We inspected this service on 26 March 2018 and 12 April 2018. The inspection was unannounced.

Ashleigh 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. The care home accommodates up to 24 older people in one adapted building. Accommodation is based on the ground floor as well as the first and second floors of the building.

There were 16 people living in the home on the first day of our visit and 14 people on the second day. Most of these were older people and some were living with dementia.

At our last inspection in November and December 2017 we rated the service as ‘requires improvement’ overall. We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 because risks related to people’s health and safety were not safely managed. There was a breach of Regulation 18 because the provider had not reported notifiable incidents to us without delay. There was also a breach of Regulation 17 because the provider did not ensure people were protected from risks to their health and safety, and systems and processes were not effective in monitoring and driving improvement. The key questions of Safe, Responsive and Well Led were all rated ‘Requires Improvement’. The provider sent us an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we checked whether the actions they had taken were effective. We found the provider was no longer in breach of two of the three regulations previously identified. Due to further improvement needed, there was a continued breach of Regulation 17 and the rating remained requires improvement.

Action was needed to improve person centred care, ensure care decisions related to restrictions in care were in people’s best interests, and to ensure audit processes were consistently effective.

There was a registered manager in post as the manager who had been in post at our previous inspection had registered with us on 4 May 2017. 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 atmosphere in the home was relaxed and people spoke positively of the staff who supported them. Staff were caring in their approach but some staff were more interactive with people than others. People said they felt their privacy and dignity was maintained. However, CCTV had been in use at the home which most people and visitors were unaware of which can compromise people’s privacy and dignity.

People did not always experience person centred care and information in care plans was limited in regards to people’s backgrounds and interests. This meant staff had limited information to assist them in providing care centred on the person’s individual needs. Some people told us they wanted more opportunities to go out of the home and to participate in activities that were of interest to them. People were able to maintain relationships and friendships with those important to them and visitors confirmed they were welcomed into the home. Where people had identified healthcare needs, some records did not support staff to help ensure they always addressed them effectively.

The provider carried out a series of recruitment checks to make sure staff were suitable to work at the home before they supported people at the home. People told us they felt safe living at Ashleigh House and said they could access staff when they needed and staff were caring and approachable. We saw enough staff were available to support people’s care

The inspection took place on 14 November 2016 and 20 December 2016. The visit was unannounced. Ashleigh House provides care and accommodation for up to 24 older people. At the time of our visit there were 17 people living in the home.

The home is required to have 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 and associated Regulations about how the service is run. There was a registered manager at the time of our previous inspection in September 2015, but they left the service in September 2016. There was a new manager in post that was not registered with us.

When we inspected the home in September 2015 people told us that some staff were not caring in their approach and people were not fully involved in decisions about their care. There were limited activities that met people’s needs and wishes. As a result, we rated the home as 'requires improvement'. At this inspection visit, we looked to see if the provider had taken action to address the issues we had identified. We found improvements had been made in relation to caring but they were ongoing in relation to responsive. In addition, this inspection found improvements were needed in regards to “safe” and “well led”.

At times there was no senior staff members available in the manager’s absence to ensure the ongoing safe and effective management of the home. This was because there was only one senior care staff member employed to cover shifts in the absence of the manager.

Where people were at risk of poor health, due to not eating or drinking enough, there were processes to monitor their food and fluid intake to help ensure their nutritional needs were met. However, records were not always clear to show instructions given by health professionals were followed.

Risks associated with people’s care and support needs were not always managed in a consistent way. This included risks associated with the use of specialist equipment, management of accidents and incidents and medicine management.

Accidents and incidents had not been reported to us consistently as required to ensure appropriate actions were taken to keep people safe. This included incidents of a safeguarding nature. Some policies and procedures had not been updated or made available to staff to ensure they were aware of their responsibilities.

Staff knew how to recognise potential abuse and understood their responsibilities to report this to the manager. However systems and processes to follow to refer abuse to the relevant external agencies, and ensure information was sufficiently recorded, were not clear for staff to follow in the absence of the manager.

Overall people received their medicines as prescribed but two medicines were identified to be used beyond the dates they should have been.

People told us they felt safe living at the home because they were treated well by staff. People said staff were respectful towards them and we saw caring interactions between staff and people. Staff members were mindful of protecting people’s privacy and dignity and people told us staff asked them before supporting them with personal care.

People said they had enough to eat and drink and there were meal choices provided each day.

The provider carried out a range of recruitment checks before staff started work to ensure staff employed were safe and suitable to work with people. There were sufficient numbers of staff employed to meet people’s basic care needs but some people had limited support in relation to pursuing their interests, hobbies and outside visits.

Staff completed training on an ongoing basis to help them develop their skills and competence to carry out their role safely and effectively. Staff told they had

This inspection took place on 23 September 2015 and was unannounced.

Ashleigh House provides care and accommodation for up to 24 older people. At the time of our visit there were 18 people living in the home.

There was a registered manager in post but they were not available at the home on the day of our visit. 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.

People told us they felt safe living at the home and staff understood their role in keeping people safe from abuse. There were enough staff available to keep people safe and maintain their health and wellbeing. Where there were risks associated with people’s care such as the risk of them falling, there were plans in place for staff to manage those risks. Recruitment checks of staff were carried out prior to them starting work at Ashleigh House to ensure they were suitable to work with people in the home.

Staff knew about people’s needs and how they preferred their care and support to be provided. Where changes in people’s health were identified, they were referred promptly to other healthcare professionals for advice. People we spoke with had mixed views about the care staff that supported them and told us some had a more caring approach than others. When we observed staff, we found this to be the case. People had some involvement in planning their care and support needs but felt more could be done to help them spend their days doing activities they enjoyed.

People were provided with sufficient to eat and drink and enjoyed the food provided which met their nutritional needs.

Medicines were managed well and people received their prescribed medicines at the right time. Systems were in place to ensure medicines were ordered on time and stored safely in the home.

Staff received training and support to ensure they could safely and effectively meet the individual needs of the people living in the home. Staff told us the training they received gave them the skills they needed to support people.

Management understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were supported in a way that did not inappropriately restrict their freedom. The provider had made applications to the local authority in accordance with the DoLS.

The registered manager and deputy manager were supportive to staff and worked with them to help support people’s needs to the standards required by the provider. The provider had systems to monitor the quality of service provision and identify where improvements were required. Staff told us they felt confident to approach the registered manager if they had concerns.

When we visited Ashleigh House on 25/26 November 2013, we found the provider was not meeting the required standards in relation to staffing. This was because staffing arrangements were not always effective in ensuring people's safety and welfare. We set a compliance action that let the provider know they needed to improve.

In December 2013 we met with the provider to discuss what they planned to do to improve staffing arrangements and the service provided at Ashleigh House. We carried out our inspection on 14 February 2014 to check appropriate actions had been taken to train staff and make sure there were sufficient numbers of staff to respond to people’s needs.

We visited Ashleigh House to follow up on concerns we had identified during previous visits to the home. These concerns related to care, the environment and medicine management. We also looked at two additional standards relating to staffing and quality of the service.

During our inspection on 22 July 2013 there were 11 people living in the home. We checked:

• There were sufficient numbers of suitably trained staff to care for people.

• People’s care needs were being met and they had suitable care plans in place.

• People had access to sufficient hot water

• Medicines were being managed appropriately.

• The views of people and their representatives on the quality of the service were being sought.

We looked at the care and medicine records for six people to see how their care needs were being met. We also looked at how medicines were being stored and managed.

We found that improvements had been made across all areas where we had previously identified concerns.

We found there were some improvements needed in relation to staff training and monitoring the quality of service. This was due to plans in place having not been fully implemented.

We visited Ashleigh House in response to concerns being identified to us by the Coventry City Council Adult Commissioning Team. We also received concerns from a whistleblower about the care and welfare of people living in the home.

On the day of our visit there were 16 people living in the home. Some of these people suffered with confusion and short term memory problems. To help us determine what it was like for people living in the home, we spend a period of time observing and speaking with people.

Those people who were able to speak with us had both positive and negative comments to make about the home. Comments included: “I’m quite happy here…I’ve had a stroke and I’m limited to what I can do. The lady here is a diamond.” “This place is a dump… everything is on the cheap here.”

We found that overall major improvements were needed to make sure people’s needs were met safely and appropriately. We had already identified during a visit on 4 March 2013 that improvements were needed in relation to medicine management. A timescale of 29 March 2013 was given for improvements to be made. During this visit we found there had been some progress in carrying out the required improvements.

We found that improvements were needed to the environment to make sure people had sufficient hot water and were warm enough.

A pharmacist inspector from the Care Quality Commission visited the home. This was in order to look at medicine management. There were 17 people living in the home at the time of our visit. We looked at the medicine administration records for nine people and how the service stored and managed medicines.

We had received a report about medicine management from a care home pharmacist from within the Coventry & Rugby Clinical Commissioning Group. This was following an unannounced visit they had undertaken on 14 February 2013. The report stated “There is a high risk of significant patient harm associated with medication errors with the current methods used by Ashleigh House”.

When we visited we found people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicine management.

We carried out this visit to follow up on improvements required in relation to: involving people in their care, the care and welfare of people and the environment. During this visit we found that sufficient improvements had been made for the service to be compliant.

We saw that the care files of people living in the home had been reviewed so that they contained more personal information about people. Families had been approached to obtain people’s background histories as well information on their hobbies and interests.

People had signed their plans of care to show that they agreed with the care planned. Where appropriate, people had been asked to consent to staff delivering care such as administering medication.

People were positive in their comments about the care they were receiving. They told us: “I think it’s very good. They look after me excellent.” “They look after me well.”

We walked around the building and saw that improvements had been made to the areas we identified during our last visit. This included hot water temperatures operating at required levels and the removal of personal information from being on display in the dining room.

We spoke with five people living at Ashleigh House to gather information about their experience of the service. People told us they were satisfied with the care they were receiving. We saw that suitable systems were in place to enable people to raise any concerns about their care if they needed to.

Each person had a care plan record but these contained minimal information about their daily living routines, interests and wishes. We did not see that there were any systems in place to determine people’s capacity to give consent.

We saw records confirming that staff had completed the appropriate training to help deliver care to people safely. People that we spoke with about the staff told us: “They are very kind and very nice.” “Quite good on the whole. Some girls really help but others ignore you a bit.”

We observed there was a calm and relaxing atmosphere in the home. We asked people if social activities were provided. They told us: “Not a lot, I am quite happy with sitting here I can see on the faces of some that they are not" (happy). “Not that I know of, I can’t imagine many of the people living here would be interested anyway.”

People told us they were satisfied with the food. They told us: “On the whole it is quite good considering… Most days they give you a choice.” “Very acceptable... I am always happy with it.”

We that saw some areas of the home had been recently refurbished but there were still some additional improvements needed.

During our visit in September 2011 and when we visited again in February 2012 we spoke with three people who live at Ashleigh House. They told us they felt happy and safe at the home. One person commented, "I am very settled here. The ladies (staff) are all nice to me and treat me well."

A person who had recently moved in said that they had received "a warm welcome."

People told us the food was "freshly cooked" and "excellent.” Staff offered people sensitive assistance with their meals.

People received prompt responses from staff when they asked for assistance and staff offered discreet support when providing personal care.

Three visitors said they had no concerns about the care of their relatives. One visitor went on to say, "I am more than happy with the care."

We observed people who, because of complex communication needs, could not answer questions about their experience of living in the home. People had clearly made positive relationships with the staff team on duty; seeking them out for company and choosing to sit next to them during activities.

People told us that there were lots of things to do in the home and looked forward to the "special parties" that took place throughout the year.

We visited Ashleigh House to follow up on concerns we had identified during previous visits to the home. These concerns related to staffing and the monitoring of the quality of service. We also looked at three additional standards relating to the care, medicine management and the environment.

When we visited there were 11 people living in the home. We checked:

1) There were sufficient numbers of suitably trained staff to care for people.

2) People's care needs were being met and they had suitable care plans in place.

3) People lived in a safe and suitable environment.

4) Medicines were being managed appropriately.

5) The views of people and their representatives on the quality of the service were

being sought.

We spoke with six people, two visitors and five staff. We also met with the provider and manager to obtain further information about the service.

We found improvements had been made across areas where we had previously identified concerns. We found staffing arrangements were not always effective to support people’s needs.