Ashmount provides residential care for up to seven people with a learning disability. At the time of the inspection there were five people living at Ashmount.

This inspection took place on 26 April 2017 and was unannounced.

The home 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 registered manager assisted us with our inspection.

We carried out an inspection to Ashmount in March 2016 were we identified breaches of regulation in relation to person-centred care (specifically individualised activities) and record keeping. Following that inspection the registered provider sent us an action plan detailing how they planned to address our concerns. We carried out this inspection to check the registered provider had taken action in line with their action plan. We found huge improvements during this inspection and had no concerns in relation to person-centred care or records.

People were protected from the risk of harm as systems were in place to keep them safe. Risk assessments were completed which identified control measures to mitigate the risks of harm. Accidents and incidents were monitored and action taken to keep people safe. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse.

Evacuation plans had been written for each person, to help support them safely in the event of an emergency. The building was purpose built with suitable fire exits and staff had undergone fire training to help them understand the procedures in the case of an evacuation.

Medicines were managed well and records showed that people received their medicines in accordance with prescription guidance. People were supported to maintain good health and had regular access to a range of healthcare professionals. People were supported to have a nutritious diet and were able to make choices regarding what they had to eat and drink.

There were sufficient staff deployed in the service and staff worked flexibly to meet people’s needs. Prior to starting work at the service recruitment checks were completed to help ensure only suitable staff were employed. Training was provided and regular supervision held for staff to monitor their performance.

People’s legal rights were protected as staff acted in accordance with the Mental Capacity Act 2005. Capacity assessments were completed and where best interest decisions were made relevant people were involved in the decision. People had access to advocates to act on their behalf.

People were supported by staff who showed kindness and care. People’s dignity and privacy was respected by staff and people were able to choose where they spent their time. Staff had a good understanding of people’s communication needs and supported people to make decisions about their care. People were supported to develop and maintain their independent living skills and had access to a range of activities both within and outside of the home to keep them stimulated.

Each person had an individualised support plan in place which detailed their needs and preferences. Staff were knowledgeable about people’s needs and we observed people’s likes and dislikes were respected. People were supported to maintain relationships with people who were important to them.

Feedback on the quality of the service provided was obtained from relatives. Annual surveys showed that relatives were happy with the care provided. A complaints policy was in place and displayed in an easy read format.

Relatives and staff told us they felt the service was well-led and that the registered manager was approachable. Regular audits of the service were completed to monitor the quality of the ser

Ashmount is a NHS service that provides care and accommodation for up to seven people who have a learning disability, such as epilepsy or autism. It is a single storey building set in the grounds of a site which houses several Surrey & Borders homes.

There was no registered manager in post. The new manager was in the process of applying to become the 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 and associated Regulations about how the service is run. The new manager assisted us with our inspection on the day.

At our previous inspections in May and August 2015, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of our concerns we placed Ashmount in special measures and have carried out this further fully comprehensive inspection to see if the provider took action to address our concerns. We had received an action plan from the provider following our previous inspections and we reviewed progress against that action plan during this inspection.

This inspection confirmed that the provider had taken the action they told us they had. Significant improvements to the way the home was being managed meant the overall rating is now Requires Improvement and we have taken Ashmount out of Special Measures.

Medicines management processes were not always followed by staff but people received the medicines they required when they needed them. Individual risk assessments for people were not always completed for people, however staff knew how to support people and they received safe care and treatment. Accidents and incidents were recorded. However, some information and action in relation to accidents and incidents had not been completed.

Care plans had been reviewed however, we found some inconsistencies in the information they contained. We found more activities were being undertaken by people. However, further improvement is required to ensure activities are individualised and meaningful.

People lived in a clean, hygienic environment and people’s rooms had been refurbished and personalised. People were provided with information on how to make a complaint should they wish to.

There were a sufficient number of staff available to support people and staff were deployed appropriately. Staff had a good understanding of their role in relation to safeguarding and the provider carried out appropriate checks on staff before they started working at Ashmount.

Staff followed legal requirements in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had been provided with up to date training and the opportunity to meet with their line manager on a regular basis to discuss their work.

People had a choice of meals each day and staff had guidance easily available to them for those people who were at risk of choking. People received appropriate foods and were supported to remain healthy by staff. For example, fresh fruit and foods were available and health care professionals involved when appropriate.

People were made to feel they mattered. Staff interacted with people and listened to them, supporting them to make individual decisions. People were shown dignity and respect by staff. The atmosphere in the home had improved hugely from our last inspection and staff told us they were much happier working at Ashmount.

Quality assurance checks were carried out by staff and the Trust to check the quality of the care provided. Actions arising from these audits were completed.

People and staff were involved in the running of the home and were given the opportunity to give their feedback on the care they received.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with four people who use the service, the registered manager, one care staff and three relatives of people who used the service. We also reviewed records relating to the management of the service which included, three care plans, daily care records, training and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that the service minimised the risk and the likelihood of abuse by making sure all the policies and procedures to promote safeguarding were in place.

Relatives told us the service kept them informed about people’s wellbeing. They told us that they felt people were safe.

We found that where people did not have capacity to consent, the provider acted in accordance with legal requirements in line with the Mental Capacity Act.

There were procedures in place to deal with foreseeable emergencies. We saw that the Trust had an emergency procedures file, which covered such things as fire evacuation, electricity power cuts, gas failure, heating failure, and adverse weather conditions. We also saw the service had followed on from these to plan and record its further contingencies, so that should a situation arise where the building cannot be used, temporally places of safety had been identified so that safe and appropriate care could continue.

We saw that doors and areas that were required to be kept locked to protect people were secure, for example electrical and medicines cupboards.

We saw risk assessments that identified what action should be taken by staff so that risks to people’s safety could be minimised.

Is the service effective?

People's health care needs were assessed with them and written in a care plan.

We were greeted by one of the people who used the service who offered us tea and to be involved with their routines. They showed us they could access the kitchen and be supported to have a snack and a drink when they wanted.

Relatives told us they had no complaints about the service people received and they felt they were listened to when they raised any concerns or minor issues.

We saw staff had a good knowledge of peoples’ needs and how people liked to be communicated with. We saw that staff demonstrated this through their positive interactions with the people who used the service. For example one person insisted on making tea and having a biscuit every time a visitor arrived. We saw staff support them to do this immediately which followed the guidelines in their care plan.

Is the service caring?

Relatives told us the staff were caring, and that people were well cared for and the service kept them informed about their relative's wellbeing.

We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner.

People’s individual person centred care plans also had a section called ‘what matters’ to the person. For example the care plan showed it mattered to a person that there was sufficient quantity of a certain product and would want to check the levels repeatedly. We saw staff support this on every occasion and show knowledge of how to support them appropriately.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. An example of this would be access to the kitchen unsupervised.

Is the service well led?

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare, but did not have an effective system to regularly assess and monitor the quality of service that people receive. People who used the service, their representatives were not always asked for their views about their care and treatment.

Ashmount used to provide a service to people with inpatient status and under the Care Programme approach (CPA). We noted that although it only transferred to the social care sector as a social care home with nursing a matter of weeks before the inspection, it had already made many of the changes needed in practice for the different purpose of the home.

Our visit was unannounced and we found the building fresh and clean and people were treated with respect and dignity.

We were greeted by some of the people who used the service who offered us tea and the opportunity to be involved with their routines. They showed us they could access the kitchen and were supported to have a snack and a drink when they wanted.

We observed that the people who used the service made real choices and confidently directed their day and the day’s events according to their current wishes and needs and that staff were responsive to this, as opposed to managing activities only through staff- planned rigid and fixed time events.

We saw that although staff did offer choices and seek consent before offering care and information was included in formats and languages people would understand better so the person’s consent would be better informed, we founf that sometimes where people did not have capacity the provider did not always act in accordance with legal requirements.

We found people’s needs were assessed and care and treatment was planned and delivered in line with an individual care plan.

We saw that people who used the service, staff and visitors were not always protected against the risks of unsafe or unsuitable premises because bedroom doors did not all provide privacy and did not have closing devises. In addition other doors were being wedged open so they could not close to protect people in the event of a fire.

We found that people were given support to make a comment or complaint where they needed assistance. People had their comments or complaints listened to and acted on, without fear that they would be discriminated against for making a complaint.

Ashmount is a service for up to seven people who have a learning disability or are on the autistic spectrum.

The main inspection took place on two days. The 20 May and 4 August 2015 and was unannounced. We returned to the home on 7 August 2015 as the provider had been able to find some information that was missing on 4 August 2015.

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 and associated Regulations about how the service is run. The registered manager was not present during our inspection. There was a new deputy manager to the home who was present on the second day of our inspection. The acting manager was present on the third day.

The provider did not deploy staff appropriately. We found staff sitting around chatting to each other whilst people were wandering outside in the garden unsupported. We witnessed other situations were people may be put at risk because of staff not being available.

Staff did not always understand their responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Some best interest decisions were made in line with legislation. We found though that people had not had mental capacity assessments with regard to the locked gate and some restrictions were in place but not authorised. We found in some instances staff had not considered the least restrictive option for everyone living at Ashmount.

People were not involved in making choices about the menu and the meals were not always the most healthy. Staff supported people to access health care professionals, such as the GP or speech and language therapy team.

Although we observed some good examples of kind care from staff, we found people’s dignity was not upheld by staff. People were not made to feel they mattered or shown respect by staff. People were living in an institutionalised way.

The premises were unsuitable as they were dirty and not homely. People’s rooms were sparse and some had no curtains or blinds.Toilets had no running water or hand drying facilities available to people all the time.

Activities were not individualised or meaningful to people and did not occur regularly enough. People were not supported to access the community as much as they could. There was no structure to people’s day.

Risks for people around their medical conditions and their health needs were not always being monitored appropriately by staff. It was difficult to identify if people received care responsive to their needs. People were not involved in developing their care plan.

Staff knew the procedures to follow should they have any concerns about abuse taking place in the home. Risk assessments were carried out for people to maintain their individual safety, however we found some of those were not complete meaning people could be at risk of harm.

Staff did not always know how to support people when visitors came to the home. There was inconsistent practice from staff meaning people were not supported in a cohesive way.

Quality assurance checks were carried out but actions arising from these weren’t always addressed.

Staff did not always have access to people’s care plans or have the support from senior management.

Staff followed correct and appropriate procedures in relation to medicines to ensure people received their medicines safely.

Care was provided to people by staff who had access to relevant training. Staff were given the opportunity to meet with their line manager on a one to one basis and their competencies were checked by management.

Complaint procedures were available to people. Relatives knew how to make a complaint.

The provider had ensured safe recruitment practices to help them employ staff who were suitable to work in the home.

People’s care and support would be uninterrupted in the event of an emergency.

During the inspection 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 of the report.

The overall rating for this service is ‘Inadequate’ and the service has therefore been placed 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.