About the service:

Ashleigh House is a large detached house. It is registered for the support of up to nine people with physical and learning disabilities including autism. Eight people were using the service at the time of our inspection. The service is larger than current best practice guidance. The service comprised of five ground floor bedrooms, three of which had on-suite facilities. There were four further bedrooms on the first floor, three bedrooms had en-suite facilities. Two communal bathrooms were also on the first floor although one of these was not in use at the time of our inspection. People were able to use two lounge areas and a dining room. There was a small outside space with a lawn area and seating.

People’s experience of using this service:

The outcomes for people did not always reflect the principles and values of Registering the Right Support for the following reasons. Most people at the service were non-verbal and poor staff communication methods meant that people did not always have a say in how their care and support was received. People had limited choice and control about their everyday lives.

Some risks people faced were not always identified or acted upon. We found environmental risks that could impact on people’s safety. Sometimes the way the service was designed had a negative impact on people. For example, the positioning of bathrooms and toilets. The provider was undertaking building and maintenance work at the time of our inspection to help make things better for people.

Staff did not always understand or remember the training they had received. Some additional training that may have helped staff meet the needs of people had not been provided. This meant there was a risk that people may not receive the care that was right for them.

Staff told us they felt supported and had regular meetings with the provider to discuss problems or issues. However, some of the recruitment practices for staff were poor and there was a risk that unsuitable staff could be employed to support people.

We were concerned that people were not able to agree to the care they received and the provider's systems meant that people were being deprived of their freedom unlawfully.

We observed people were relaxed in the company of staff and the staff we spoke with knew people well. However, sometimes people did not receive the privacy and dignity they should have.

People had enough food and drink to keep them healthy but they were not able to choose their weekly menu. Instead staff would offer alternatives if people refused the menu choice.

People were not always helped to communicate their needs or be involved in how the service was run. Although guidance had been given to staff about ways to communicate, this was not always followed. Information was not always available to people in a format they could understand.

The provider made regular checks to make sure the service was running well. However, they did not identify the issues we found during our inspection. So, they need to do more work to make sure improvements are made.

Rating at last inspection:

The overall rating at the last inspection was good. Well led was rated as requires improvement. The last inspection report was published on 19 February 2018.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Following an incident, we received information from the local authority regarding concerns about the service. We completed this inspection based on these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement:

The service met the characteristics of Inadequate in three key questions of safe, effective and well led and Requires Improvement in caring and responsive. We are considering enforcement action and will report on this when it is completed.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local aut

We carried out this unannounced inspection to Ashleigh House on 23 January 2018. Ashleigh House is registered to provide accommodation with personal care for up to nine people with physical and learning disabilities. 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. At the time of our visit eight people lived at the service.

We last inspected this service in April 2016 when we rated the service as Good.

There was a registered manager in place, who had taken up their post since our last inspection. 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 assisted us with our inspection.

People were cared for by staff who knew them and knew their needs. Staff were attentive to people and displayed a kind, caring approach. People seemed relaxed in their environment and were given the opportunity to spend time where they wished and remain as independent as possible. However, we found some records in relation to people needed to be updated. We also found some out of date items in the first aid box and that the service’s complaints policy contained incorrect information.

People were supported by sufficient staff to meet their needs and good recruitment processes were in place to ensure only suitable staff were employed. Risks to people had been identified and as such staff took appropriate steps to help mitigate any risk of harm of injury to people. Staff were aware of their responsibilities in safeguarding people from abuse.

Staff received on-going training, induction and supervision to support them in their roles. Staff were able to describe good infection control processes and we found the environment people lived in was clean and hygienic. Although people’s rooms were not all personalised we found they were comfortable and provided appropriate furniture for people’s needs. People could have privacy if they wished as we found some people had their own keys to their rooms. The environment was suitable for people who have a learning disability and the provider planned to make further improvements in response to people’s needs to improve the quality of the service people received.

People were assessed to see if they had capacity to make specific decisions. In the event that they did not, staff followed the legal requirements in relation to consent. Before people moved into the home a full assessment of their needs was carried out and relatives felt engaged in this process.

People received support from staff who demonstrated a good understanding of people’s communication styles and ensured people received care that focused on their health and wellbeing. People received the medicines prescribed to them and staff sought advice from external professionals to help ensure people received the most appropriate, effective and responsive care.

People had access to the food of their choosing. People’s care records were completed in detail and contained sufficient guidance for staff to understand people’s needs. People had access to a range of individual activities in line with their interests.

Systems were in place to monitor the quality of the service provided and ensure continuous development. People and staff were involved in the running of the home and relatives played an active role. The service had a registered manager who was also the provider. The registered manager was aware of their statutory duties in relation to CQC. Staff felt supported by the re

Ashleigh House is a large detached property located on the outskirts of Redhill Town. It is registered to provide care and accommodation for up to nine people with a learning disability, such as autism or epilepsy. On the day of our inspection six people were living in the home.

The registered manager in post is also the provider. 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 were protected from abuse because staff were able to recognise the signs of abuse and had undertaken training regarding safeguarding adults.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the provider had good management oversight of the home.

People were encouraged by staff whenever possible to be independent. Staff supported people to keep healthy by providing people with a range of nutritious foods. People who were able to were involved in the menu planning and shopping. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful for people. We heard people chose what they wished to do on the day. For example go for a drive or play ball.

The risk of harm to people was well managed and risk assessments were in place for identified risks. The registered manager logged any accidents and incidents that occurred and staff responded to these by putting measures in please to mitigate any further accidents or incidents.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (Dolls).

Staff were kind and caring and respected. There were sufficient numbers of staff on duty to meet people’s needs and support their activities. People and staff interaction was relaxed. Staff were aware of people’s needs. They were caring to people and respected their privacy and dignity.

Staff received a good range of training to undertake their roles. This allowed them to carry out their role in an effective and competent way.

The registered manager and deputy manager undertook quality assurance audits to ensure the care provided was of a good standard. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place to support people and keep them safe.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had assess to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas regarding the running of the home.

Our inspection of this care service helped to answer our five questions. Is the service safe? effective?, responsive?, caring?, and well led?.

Below is a summary of what we found when we visited the home on 9 April 2014 and 8 May 2014.

Is the service safe?

People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. The provider had facilitated training for staff with regard to safeguarding vulnerable adults and we saw this was updated yearly. We saw health and safety was monitored and promoted and all appropriate utility checks were in place.

Is the service effective?

People's health and care needs were assessed and people were involved in their care planning as much as they were able. People were able to visit their GP and we saw people also had annual health checks. When people's care need changed these were not always reflected with an appropriate risk assessment and therefore did not protect people receiving care. We have asked the provider to tell us what they are going to do to meet requirements of the law in relation to assessing people's needs and updating risks. Staff supported people to maintain family links and provided transport to enable people to visit family at home or to engage in community participation.

Is the service caring?

Some people who used the service were able to tell us they liked living in the home and the staff were kind. Other people were able to communicated to us with gestures, and the support of staff that they were happy living in the home. We saw staff interacted with people in a kind and sensitive manner. We observed staff encouraged people during lunch to help people eat independently and also provide sensitive support with their personal care.

Is the service responsive?

We saw there was a complaints procedure in place which was available to people who used the service and their relatives. We noted there had been no complaints recorded since CQC's last visit. It was noted that in the event of a complaint being made the provider had made clear provision to ensure this would be responded to in a timely manner. We noted the changing needs of a person who used the service required a move to ground floor accommodation. This was done following a physiotherapy assessment.

We noted the provider was not pro active in assessing and undertaking repairs and maintenance in the home within a reasonable timescale. We did however note the home was in the process of refurbishing a room on the ground floor.

Is the service well-led?

The service had a quality assurance system in place for monitoring and improving the quality of the service. We saw regular auditing of care plans, medication records, health and safety audits, and housekeeping audits were undertaken.

The service worked well with other professional bodies and authorities that have placed people in the home.

Staff told us they liked working in the home and felt they had the training and support required to undertake their roles effectively.