We inspected this service on 12 and 15 October 2018. This was an unannounced inspection. Our last inspection took place in March 2018. Our inspection in March 2018 was a focussed inspection and we only looked at the key questions, ‘is the service safe?’ and ‘is the service well-led?’ We identified at the March 2018 inspection that improvements were needed to ensure people were always safe and that the service was well-led.

As a result of previous enforcement action, a condition was placed on the provider's registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people's safety and remains in place. At this inspection, we identified further breaches of regulation.

Ashview House Residential Care Home 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.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection ten people lived in the service however, two people were in hospital.

There were two registered managers at the home, however only the most recently registered manager was actively working in the home. The other registered manager, who was also a director in the business, also worked at another home and was spending their time at the other home. 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.

Systems in place were not always effective at identifying areas to improve on and timely action was not always taken to ensure concerns were resolved promptly. The registered manager did not always have sufficient time to be able to effectively complete their role. Information was not always accessible when it was required. Staff felt supported by the registered manager however there were some tensions between staff.

People’s medicines were not always safely managed. Prescription labels and guidance was not always being followed.

Staff did not always have enough time to support people effectively as they were expected to carry out additional duties in the kitchen. Generally, staff were recruited safely however improvements were needed to verifying employment history or new starters.

Risks were assessed and planned for but further improvement was needed to ensure plans were reviewed when necessary and being followed. Lessons were not always learned in a timely manner; however, some improvements were identified.

People were protected from avoidable harm by staff who understood their safeguarding responsibilities. The risk of infection control was minimised by the home being kept clean and staff wearing personal protective equipment when necessary.

There was mixed feedback about the food, however people were supported to have sufficient amounts to eat and drink that was appropriate for their dietary needs. People had their health conditions monitored when necessary and had access to other health professionals when required. We made a recommendation to ensure staff had their training updated at appropriate intervals.

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. We have made a recommendation to avoid future delays of Deprivation of Liberty Safeguards (DoLS) applications.

The environment was clutter free and had some appropriate labelling, howeve

We undertook an unannounced focused inspection of Ashview House Residential Home on 28 March 2018. This inspection was completed to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in January 2018 had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and is the service safe? This is because the service was not meeting some legal requirements in these areas and people were at risk. At this inspection we found that improvements had been made in these two areas, however further improvements were required.

Ashview House 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. This care home is registered to provide care to up to 22 people. At the time of the inspection six people were using the service, however two of these people were in hospital on the day 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.'

Although significant improvements to the quality of care had been made over a period of time, further improvements were required. The registered manager had put systems in place to monitor and improve the quality of service and some of these had been effective.

The registered manager had acted upon issues of concern and managed staff performance to ensure people received appropriate care.

The registered manager knew their requirements in relation to their registration with CQC and the provider was carrying out quality checks on the service.

People's medicines were not being consistently well managed and staffing levels had not been assessed as sufficient to meet people's needs and keep them safe.

Risks of harm to people were minimised and lessons were learned following incidents that had resulted in harm to people.

People were safeguarded from the risk of abuse as staff followed safeguarding procedures when they suspected abuse.

New staff were employed through safe recruitment procedures.

There were infection control procedures in place to prevent the spread of infection.

We inspected this service on 15 and 16 January 2018. This was an unannounced inspection. Our last inspection took place on 4 September 2017. At that inspection, we identified some Regulatory breaches and we told the provider that improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as 'inadequate' and remained 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.

As a result of previous enforcement action, a condition was placed on the provider's registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people's safety and remains in place.

At this inspection, we identified continued and new Regulatory breaches. The overall rating for this service remains 'Inadequate' and the service therefore remains in 'Special measures' whilst we continue our enforcement action.

Ashview Residential Care Home 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.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection six people were using the service.

There was a registered manager at the home. 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.

Systems were not always effective at identifying quality concerns. Medicines audits were taking place but they were not always finding issues that were present. Other audits were taking place such as environmental, kitchen and infection control audits which did not always identify issues. Timely action had not always been taken to resolve actions if they had been identified. These shortfalls posed a significant risk to the people living in the home.

Quality assurance records were not always up to date, such as the training matrix which had a member of staff missing from it, despite them receiving t

We inspected this service on 4 September 2017. This was an unannounced inspection. Our last inspection took place on 12 January 2017. At that inspection, we identified a number of Regulatory breaches and we told the provider that improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as ‘inadequate’ and remained under 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.

As a result of previous enforcement action, a condition was placed on the provider’s registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people’s safety and remains in place. This condition has been breached by the provider since our last inspection and we are taking action to address this.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection nine people were using the service. However, one of these people was in hospital as a result of a safety incident that had occurred at the service.

There was a registered manager at the home. 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.

At this inspection, we identified a number of continued and new Regulatory breaches. The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘Special measures’ whilst we continue our enforcement action.

We found that the provider continued to have ineffective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

A notifiable safety incident had not been reported to us, which meant that we could not accurately monitor safety at the service.

Risks to people’s health, safety and wellbeing were still not always assessed, planned for, managed and reviewed to promote people’s safety.

Safe recruitment systems were still not in place to ensure staff were of suitable character to work with the people who used

We inspected this service on 12 January 2017. This was an unannounced inspection. Our last inspection took place in April 2016. At that inspection, we identified a Regulatory breach and we told the provider that improvements were needed to ensure people consistently received care that was safe, effective, responsive and well-led. The service was rated as ‘requires improvement’. As a result of enforcement action, a condition was placed on the provider’s registration with us that prevent them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people’s safety.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 11 people were using the service.

There was a registered manager at the home. 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. A home manager had also been recently recruited and the registered manager told us they also planned on registering with us.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘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.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Recent changes in management had led to people and staff feeling unsettled.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care.

People were not always protected from the risk of abuse because some staff were not trained in how to recognise and report abuse. Suspected abuse was not always reported as required. Safe recruitment systems were not in place to ensure staff were of suitable character to work with the people who used the service.

Safety incidents were not always analysed and responded to effectively, which meant

We inspected this service on 19 April 2016. This was an unannounced inspection.

We previously inspected this service on 25 January 2016 and 1 December 2015 where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. This service was placed into special measures as a result of an earlier inspection in April 2015 and it had remained in special measures until this inspection. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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. At this inspection we found that the improvements the provider and registered manager had made were enough for us to remove the service from being under special measures.

At this inspection three people were using the service. The numbers of people using the service were low because of the action taken by us (CQC) and the local authority after our previous inspections, to safeguard people from risks to their health, safety and well-being. Following our December 2015 inspection, where we identified concerns for people’s safety and wellbeing, we placed a condition on the provider’s registration preventing them from admitting new people to the service. In March 2016 we agreed that the provider could begin to admit people to the service. The service can therefore now provide accommodation and personal care for up to 15 people.

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 and associated Regulations about how the service is run.

Although we identified some improvements had been made, further improvements were required to ensure people consistently receive care that is safe, effective, responsive and well-led.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not always followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This was a continued breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Improvements were needed to ensure risks to people’s health, safety and wellbeing were consistently and promptly assessed, monitored, managed and reviewed.

Gaps in the staffs’ knowledge and skills needed to be addressed and maintained to ensure people receive care that is safe and meets their needs.

Improvements were needed to ensure people’s care preferences were thoroughly assessed, recorded, monitored and met.

A manager or senior member of staff was not always available to lead shifts and coordinate people’s care. When concerns with the quality of care were identified, appropriate action to sustain improvements in quality were not always effective.

People’s medicines were managed safely and people’s health needs were monitored and prompt advice from health and social care professionals was requested when people’s needs changed.

Staff understood how to protect people from the risk of abuse and there were sufficient numbers of staff to meet people’s needs.

People could eat and drink suitable amounts of food and drink that met their individual preferences.

Staff treated people with kindness and compassion and people’s privacy was promoted. People were encouraged to make choices about their car

We inspected this service on 25 January 2016. This was an unannounced inspection.

Our last inspection took place on 1 December 2015, where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. This service was placed into special measures as a result of an earlier inspection in April 2015. After our December inspection, we found there was not enough improvement to take the service out of special measures and we continued to take enforcement action against the provider. This included preventing the provider from accepting new admissions to the service. Following this inspection, we found that although some improvements had been made, these were not sufficient enough to remove the service out of special measures. CQC is now considering the appropriate regulatory response to resolve the on-going problems we found.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection three people were using the service. The numbers of people using the service were low because of the action taken by the local authority after our last inspection, to safeguard people from risks to their health, safety and well-being.

The service had a registered manager. However, they were no longer working at the home. 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. A new manager had been appointed by the provider and they had applied to register with us. At the time of our inspection, their application was being considered by us.

During this inspection we found that some of the required improvements had not been made and we identified a number of continued and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

Risks to people’s health and wellbeing were not consistently assessed, managed and reviewed. This meant systems were not always in place to promote people’s health, safety and wellbeing.

The provider did not have effective systems in place to consistently assess, monitor and improve quality and manage risks to people’s health, safety and wellbeing. This meant that concerns with people’s care, including safety concerns were not always being identified and rectified by the provider.

People’s health needs were not consistently monitored and prompt advice from health and social care professionals was not always requested when people’s needs changed.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not always followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Effective systems were not in place to ensure everyone who used the service could safely access the community if they chose to do so.

Improvements had been made to the way medicines were managed. This meant people were protected from the risks associated with medicines. Staff understood how to protect people from the risk of abuse.

There were sufficient numbers of staff to meet people’s needs. Staff had started to receive the training they required to provide them with the knowledge and skills to meet people’s needs effectively.

People could eat and drink suitable amounts of food and drink that met their individual preferences.

Staff treated people with kindness and compassion and people’s privacy was promoted. People were encouraged to make choic

We inspected this service on 1 December 2015. This was an unannounced inspection.

Our last inspection took place in April 2015, where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. As a result of our last inspection, this provider was placed into special measures by CQC. This inspection found that 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

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 16 people were using the service. Two of these people were using the service for an agreed short period of time. This is called respite care.

The service had a registered manager. However, they were no longer working at the home. 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. An acting manager had been appointed by the provider and they had begun the process of registering with us.

During this inspection we found the required improvements had not been made and we identified a number of continued and new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. We are therefore continuing to take enforcement action against the provider.

There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual care needs and preferences were not always met.

Risks to people’s health and wellbeing were not consistently assessed, managed and reviewed and people did not always receive their planned care. People were also not always protected from potential abuse. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.

Medicines were not managed safely which meant people did not always receive their medicines as prescribed.

People were not always supported to eat in accordance with their agreed care. This meant people’s risk of malnutrition was not always being managed effectively.

When people were unable to make important decisions about their health and wellbeing, the provider did not always act in accordance with the law.

People’s health needs were not consistently monitored and prompt advice from health and social care professionals was not requested when people’s needs changed.

There were gaps in the staffs’ knowledge and skills that meant some people’s specialist needs were not met safely or effectively.

The provider did not have effective systems in place to assess, monitor and improve quality and manage risks to people’s health and wellbeing. This meant that poor and unsafe care was not being identified and rectified by the provider. The provider could not demonstrate that feedback from people and the staff was used to improve the quality of care. People were reluctant to complain about the quality of care.

The provider did not always inform us of incidents that occurred at the service and pre-inspection information was not completed accurately. This meant we were not always aware of reportable incidents that had occurred within the home.

People were not always treated in a caring manner by the staff and people’s privacy and dignity was not consistently promoted. People were not always able to make choices about their care.

Some improvements had been made in the recording of people’s care preferences and activity provision. However, further improvements were needed

We inspected this service on 23 April 2015. This was an unannounced inspection. This was the service’s first inspection under their registration as a new provider.

The service was registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia.

At the time of our inspection 18 people were using the service. Two of these people were using the service for an agreed short period of time. This is called respite care.

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 and associated Regulations about how the service is run.

At this inspection we identified areas of unsafe, ineffective and unresponsive care. This was because the service was not well led. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. People were also not always protected from potential abuse. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.

There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual care needs and preferences were not always met.

Records relating to people’s care were not always accurate and up to date and medicines were not consistently managed safely. This meant people were at risk of receiving unsuitable or unsafe care.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

The registered manager did not always inform us of incidents that occurred at the service and pre-inspection information was not completed at our request. This meant we were not always aware of reportable incidents that had occurred within the home.

There were gaps in the staffs’ knowledge and skills that meant some people’s specialist needs were not met effectively.

People were not always supported to eat in a dignified manner and the staff could not always show that people’s risk of malnutrition were being managed in accordance with professional advice.

People’s feedback about care was not sought and people did not always feel empowered to complain about the quality of their care. This meant the registered manager and provider could not use people’s feedback to make improvements to the quality of care.

When staff had the time they supported people with care, compassion and respect. However, we saw that the staff did not always have the time to consistently support people in this manner.

Some people who used the service were unable to make certain decisions about their care. Under these circumstances the registered manager followed the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This meant that decisions were being made in people’s best interests when they were unable to make decisions for themselves.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.