About the service:

Ashleigh House is registered to provide accommodation and personal care for up to a maximum of 13 people some of who may be living with dementia. At the time of our inspection there were 13 people living at the home.

People’s experience of using this service:

The provider had systems in place to respond to any identified risks to people. This included appropriate fire safety training. Staff members were aware of the necessary action they should take in the event of an emergency. In addition, the provider had assessed risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the risk of harm to people.

People received safe care and support as the staff team had been trained to recognise potential signs of abuse and understood what to do to safely support people. Staff members followed effective infection prevention and control procedures.

People received safe support with their medicines by competent staff members. The provider had systems in place to respond to any medicine errors should they occur. The provider completed regular checks to ensure that people were receiving the right medicine at the right time and people’s medicines were stored correctly.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision. Staff members were knowledgeable about the relevant legislations that informed their practice and supported the rights of those living at Ashleigh House.

People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding food and drink. The environment where people lived was well maintained and suited their individual needs and preferences.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to retain their independence.

People participated in a range of activities that met their individual choices and preferences and found interesting and stimulating. People were provided with information in a way that they could understand. The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

The provider had systems in place to ensure the Care Quality Commission was notified of significant events in a timely manner and in accordance with their registration. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed. The provider, and management team, had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection:

Requires Improvement for the key questions ‘Safe,’ ‘Effective’ and ‘Well-led’ (date last report published 21 July 2017). At that inspection we found the provider needed to improve their staff members knowledge regarding fire safety and the provider needed to make improvements to how they identified and mitigated risks to people. Staff members knowledge of the mental capacity act and the deprivation of liberty safeguards needed to be improved. The provider needed to improve how they monitored the quality of support they provided to ensure people received ‘Good’ care. At this inspection we found they had made these improvements and therefore rated Ashleigh House ‘Good’ in all key questions.

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Requires Improvement.’ At this inspection we found the service had improved.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

We inspected this home on 8 June 2017. This was an unannounced Inspection. Ashleigh House is registered to provide care to 13 older people with a variety of needs including the care of people living with dementia. At the time of our inspection 12 people were residing at the home.

The service was previously inspected in January 2016 and at that time we found the service was not compliant with one of the regulations we looked at. The issues identified that the provider’s systems in place to assess the appropriate staffing levels were not effective and staff were not always appropriately skilled or enabled to use their skills in order to provide people with the care and support they required. Following the inspection in January 2016 we spoke with representatives of the provider. We issued a warning notice using our enforcement powers. These are formal ways we have of telling providers they are not meeting people’s needs or the requirements of the law, and that improvements are required. The provider sent us an action plan detailing the improvements they would make. They have updated us regularly and informed us that the actions had been completed. In July 2016 we revisited the home and found the warning notice had been met.

The home had a registered manager, and they were present throughout the 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.

Staff that we spoke with were not consistent with their responses in relation to the fire procedure and the actions they would take in the event of a fire. Some risk assessments did not contain sufficient guidance for staff to follow. People told us that they felt safe living at the home. Staff were aware of their responsibilities to protect people from allegations or suspicions of abuse. People and staff told us there were enough staff available to meet people’s needs. People received their medicines as prescribed.

Staff told us they had the knowledge and skills to support people effectively. Staff worked in a manner that showed they sought people’s consent. However, staff had limited knowledge around the Mental Capacity Act (2005) and The Deprivation of Liberty Safeguards (DoLS). Care plans did not reflect how to support people in the least restrictive way. People told us that they enjoyed the food and the choices offered. People had access to healthcare professionals when needed.

People spoke highly of the care they received and praised the kindness of the staff who supported them. People were supported to make their own choices and decisions in line with their wishes. Staff supported people in ways that promoted their privacy and dignity and respected their views.

People told us they were involved in the initial planning of their care and that they were happy with their care. People contributed to the reviewing of their individual needs. People told us some activities of particular interest to them were provided for them to participate in. However the activities offered on occasions were not engaging enough for all people in the home. A complaints procedure was available for people to use. People felt assured that concerns raised would be dealt with promptly.

Although there were some systems in place they were not sufficient in monitoring the quality of the service people were receiving. Since our last inspection the registered manager had introduced new audits and monitoring systems to look at the quality and safety of the care provided. However, the audits had not identified the shortfalls we had found during the inspection. One risk assessment did not refer to any risks associated with using a bedrail and did not specify how to safely use the equipment. Although we saw that acciden

When we completed an unannounced comprehensive inspection of this service on 27 and 28 January and on 5 February 2016 we found there was a breach in the legal requirements and regulations associated with the Health and Social Care Act 2008. The provider had not always ensured that there were enough staff available to keep people safe and staff were not always appropriately skilled or permitted to use their skills, in order to provide people with the care and support they required. We also found that some of the management systems in place to assess and monitor the quality and safety of the service were not always used effectively to identify and manage the risks to people nor any evidence of effective management plans in place to reduce these risks re-occurring in the future.

We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulations and gave them until 23 May 2016 to demonstrate their compliance.

We undertook this focused inspection on 14 July 2016 to check the provider had followed their plan and to monitor their compliance with the legal requirements of the regulations. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Ashleigh House on our website at www.cqc.org.uk.

Ashleigh House provides accommodation and personal care for up to 13 older adults. Nursing care is not provided. At the time of our inspection there were 10 people living at the home.

There was 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 2008 and associated Regulations about how the service is run.

We found that improvements had been made to promote the safety of the service.

People were supported by enough members of staff who had the knowledge and skills they required to meet the needs of people safely.

People had access to medicines when they required them and were supported by staff who were adequately trained and permitted to administer medication safely.

The provider had also improved their quality monitoring processes to further promote the safety and quality of the service in other areas including infection control, manual handling, record keeping and fire safety.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ we would require a longer term track record of consistent good practice.

We will review our rating for ‘safe’ at the next comprehensive inspection to make sure the improvements made continue to be implemented and embedded in to practice.

This inspection took place on 27 and 28 January 2016. The inspector also returned on 5 February 2016 to follow up on information that was unavailable at the time of the previous site visits. This was an unannounced inspection. At the last inspection on 3 February 2015, the provider was found to require improvements.

Ashleigh House provides accommodation and personal care for up to 13 older adults. Nursing care is not provided. At the time of our inspection there were 11 people living at the home.

There was 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 2008 and associated Regulations about how the service is run.

The provider had some management systems in place to assess and monitor the quality of the service; however these had not always been used or recorded effectively.

Peoples needs were not always met because there was not always enough staff available to support them.

People were not always safe from the risk of cross infections because infection control processes were not always followed.

People did not always feel involved in the planning or review of their care.

People were engaged in group or individual social activities to prevent isolation, but access to this was limited to three days a week when the activity coordinator was available.

People received their medicines as prescribed; however medication administration was not always available at night and was not always recorded accurately .

Therefore we found the service to be in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 because systems in place to assess the appropriate staffing levels were not effective and staff were not always appropriately skilled or permitted to use their skills in order to provide people with the care and support they required. You can see what action we have asked the provider to take and the end of the report.

People who lived at the home felt safe and secure and people were protected from the risk of harm because staff were aware of the processes they needed to follow.

People received care from staff who had received adequate training to gain the knowledge and skills they required to do their job effectively.

Key processes had been fully followed to ensure all people’s rights were protected to ensure people were not unlawfully restricted.

People were supported to access health care professionals to ensure that their health care needs were met. Health care needs for people were assessed and regularly reviewed.

People were supported to have food and drink that they enjoyed.

People and relatives felt staff were caring, friendly and treated people with kindness and respect.

People and relatives were encouraged to offer feedback on the quality of the service and felt confident that if they had any concerns or complaints, they would be listened to and the matters addressed quickly.

Staff felt supported in their work and reported Ashleigh House to have an open, honest leadership culture.

The inspection took place on 3 February 2015 and was unannounced. At the last inspection carried out on 9 July 2013 we found that the provider was meeting all of the requirements of the regulations inspected.

Ashleigh House is a care home which is registered to provide care to up to 13 people. Nursing care is not provided. The home specialises in the care of older people. At the time of our inspection we were told that there were 13 people living at the home.

Ashleigh House 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. At the time of this inspection a registered manager was in post.

All of the people spoken with told us that they felt safe living at the home. Staff we spoke with told us that they understood their role in keeping people safe from the risk of abuse and would report concerns. But, we found they did not always have the information to escalate their concerns if needed.

People had their prescribed medicines available to them and appropriate records were kept when medicines were administered by trained care staff.

We found that overall the home was visibly clean. But, we saw some risks of cross contamination and infection in the kitchen.

The Mental Capacity Act 2005 (MCA) states what must be done to ensure the rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to the Local Authority to deprive someone of their liberty. We found that the provider was meeting the requirements set out in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

Staff spoken with knew the people they were supporting and felt they understood their support needs.

The provider had a safe system in place to recruit new staff. Staff received an induction and on-going training and supervision.

The provider had a complaints system in place. People and their relatives knew how to raise concerns or complaints.

We found that systems, such as audits, were in place to monitor and improve the quality of service provided to people. However, we found that these did not always identify or implement actions needed to improve the quality of the service.

We found that records were maintained but these were not always as robust as required.

On the day of our inspection there were thirteen people living at the home. We spoke with seven people and one relative. We spoke with five members of staff, this included a manager from another of the provider's home. We also looked at three sets of care records.

Care was planned and delivered to ensure people's safety and welfare. One person told us, "I am very happy with the care, I get help when I need but also can do my own things it's my choice". This meant that people experienced care and support that met their needs and protected their rights.

People's nutritional needs were assessed and monitored. People were provided with a choice of suitable food and drink to meet their nutritional needs. One person told us, "The meals are good and I can have a cup of tea whenever I want".

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Systems were in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others

Records contained relevant information about people's health and wellbeing so that people were not at risk of inappropriate or unsafe care.

On the day of our inspection there were eleven people living at the home. We spoke with five people living at the home and five relatives. We spoke with the provider who was also the registered manager and four members of staff. We looked at three sets of care records for people living at the home.

People told us that they were afforded dignity and respect and their independence was promoted. One person told us, "I am fairly independent I do my own things and staff respect that".

Care plans and risk assessment were in place to support people's needs and care was person centred.

Systems were in place to ensure that people received medication that they needed for their health.

People that we spoke with were complimentary about the staff at the home. We saw that staff were trained and supported to deliver care safely and to an appropriate standard. One person that we spoke with said, "The staff are very good, they help me when I need it".

Systems were in place to monitor the quality of service provided. However the systems were not robust enough to be effective in identifying, assessing and managing risks to the health,safety and welfare of people who use the service and others.

We spoke to two people who use the service about the support with medicines that they received from staff. One person told us “As far I am concerned they are very good. I have my medicines in the morning”. The other person said that they were ok. We spoke to their son who told us that “They do a lot and we are happy with the arrangements”.

All the people living in the home that we spoke with told us that they were happy with the care they received and liked living in the home.

Some people living in the home told us that they did not always know what was for lunch. One of them said they liked a surprise and another said they sometimes got choices.

Friends and relatives told us that they were able to visit the home at all times during the day.

People using the service and their relatives told us that they could go to their bedrooms when they wanted.

One relative told us that the care workers were very quick to get medical help for people.

A visitor told us that they felt able to raise any issues of concern and were assured that they would be addressed.