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Inspection carried out on 24 August 2017

During a routine inspection

Ashley House is registered for a maximum of 13 people offering accommodation for people who require nursing or personal care and specialises in supporting adults with mental health conditions. At the time of our inspection there were 13 people living at the home.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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.

People were complimentary and satisfied with the quality of care they received. People received care that enabled them to live their lives as they wanted and to make choices about maintaining their independence. People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes. People were supported to maintain relationships with people who were important to them.

Care plans contained accurate and detailed relevant information for staff to help them provide the individual care people required. People were involved in making care decisions and reviewing their care to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care. Staff received essential training to meet people’s individual needs, and used their skills, knowledge and experience to support people effectively and develop trusting relationships.

Medicines were stored and administered safely and as prescribed. Where people were prescribed ‘as required’ medicines, guidance for staff on when these might be required needed to be more personalised.

People’s care and support was provided by a caring staff team and there were enough trained and experienced staff to be responsive to meet their needs. People told us they felt safe living at Ashley House. Staff knew how to keep people safe from the risk of abuse. Staff and the manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety. They took immediate action when we found an incident had not been reported to the local authority.

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 approach.

People received a choice of meals and drinks that met their individual dietary requirements at times they wanted them.

People knew how to voice their complaints and felt confident to do so.

People and staff were encouraged to share their views of the service through regular meetings and surveys. The registered manager had an ‘open door’ policy for people, relatives, staff and visitors to the home. This meant there was an open and honest culture promoted in the home.

Further information is in the detailed findings below.

Inspection carried out on 11 June 2015

During a routine inspection

We carried out this inspection on 11 June 2015. The inspection was unannounced.

Ashley House is registered for a maximum of 13 people offering accommodation for people who require nursing or personal care and specialises in supporting adults with mental health conditions. At the time of our inspection there were 11 people living at the home, one person was in hospital.

A requirement of the service’s registration is that they have 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 a 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 left the service in July 2014. A new manager had been recruited to manage the service and was in the process of becoming the registered manager. We refer to the new manager as the manager in the body of this report.

At our last inspection on 1 April 2014, we found some concerns in four areas. These were safeguarding people who use services from abuse, and assessing and monitoring the quality of service provision. Also care and welfare of people who use services, and respecting and involving people who use services. Following this, the registered manager sent us an action plan which told us about the improvements they would make. At this inspection we found improvements had been made in these areas.

Care was provided that met people’s needs and we found there were enough staff to care for people safely. People’s health and social care needs were reviewed regularly, and staff referred to other health professionals when needed, so people were supported to maintain their health and wellbeing. Risk assessments were completed and plans minimised risks associated with people’s care.

People told us they felt safe at the home. Staff knew about safeguarding people and what to do if they suspected abuse. People were protected from harm as medicines were stored securely and systems ensured people received their medicine as prescribed. Checks were carried out prior to staff starting work at the service to make sure they were of good character and ensure their suitability for employment.

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). When there were concerns about people’s capacity to make decisions, we saw decisions were made in their best interests.

Staff had training to do their jobs effectively, in order to meet people’s care and support needs. Staff were encouraged to continue to develop their skills in the area of health and social care. Staff told us they felt supported by the management team so they could carry out their roles effectively.

People told us they liked living at the service. People’s nutritional needs were met and there was a variety of food available. Snacks and drinks could be accessed when people required these. People enjoyed taking part in organised activities, and many people chose to go out either individually or with care staff, and pursue their own interests.

Everyone we spoke with was positive about the management team and the running of the service. The manager knew the staff and people at the service well. We saw systems and checks made sure the environment was safe for people that lived there and that people received the care and support they needed. People knew how to complain if they wished to and complaints were actioned quickly and effectively.

People told us the staff were caring. We saw people were treated as individuals with their preferences and choices met where possible. Staff showed dignity and respect when providing care and all the people we spoke with were positive about the staff. Relatives were encouraged to be involved in supporting their family members where possible.

Inspection carried out on 1 April 2014

During a routine inspection

We spoke with three people who lived at Ashley House about their experiences of the service. We observed the care that was given to people during our inspection. We also spoke with a range of staff including the deputy manager.

Is the service safe?

People did not always receive safe care. People or their relatives were not involved with the planning of their care. People told us there were no reviews held. We found reviews were not recorded to demonstrate that people were involved in planning their care. Records were not always clear on what care should be provided to people. In some instances care records provided contradictory information.

There were no robust systems in place to monitor the quality of service being provided to people.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Staff were not always clear on which body investigated any allegations when abuse may be suspected.

Staff told us they felt supported within their role.

Is the service effective?

The care provided to people was not always effective as people had not been involved with the planning of their care. People told us that they were happy with the care that had been delivered and their needs had been met. Staff had a good understanding of people�s care and support needs and they knew people well. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

We saw staff were compassionate and caring when supporting people. People we spoke with told us that staff were friendly and supported their needs well. We saw staff understood people's care needs and how they needed to be supported.

Staff told us they were clear about their roles and responsibilities

Is the service responsive?

People�s needs had been assessed before they moved into the home; however, these had not been updated on their care plans. Records provided limited information on people�s preferences, interests and diverse needs, to ensure people could be cared for and supported in accordance with their wishes.

We found staff had a detailed understanding of what people's preferences and interests were. People had access to activities that were important to them and had been supported where possible to maintain relationships with their friends and relatives.

Is the service well-led?

We found the service was not well led as there were no quality assurance processes in place. There was no emergency care plans in place for people in the event of a fire. We found there were no health and safety checks undertaken to assess any risks to people living there.