Ashlea House

Ashlea House is registered to provide accommodation and personal care for up to four adults with a learning disability. At the time of the inspection there were four people living at the service.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence such as making decisions about what they want to do and being able to change their mind, supported to find voluntary and paid work. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

At our last inspection in October 2016 we rated the service as good in all domains except Well led because they had not had a registered manager for two years.

At this inspection we met the newly registered manager. We found their leadership and enthusiasm had helped to sustain the continued rating of good overall. They and staff fostered a lovely homely atmosphere in the house and outcomes for people remained good.

Staff enabled people to lead a busy and active lifestyle and supported them to maximise their potential for independence. Boundaries were in place for some people who understood the reasons why this was. Staff worked to clear guidance to ensure any restrictions they needed to impose to maintain peoples safety were consistently applied and reviewed.

Staff received a broad range of training to provide them with the skills and knowledge needed to support people appropriately and understand their needs. Medicines continued to be managed safely.

People spoke positively about what they liked about living in the service and how being there had helped them develop their independence and for some inspired a desire to move to less dependent accommodation in the future. They understood what to do if they were not happy with anything. A relative told us that they were happy with all aspects of their relatives care and would be happy to recommend the service to others.

There were enough staff available to provide flexible support to people, A safe system of staff recruitment was in place. Staff were trained to recognise abuse and discrimination and protect people from harm. Risks were assessed, and measures implemented to reduce the likelihood of harm to people or others.

People were consulted about all aspects of their daily lives and their consent obtained. 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 (did not support) supported this practice.

They were encouraged to eat healthily but had choice about what they ate. They were supported by staff to ensure their health needs were met.

Staff demonstrated warmth, compassion and kindness in their everyday interactions with people. Staff said they felt supported and that communication within the team was good. Staff had received safeguarding training and understood their responsibilities to protect people from abuse and protect them from discrimination.

The house was well maintained, and all equipment regularly tested and serviced. People had their own rooms that they personalised to their own taste.

There was good oversight and monitoring by the registered provider and registered manager to ensure people received the right support. They sought feedback from people staff relatives and professionals about the service to help drive improvement.

Rating at last inspection:

At the last inspection the service was rated Good overall. However, Well-Led was rated Requires Improvement (report published 17 November 2016). At this inspection in May 2019 all domains were rated good and the overall rating of the service remained Good.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the last inspection in October 2016.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

On the day of our inspection there was not 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. We checked our records and did not find an application in place for a person to become registered to manage this home. We have raised this with the current manager and they have agreed to take action to address this.

People told us they felt safe living at the home. People were supported by staff who could identify the different types of abuse and who to report concerns to. Assessments of the risks to people’s safety were in place and regularly reviewed. Emergency evacuation plans were in place, but these needed amending to ensure they took into account each person’s individual needs. There were sufficient numbers of suitably qualified and experienced staff in place to keep people safe. Safe recruitment processes were in place. People’s medicines were managed safely.

Staff were well trained, received regular supervision and felt supported by the manager. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People received the food and drink they wanted and were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People felt the staff were kind and caring and treated them with respect and dignity. People were involved with decisions made about their care. Information was available for people if they wished to speak with an independent advocate, but this needed to be more easily accessible. People were supported to live as independently as they were able to and staff respected people’s privacy.

People were supported to take part in the activities that were important to them. People’s care records were person centred, focussed on what was important to each person and provided staff with relevant information to respond to people’s needs. Complaints and concerns were managed in line with company policy.

There was not a registered manager at the home. However, people and staff spoke highly of the manager. The manager welcomed people’s views on developing the service and they understood their roles and responsibilities required of them as the manager of the home. Robust quality assurance processes were in place.

We found that the manager responsible for the Regulated Activity "Accommodation for persons who require nursing or personal care" was no longer working at this service. He was now employed by the company to provide day facilities for people using the company's services. This person is named as the manager in our report as he was still registered with the Commission (CQC) as the manager at the time of our inspection. A new manager, Clair Davies, had been appointed as manager and was in the process of completing formal registration processes with CQC. She was available throughout the inspection.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We looked at two people's support plans and saw that they had individual risk assessments in place to identify potential risks and to show how these could be avoided or minimised. We saw that the assessments were reviewed regularly, and provided clear directions for staff to follow. This meant that there were ongoing procedures in place to maintain people's safety.

We saw that people's views on their placement were taken into account, and one person had recently stated 'I do not want to live on my own, I know I am safe at Ashlea House'.

We found that staff understood safeguarding procedures, and how to safeguard the people they supported. There were systems in place to make sure that the staff learnt from events such as accidents and incidents, complaints, concerns, and investigations. Staff had been trained in regards to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) although it had not been necessary to submit any DoLS applications.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as managing challenging behaviour and autism awareness. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

Is the service effective?

One person told us that they had moved to the service from another home within the same company, and were more settled at Ashlea House as it was a quieter environment. We saw from looking at care plans and daily reports that people were developing their life skills and were able to try out new experiences. This showed that people were receiving effective care and support that met their needs.

Is the service caring?

We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as 'I like living here, the staff are very good', and 'The manager and staff are fantastic!'

We found that the staff were constantly looking out for opportunities for people to provide them with different choices, such as work experience, and different activities. They discussed everything with people in regards to their care planning, their rooms, their interpersonal relationships, their likes and dislikes, and their hopes and fears. This meant that staff were able to get to know people well, and recognised when they were feeling unwell or upset, and knew what action to take to help them.

Is the service responsive?

On the day of the inspection a person was being supported to attend their doctor's (GP) practice due to ill health. We found that staff were quickly aware when people needed support from health or social care professionals, and arranged visits as needed.

Some people had medicines to take 'as necessary' (PRN), and the staff had clear directions on when these medicines should be given. This showed that the service was responsive to people's health needs.

We found that the staff listened to people, and took appropriate action to deal with any concerns. There was a house meeting each week when people living in the home sat together with staff and planned for the following week. This included discussing menus and agreeing meals together. People were able to change their minds about meal choices, and were able to take part in meal preparation according to how they felt on the day, and according to their individual abilities. The staff allowed people to be flexible in their choice of activities each day, even though each person had a weekly planner to provide structure to their week. This showed that the service was responsive to people's feelings, moods and behaviours.

Is the service well-led?

The company and the manager had systems in place to provide ongoing monitoring of the home. This included care plan reviews, and checks for the environment, health and safety, fire safety, staff training needs and medication audits.

We saw that people living in the home related well to the manager and staff, and respected them. They said that the staff supported them with whatever they needed. People were invited to fill in satisfaction surveys to show how they felt about living in the home. The results of these were given when they next met together, and any agreed actions were followed through.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns. Staff were provided with staff surveys so that they could share their views in a written format if they wished to do so.

This showed that there were reliable systems in place to provide oversight for the service, and effective leading by the management.