The inspection took place on 29 and 30 November 2017 and was unannounced.

Ashridge 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. Ashridge accommodates 18 people with learning disabilities or autism. The home comprises of a main house and a single story extension referred to as the “bungalow” which is for more able people.

There was a registered manager for the home. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.’

This is the second consecutive time the home has been rated requires improvement.

The provider was not meeting the legal requirements in relation to good governance and the premises. They had not ensured that the systems to monitor the quality of care were effective and had not taken action when they had gathered the views of people living at the home. In addition the premises had not been maintained to and appropriate standard. You can see the actions we have asked the provider to take at the back of this report.

People were supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the home did not support this practice. People were able to access information in a format they could understand.

People were comfortable with the staff and happy to go to them for support. However, we saw that staff were not always able to comfort and calm people. Staff supported people’s relationships and gave them time to be private.

Staff had received training in keeping people safe from abuse, however, they had not always followed the systems in place to support people. Staffing levels had been set by the provider and did not take account of people’s needs. In addition, at times the home had been short staffed and this had impacted on people. Recruitment processes ensured staff were safe to work with people living at the home.

People had not been fully supported to help plan their care. Care plans did not fully reflect people’s needs and risks to people had not been fully identified or care planned. People’s end of life wishes had not been recorded. When incidents occurred the provider did not always ensure that lessons were learnt to prevent similar incidents in the future. The activities provided did not fully support people.

Medicines were safely administered. However, medicines in bottles were not always dated when opened. People were happy with the quality and choice of food provided. The kitchen was clean and tidy and systems ensured that food was safe to eat. However, other areas of the home were not clean and in parts there was an offensive odour. The environment was not maintained to support people’s wellbeing.

People’s needs were not assessed when they moved into the home and care was not always planned to support the best practice guidelines. People had been supported to access healthcare professionals but their advice was not reflected in people’s care plans.

The provider had not supported the registered manager to improve the quality of care people received. People’s views about the care they received were gathered and complaints had been responded to appropriately.

The inspection took place on 13 June 2016 and was unannounced.

The home is located close to the centre of Boston and is registered to provide accommodation with personal care for 18 people who are living with a learning disability or autism. There were 17 people living at the home when we inspected. There was a bungalow attached to the home and the six people who lived in the bungalow were able to live more independently.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. People’s abilities to make decisions were assessed and where necessary DoLS authorisations were in place.

The registered manager was well liked by people living at the home and staff. People had confidence that they could talk to them about any concerns and that the registered manager would support them. However, people did not have so much trust in other staff and at times felt that the staff did not listen to them.

People’s care plans identified the risks to them. However, care plans did not fully identify the care needed to keep people safe. While staff had received training in keeping people safe from harm the lack of information in the care plans had put people at risk when accessing the community.

There were enough staff needed to meet people’s needs and the provider had ensured that checks had been completed to ensure staff were of good character. Training was in place to support staff to develop the skills they needed to provide appropriate care to people. Staff were supported with supervisions which allowed them to identity shortfalls in training and any other support they needed. However, at times staff were focused on the systems needed to provide safe care and failed to ensure care was meeting people’s individual needs.

People were supported to develop personal relationships and to know how to stay safe in a relationship. However, people were not always fully supported to explore their own personalities and lifestyle choices.

People were engaged in reviewing their care plans but at times felt staff did not always fully support them and did not always listen to what they were trying to say. Where individual staff support had been identified as needed to help people to be occupied during the day and to access the community this was in place. However, more independent people were left to engage themselves in activities and may have benefitted from more support.

There was a set of audits in place to monitor the quality of the service provided and the registered manager had gathered the views of people using the service.

Ashridge is two separate homes that are interlinked. Twelve people were living in the main house at the time of our visit, although only eight were actually present during the inspection. A further six people were living more independently in the attached bungalow and were assessed as requiring less staff support.

We spoke with four people and we observed the care and support people received from staff. Staff interacted with people appropriately, showing respect and patience. Staff respected peoples' dignity. One person showed us proudly around their house with support from staff and told us they were, "Very happy here." Another person said, "I like living here; staff allow me to do what I want."

The accommodation was adapted to meet the needs of the people living there and had recently been extensively refurbished. Any risks to people living in the home had been assessed. The home was warm, clean and was personalised to the people who lived there.

We saw that people's support plans and risk assessments reflected their needs and were up to date. Staff that we spoke with were aware of the contents of the support plans, which enabled them to deliver appropriate and safe care.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. There were enough qualified, skilled and experienced staff to meet people’s needs.

On the day we visited 17 people were living in the home. We were able to speak with the manager, two members of staff and eight people who lived there.

People in the home said they were treated with dignity and respect and supported to be as independent as possible. They said they had access to all the activities they wanted.

People told us they liked living in the home, they felt safe and staff were kind and friendly and knew what they were doing. They also said they could get access to a doctor or other health professional if they needed to.

People also said they knew what to do if they wanted to complain about anything and felt sure something would be done about it.