About the service:

•Ashely House Care Home is registered to provide accommodation and personal care support to three people who have a mental health condition and, or, older people.

•Ashley House Care Home is a terraced house and accommodation is provided over two

floors. The ground floor communal areas comprise of an open plan kitchen and dining room, and a sitting room. All rooms are of single occupancy.

•At the time of our inspection, three people were using the service.

•For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

•People told us they felt safe living at the service.

•People were safeguarded from the risk of harm, abuse and neglect.

•There were sufficient and suitable staff to meet people’s needs safely.

•Staff knew risks to people and how to provide safe care.

•People told us they were satisfied with the medicines support.

•The service was clean. Staff protected people from the risk of infection.

•Staff told us they felt supported and they received regular supervision.

•People’s needs were assessed before they started receiving care.

•People told us they were supported by appropriately trained and skilled staff.

•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.

•People's care plans were person-centred. Staff knew how to meet people’s personal needs.

•People told us staff respected their privacy and treated them with dignity. People were involved in the care planning process and their independence was encouraged.

•People knew how to raise concerns and they told us the service was responsive.

•People, staff and healthcare professionals told us they the service was well managed and they found the registered manager approachable.

•The provider had effective systems and processes in place to ensure the quality and safety of service.

Rating at last inspection:

•Requires improvement (report published 27 March 2018).

Why we inspected:

•All services rated "requires improvement" are re-inspected within one year of our prior inspection.

•This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

•We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 5 December 2017 and it was unannounced. We last inspected the service on 3 September 2015 where the service was rated as Good. This is the first time the service has been rated Requires Improvement.

Ashley House Care Home is a residential care home for up to three people living with mental health needs and or older people care needs. The service is a terraced house and accommodation is provided over two floors. The ground floor communal areas comprise of an open plan kitchen and dining room and a sitting room. All rooms are of single occupancy. Ashley House Care home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, two people were using the service.

The service had a registered 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.

The provider had failed to fulfil their statutory obligation to notify us of four police incidents which occurred at the service.

People and a relative told us the service was safe and they enjoyed living at the service. The provider identified, assessed and managed risks to people’s health and care. Staff were provided with sufficient information to provide safe care. There were sufficient staff to meet people’s individual needs. People’s medicines were managed safely and staff were competency assessed to ensure they were administering medicines in a safe manner. The provider met infection control requirements and the service was clean without any malodour. Staff were appropriately checked and vetted to ensure they were suitable to work with people who used the service.

Staff received regular training and supervision to do their jobs effectively. People’s nutrition and hydration needs were met and they were encouraged to maintain a healthy lifestyle. Staff knew and understood people’s needs, abilities, likes and dislikes. The service worked well with healthcare professionals to provide effective care to people. Staff sought people’s consent before supporting them and gave them choices.

People told us staff were caring and treated them with dignity and respect. Staff were trained in dignity and respect, and equality and diversity. People’s care plans detailed their likes and dislikes and their religious and cultural needs. Staff supported and encouraged people to carry out various activities as per their wishes. People’s end of life care wishes were documented in their care plan.

People, a relative and staff told us the service was well managed. They further said the registered manager was approachable and helpful. The registered manager worked closely with staff and involved them and people in improving quality of the service. Staff worked well together and told us they felt well informed by the management on aspects related to care delivery.

The service carried out regular monitoring and audit checks to identify any gaps and areas of improvement in quality and safety of the service delivery.

We found the registered provider was not meeting legal requirements and there was a breach of Regulation 18 Registration Regulations 2009 notifications of other incidents.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection was unannounced and took place on the 3 September 2015. There were no breaches of regulations identified at the last inspection that took place in 26 June 2013.

Ashley House Care Home is registered to provide accommodation for persons who require personal care, Mental health conditions, Caring for adults over 65 years and can accommodate up to three people. At the time of inspection there were two people using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People spoken with were happy with their support. Staff supported people in a caring way respecting their dignity and choices.

Health professionals told us the service was proactive in raising concerns and that they would be happy to place people there.

Staff had the training and supervision they required to provide care and support to the people and worked with health care professionals to provide good care.

Staff understood what safeguarding meant and were able to explain what constituted abuse. Staff understood the whistleblowing policy and the importance of speaking up if there was a concern of a safeguarding nature that was not being addressed by the service.

People were provided care in a person centred manner and were involved in their care planning.

The service was well led because of the empowering and inclusive culture

People were asked their views of the service; however, there was not an effective method of collating and acting on the responses. You can see what action we told the provider to take at the back of the full version of the report.

At the time of the inspection there were two people living at the home. We had the opportunity to speak with both of them. People told us that they liked living at the home. Comments included “It is fine here,” “The staff are good,” “You can choose what you want to eat,” “It is okay living here,” and “I don’t mind it.”

We also spoke with two staff members and the registered manager for the home, and looked at both people’s care records. People told us that staff provided them with the support that they needed, and encouraged them to maintain independence skills. They said that staff listened to them and supported them to take part in activities.

Medication administration systems were in place to ensure that people received their prescribed medicines safely. The home environment was clean and adequately maintained.

Staff told us that they received appropriate support, training and supervision to ensure that they delivered care and treatment safely and to an appropriate standard.

We noted significant improvements in the record keeping within the home to protect people from the risk of unsafe or inappropriate care.

This inspection was undertaken to look at the progress Ashley House Care Home had made since we visited 12 September 2012 and found that, as the rota was inaccurate, we were not able to confirm that the provider ensured there were sufficient numbers of suitably qualified, skilled and experienced care workers on duty at all times to meet people's needs. We issued a warning notice asking the provider to ensure it always had evidence that there were sufficient staff to meet people’s needs.

When we visited on 21 February 2013, we found that there were enough members of staff to meet people's needs. In addition to the manager there was one care worker. This reflected the staffing rota.

There were two people living at the home. On our visit we spoke with one of them. They told us they were happy with the support they received, “I like living here. I want to stay.”

We found that the records relating to the finances of one person living at the home were inaccurate. When we checked the dates on receipts these were not the same as those recorded in the person’s file. The final total recorded in the file was the same as that recorded in bank statements.

When we visited there were two people living at the home. We spoke to both of them. They told us they had no concerns with the home and liked it. Their comments included the following:

“It is good here. They look after you”

“It’s all right here”

They also told us that they thought the food was good and that if they had any concerns they would talk to the staff.

When we visited we saw staff interacting with people in a polite and respectful manner. The home was clean and we saw staff cooking lunch, which the people who live at the home had chosen.

When we arrived at the home there was one member of staff at the premises. They were not the member of staff who was recorded on the staffing rota as working at that time. We found the rota did not reflect the staffing who were actually working in the home.

There were three people living at the home at the time of our inspection. One person did not want to talk to us. The other two spoke to us briefly. They said they can come and go from the home as they please, that staff make them tea and give them their medication. One person said the food was "alright" and two said they liked the meal they had on the day of the inspection. As people only spoke to us very briefly we spent time reading their care records, observing how staff interacted with them and talking to staff to get information about the care provided in this home.