This inspection took place on 7 November 2018 and continued on 12 November 2018. We previously inspected Ashmeadows in January 2018 and rated it overall as requires improvement. There were no breaches of regulation found.

Ashmeadows Care Home provides residential care for up to 17 people. At the time of our inspection, 15 people were living at Ashmeadows. Ashmeadows 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.

At the time of our inspection, Ashmeadows did not have a registered manager in post. A home manager started working at the home in August 2018 and they had started their application to become registered. Following our inspection, we were able to confirm the application process had completed and they had become registered with the Care Quality Commission.

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.

Individual risks to people were not consistently well managed. Certificates relating to gas, electricity and lifting equipment showed maintenance had been regularly carried out. However, the home manager who was checking hot water temperatures had not tested this in people’s own rooms.

Quality assurance audits had identified care plans needed refreshing which the home manager had started. People, relatives and staff were involved in this process. New care plans were found to be easier to use and contained better detail. We found some gaps in other care plans we reviewed. End of life care records required improvement.

The registered provider had a dependency tool, although this was not being used to calculate staffing levels. People told us staff responded to them quickly. Regular agency staff were used as needed on night shifts and permanent night staff were being recruited.

Safe recruitment procedures were followed. The registered provider used a risk assessment and character reference to assess the level of risk in one case where they were unable to access a reference.

The administration and storage of medicines was safe. People received their medicines as prescribed and protocols for ‘as required’ medicines were in place. The home manager was in the process of completing medication competency checks for all staff.

People told us they felt safe and protected from harm. Staff received safeguarding training and knew how to report abuse. Weekly and monthly fire safety checks were carried out. Each person had an up-to-date evacuation plan for staff to follow.

The home was found to be clean and the lounge area had been refurbished with new carpet and had been redecorated.

Activities were being provided, although feedback we received indicated this could be better. The operations manager was looking to invite befriender volunteers to visit people in the home. The home manager said they wanted to have a singer visit monthly.

There were systems in place to ensure people and their relatives knew how to complain if they were dissatisfied. Complaint records provided evidence to show how these matters had been resolved.

People’s equality, diversity and human rights were respected. People’s religious needs were supported. Staff were seen to be caring and knew people’s needs well. Staff were able to explain how they supported people to maintain their privacy and dignity.

Staff training completion rates were found to be high. Staff received supervision support and the home manager had scheduled staff appraisals for January 2019.

People were supported to have maximum choice and control of their lives and staff supported them in the least restri

The inspection took place on 5 October 2017. We previously inspected the service in March 2017 and the rating was ‘requires improvement’ with three breaches in the regulations, relating to safe care and treatment, good governance and fit and proper persons employed. We had begun to take some enforcement action, due to the provider having a long history of breaches in regulation. However, the provider made an appeal and so we inspected the service again. We noted significant improvements at this inspection.

Ashmeadows Care Home provides residential care for up to 17 people. On the day of our inspection, 10 people were 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.

Staffing levels were sufficient to meet people’s needs promptly and offer high levels of attention and care. Recruitment procedures had improved so staff were thoroughly vetted before they were allowed to work with people.

Risks to individuals were clearly documented and known by staff. Care records were being improved to ensure all information was easily accessible to give clear guidance to staff on how to provide safe care. Improvements had been made to ensure medicines were stored securely and clear direction was in place for staff to support people with medicines.

Staff were well supported through supervision and training and they were confident in their knowledge of how to meet people’s needs. Staff understood the impact of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; there were policies and systems in the service to support staff practice. Assessments of people’s mental capacity were clearly recorded.

People enjoyed their meals and staff were clear in their knowledge and recording of people’s food and fluid where necessary. Staff understood how to ensure effective nutrition to support people’s health and how to monitor where there may be concerns.

Staff demonstrated skills in providing care based upon people’s individual and personal preferences. Engagement between staff and people was meaningful, respectful, supportive and especially caring.

The registered manager was more confident and clear about their roles and responsibilities and there was a culture of open communication, with people at the centre of the way the home was managed. Audits and quality checks were more regular and robust and there was evidence of steps taken to improve the quality of the service in response to previous inspections. Some aspects of the environment requiring expenditure needed prompt attention and we made a recommendation the provider addresses these without delay.

The inspection took place on 14 and 21 March 2017. We previously inspected the service in September 2016 at that time we found the registered provider was not meeting six of the regulations and we decided to take enforcement action. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made. We found some noticeable improvements had been made, although there were still areas that the provider needed to address.

Ashmeadows Care Home provides personal care for up to a maximum of 17 older people. On the days of our inspection 13 people were living at the home.

The service had a registered manager in place. 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.

Staffing levels were sufficient to meet people’s needs and this had improved since the last inspection, which meant people did not have to wait for staff to support them in their care. However, procedures for the recruitment of new staff did not demonstrate staff had been thoroughly vetted before they were allowed to work with vulnerable people.

There were improvements to the management of risks in the service, such as with the premises and equipment, although some risks to individuals were not sufficiently assessed or managed.

The management of medicines was not always carried out safely to ensure medicines were stored securely or given with clear direction.

Support for staff was more consistent than at the previous inspection, with regular supervision and opportunities for training. Staff were more confident regarding people’s mental capacity, although there were some minor errors in recording mental capacity assessments.

People were enabled 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 dietary needs were known by staff and staff encouraged and supported people to eat and drink. However, monitoring of people’s food and fluid intake was not done thoroughly and recording was not accurate.

Staff were kind, caring and compassionate and they had secure professional relationships with people living at Ashmeadows. The environment was welcoming and homely and people were happy living there.

People were involved in meaningful activities and staff engaged well with them in conversation. Staff understood people’s individual needs although it was not clear how people’s preferences for personal care were reviewed day to day.

The complaints process was known by people and their relatives and they were confident any matters they raised would be dealt with by staff and the registered manager.

Improvements to the way the home was run and managed were evident with staff having more clear direction and support in their role. The provider had made noticeable improvements in response to the last inspection in relation to the premises, environment, staffing levels, staff working hours and audits of the quality of the service. However, some audits still lacked rigour around key areas of safety and there were still three breaches in the regulations identified at this inspection.

You can see what action we told the provider to take at the back of the report.

The inspection took place over two days, on 6 and 15 September 2016. The inspection was unannounced on both days. The last inspection was done in December 2015 and there were six breaches of regulations identified at that time, which meant the service was in special measures. Some improvements had been made to meet the requirements, but not enough, and we identified continued breaches at this inspection.

Ashmeadows is a small care home that was formerly the local vicarage, situated next to the local church. It has capacity to accommodate 17 people in 13 single rooms and two shared rooms. There were 16 people living in the home at the time of the 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 home had a friendly atmosphere and people told us they were happy and content, but we found continued concerns in the quality of the service and although there had been some progress made since the last inspection, this was limited.

Staffing levels were poor. This was raised at the last inspection and had not been addressed and there were not enough staff to meet people’s needs. The suitability checks for new staff were not thoroughly carried out and some staff were not adequately trained or supported to carry out their role safely.

Not all staff had sufficient knowledge of safeguarding and we had not been notified of significant events.

Medicines were managed safely although the recording was not always clear enough to avoid mistakes being made.

There were some very strong odours in the home and there were poor procedures to prevent the risks from legionella.

Risks were not all assessed thoroughly, mitigated or monitored to ensure people’s safety.

We found there was a lack of understanding of the legislation around people’s mental capacity and we saw there was restrictive practice in place which meant the provider did not always act in accordance with the Mental Capacity Act 2005 or the Human Rights Act.

Staff had a kind and caring approach on the whole and people’s dignity and independence was promoted well. Relationships between staff and people were mostly supportive.

People enjoyed the meals and food was well presented and appetising. Mealtimes were sociable occasions and people were offered appropriate regular support and encouragement to eat and drink, although weight management audits were not robust.

There was a lack of meaningful activity and people had little to occupy them. Personal care was not in line with people's preferences.

Quality assurance systems were not thoroughly used and audits carried out lacked consistency and rigour.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that although some improvements had been initially made, there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

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.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 17 December 2015 and was unannounced. There were two adult social care inspectors. The home was last inspected in 2013 and was compliant with regulations at that time.

Ashmeadows is a small care home that was formally the local vicarage, situated next to the local church. It has a capacity to accommodate 17 residents in 13 single rooms and two shared rooms; eight have ensuite facilities with a toilet and wash basin. On the day we visited there were 12 people who lived at the home.

There was a registered manager at the service. 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 the home had an open and friendly atmosphere, but on further inspection during our tour of the building we found significant concerns with the premises and equipment. These included electrical safety and fire safety and we asked the fire officer to make a visit following our inspection. The fire officer made several recommendations to ensure the safety of people in the home.

Staffing levels were not always sufficient to meet the dependency needs of the people in the home and staff training was not up to date.

Systems and processes to manage medications were not robust.

Staff were kind and caring and there were good relationships with people.

There was teamwork within the home and through working with other professionals involved in people's care. However, referrals were not always made to other professionals where people's needs changes, such as for needed specialist seating.

Care documentation was up to date and in place, although lacked detail and was not discussed with people so they could be involved in their care and support.

There were limited activities for people to be meaningfully engaged.

Systems for assessing and monitoring the quality of the provision were not robust and although identified areas of concern highlighted by the inspection, there had been little done to secure improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection we had the opportunity to speak with four people who used the service and two friends of people who used the service. They told us they were happy and felt safe with the care and treatment provided.

Their comments included: "The staff here talk to me and make me feel at ease, they are superb here", “We are in safe hands” and “the place is alright and clean.”

We found the home had appropriate systems in place to ensure consent was gained before they proceeded with personal care.

We saw evidence there was an appropriate system in place for listening to and acting on people’s comments and concerns.

We spoke with two out of the 15 people who live at the service, they told us that they were happy and comfortable living at Ashmeadows and that they got the care and support they need.

People we spoke with told us they received care that was appropriate to their needs. One person told us “Very nice, top class.”

People told us they were satisfied with the care and support they received. Comments included “Its lovely here”, "The staff are good here” and “It’s a 24hr service here”.

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at Ashmeadows. One staff member said “I love it here; I enjoy the caring side of things”.