a manager in post who was not yet registered with CQC but their registration interview was imminent. 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.

In summary we found the service was improving and people were confident in the care they received. We identified one repeated breach of regulation for safe care and treatment in relation to medicines. The manager was newly in post and had only been in post for three months. They had worked hard to stabilise the service and boost the confidence and morale of staff. They were very focused on people’s experiences. The quality assurance systems were not yet fully developed and could not clearly demonstrate how they improved the service based on feedback from people. Record keeping needed to be improved to clearly show people’s care needs and how staff were acting consistently to meet them. Staffs knowledge and training required improvement and some staff had not had the support or training they needed in the past so we were not assured of their competency. The environment required some further update but was much improved. The level of activity and opportunity for people also needed improvement.

Since the last inspection there have been two different managers with a third manager starting only recently. We have received a high number of concerns about this service which have recently subsided and there have been genuine attempts to improve the standards of care provided. The service has been supported by the local authority quality monitoring team who recently visited and inspected the service and helped determine what was working well and where the service needed to improve. We found some of the impro

Ashill Lodge 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.

Ashill Lodge provides accommodation and personal care to a maximum of 20 older people, some of whom may be living with dementia. Bedrooms are arranged over two floors with a stair-lift between them. This makes parts of the home unsuitable for, and inaccessible to, people with significant difficulties with their mobility.

There were 14 people using the service when we inspected with one additional person accommodated each weekend. We inspected on 12 and 14 December 2017 and the first day of our inspection was unannounced.

There was no registered manager in post, the previous registered manager having left the home before our inspection. They were in the process of cancelling their registration. 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 (HSCA) 2008 and associated Regulations about how the service is run.

The provider of the service had appointed a new manager who had submitted a successful application to register with CQC. However, shortly after our inspection visits and while this report was being drafted, the new manager left the service. This meant that the director, who was the provider's Nominated Individual with CQC, was responsible as a registered person, for ensuring the satisfactory operation of the service.

The new provider registered with us on 6 February 2017 when they took over the service. This was their first inspection. We acknowledged the very poor standards the new provider found when they started to run the home and that they had made some progress. However, we found that improvements were still needed in all areas.

There were concerns about how people's safety was promoted. Risks to people's safety were not always properly and fully assessed. This included arrangements in an emergency such as a fire. Although staff understood how to administer medicines safely and completed records showing they had done so, people's medicines were not always managed safely. Sometimes people were left without the medicines they had been prescribed.

The director of the service had plans to develop and improve the premises and had already improved some of the décor. Major works to control infection were needed and scheduled. However, there were some areas needing addressing as part of routine day-to-day management.

These concerns represented a breach of Regulation 12 of the HSCA 2008 (Regulated activities) Regulations 2014 for safe care and treatment.

Staff recruitment measures were not robust enough to properly contribute to protecting people from the appointment of staff unsuitable for care work. Appropriate checks were not completed to promote safe recruitment decisions and contribute to safeguarding people from the employment of unsuitable staff. This was a breach of Regulation 19 of the HSCA 2008 (Regulated activities) Regulations 2014 for fit and proper persons employed.

There were systems for monitoring when staff needed to complete training so shortfalls could be addressed. However, staff were not always properly supported, including through supervision and when they were new to the home, to ensure they could support people effectively. This was a breach of Regulation 18 of the HSCA 2008 (Regulated activities) Regulations 2014 for staffing.

People's needs were not always properly and fully assessed and planned for. They were not always involved in planning their own care and their preferences were not always taken into account. People's social and recreational needs were not met. They described themselves as bored and