Ashlodge 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.

Ashlodge is a detached property close to the seafront in Bexhill -on-Sea. It provides care and support for up to 16 older people with care needs associated with older age. This includes people with low physical and health needs and people with mild dementia and memory loss. Ashlodge provides respite care that includes supporting people while family members are on a break, or to provide additional support to cover an illness.

At the time of this inspection 13 people were living in the service. This inspection took place on 14 June 2018 and was unannounced.

There is a registered manager at the home who is also one of the partners and a registered provider that owns the service. 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 and associated Regulations about how the service is run.

We inspected Ashlodge in February 2016 and found the provider was in breach of three regulations. At the last inspection improvements had been made but the provider remained in breach of two regulations. This was because the provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to. The management systems that included quality monitoring had not always ensured safe and best practice was followed or required improvements were responded to. Following this inspection, the provider wrote to the CQC with an action plan on how these regulations were to be met.

At this inspection we found these regulations had been met and the service was rated ‘Good’ overall.

However, we found the management arrangements did not ensure effective leadership in all areas. Some records had not been completed in a consistent way and although there was no evidence that this impacted on care, evidence of appropriate care and support was not always clearly recorded. This included records relating to DoLS and best interest decisions. This was identified to the registered manager as an area for improvement.

Staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They understood the principles of gaining consent and the registered manager had a good working knowledge of the MCA and involved health care professionals to support them when people did not have capacity to make decisions. They recognised when people may be deprived of their liberty and followed correct procedures to protect people's rights.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness, they were polite and considerate in their contact with people. They demonstrated genuine care for each person. People's dignity was protected and staff were respectful. We received positive feedback about the care and the atmosphere in the service. People liked the ‘homely’ feel of the service and told us they felt ‘safe’. They liked living in a small home where everyone knew each other. Visiting professionals told us staff were kind and responded to people’s health and welfare needs fully and appropriately.

Medicines were stored and handled safely. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what they should do if they believed people were at risk of abuse. Staff received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They understood the principles of gaining consent and the registered manager had a good working k

Ashlodge provides care and support for up to 16 older people with care needs associated with older age. The needs of people varied, some people were mainly independent, some had low physical and health needs and others had a dementia and memory loss. The service provided respite care that included supporting people while family members were on a break, or to provide additional support to cover an illness. Some people had more complex care needs that were met with community health care support that had included end of life care when required. At the time of this inspection 14 people were living at the service.

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 registered manager is also one of the registered owners of Ashlodge.

Ashlodge was inspected in February 2016. We found the provider was in breach of three regulations. Improvements were required to quality monitoring systems to ensure the environment was safe and well maintained. Risk assessments to ensure emergency evacuation procedures needed to be reviewed and updated to ensure they were appropriate. Systems to ensure people did not have unnecessary restriction to their liberty needed to be reviewed and updated. The provider gave us an action plan on the day of this inspection. This confirmed they had addressed all these issues.

This comprehensive unannounced inspection took place on 17 and 18 May 2017. At the time of this inspection 14 people were living in the service. This was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements. We found some improvements but the provider remained in breach of two regulations.

The provider had not identified, assessed and responded to all risks in the service, or ensured all health and safety legislation had been adhered to. The passenger lift had not been thoroughly checked in accordance with health and safety legislation. The risk of legionnaire’s disease had not been fully addressed and hot water checks were not consistently completed. Medicines that were being stored under refrigeration had not been stored securely. Emergency evacuation procedures did not clearly clarify how people would be evacuated quickly and a contingency plan for guidance was not available. The provider had not ensured staff were clear on action to be taken following a foreseeable emergency. Therefore the provider remained in in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The leadership of the service was not effective in all areas. Management systems that included quality monitoring did not always ensure safe and best practice was followed or required improvements were responded to. The PIR was poorly completed and an action plan was not supplied following the last inspection report. A system to ensure required notifications were sent to the CQC was not established. The service did not have up to date policies and procedures to underpin the care and practice within the service. For example, there was no staff supervision or appraisal policy or procedure that clarified how staff were to be supported. Therefore the provider remained in in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to live a life that they enjoyed. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service,

Ashlodge provides accommodation for up to 16 older people who required a range of personal and care support. Some people lived independent lives but required support, for example with personal care and moving safely. Some people had a degree of short term memory loss. There were ten people living at the home at the time of our inspection.

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 registered manager is also one of the registered owners of Ashlodge.

This comprehensive unannounced inspection took place on 10 and 11 February 2016.

Some of the systems to monitor the quality of the environment were not thorough. For example, cleanliness of the kitchen. In addition, the electric wiring certificate was out of date and problems with fire safety checks were not resolved in a timely manner. The registered manager was not fully aware of their responsibilities in relation to ‘duty of candour.’

There were no records of maintenance issues that had been identified. Although there was a fire risk assessment in place this was not detailed and did not cover all aspects of fire safety. There were individual fire risk assessments for people but it was evident that to follow the procedure as stated, would mean that people could not be evacuated quickly.

The registered manager and staff had training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard. They had assessed that some restrictions were required to keep people safe and had made referrals to the local authority for authorisations. However, there was no documentation to demonstrate that the least restrictive option had been used before someone’s freedom was restricted.

Staff had a good understanding of people as individuals, their needs, interests and hobbies. They were committed to ensuring people lived happy and enjoyable lives. There was emphasis on supporting people to maintain their independence.

Staff monitored people’s nutritional needs and people had access to food and drink that met their needs and preferences. One person told us, "The food is very good here, there is nothing to grumble about with it, it’s fresh and there is plenty of it."

People brought photographs and memorabilia with them when they moved to the home so bedrooms were homely. People could opt in or out of activities and their decisions were respected. They valued the advantages of living in a care home. For example, one person told us, "The best thing about being here is you are not on your own." Another said, "I enjoy talking to the carers and the others, there are always people around."

Staff received the training and supervision they needed to meet the needs of people who lived at Ashlodge. There was a training and supervision programme in place to ensure staff maintained current knowledge and skills. As the home is hoping to change their registration to care for people with dementia, staff had received training on dementia and on caring for people who challenged others.

People were supported to have access to healthcare services and maintain good health on a day to day basis or when there was a change in their health. This included GP’s, dentists and opticians.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with her at any time and knew they would be addressed appropriately. Staff and people spoke positively about the way the service was managed.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version o

The home had a peaceful and relaxed atmosphere. People who use the service told us that “the manager took great care to ensure I was happy with my care and I was given plenty of time to consider my needs, speak and tell them what I wanted”. Before coming to the home, people had an assessment of their needs undertaken. This was usually done by the manager unless the person was coming from a location a long distance away, in which case the professionals involved in their care completed the form. This assessment and care plan remained in place for up to four weeks during which time the home made adjustments and developed the care plan as required.

One person told us that “they can’t be beaten in my opinion. Anything I need, they help me with and they push me to carry on doing as much as I can, including my exercises”. People told us that they knew all the staff by name and felt they had a good relationship with them. We observed that people were very comfortable with the staff and there appeared to be good rapport and a friendly atmosphere.

We looked at the staff files and found evidence of supervision and appraisals for staff which included observation of work and self-assessments. These included providing personal care. We found that the staff had undergone mandatory and additional training to support them in their roles.

We carried out this inspection to follow up on a compliance action made in November 2012. We spoke with the manager and reviewed records in the home.

We looked at records relating to the care and welfare of people living and working in the home. On the whole these were found to be well completed. Records pertaining to the maintenance and safety of the premises and equipment were available in the home.These demonstrated that the home and its equipment were suitably maintained.

We looked at the storage facilities and staff practice followed to safeguard confidential records. We found that records were kept securely.

We spoke to eight of the 14 people living in the home and one visiting relative. People told us that they were treated with kindness and respect, and that their choices and preferences were responded to. Feedback from everyone was positive about the care and staff. Comments included. ‘’It’s absolutely marvellous here.’’

People using the service and staff told us that staffing levels were appropriate. This meant that staff were able to provide the care required. We saw that staff responded promptly and sensitively to requests for help. People told us they felt safe living in the home and were well looked after by staff who had the skills to do their job. One person said. ‘’There are enough staff and they are very caring.’’

We looked at the systems and processes that the home had in place to ensure the environment was safe and that complaints were dealt with appropriately. Records seen and processes followed ensured a safe well maintained environment and ensured complaints could be raised.

We looked at records held in the home and how these were stored. Not all care records were up to date or reflected all the current needs of people using the service. Certificates to demonstrate the safety of some equipment and services were not available.

People told us that their privacy and dignity was respected and that they were able to raise any issues about the care directly with the manager.

All people spoken with recorded a satisfaction with the care and food provided

People told us that they liked their rooms and that they were cleaned regularly.

Two people using the service told us that the home was short of staff and one told a social care professional that he had to go to bed early as there was not enough staff.