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Ashlee Lodge Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 22 August 2019

Ashlee Lodge is a residential care home providing personal care to a maximum of five people. At the time of inspection, five people were living at the service. People living at Ashlee Lodge have a learning disability and may also have autism.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. However, staff levels, on occasions, did not always support this. See below.

People’s experience of using this service and what we found

Staff rotas did not demonstrate there were always enough staff to meet people’s assessed needs. Whilst the service had referred potential safeguarding matters to the local authority, they had failed to send these to CQC. The quality assurance systems were not always effective and had not identified some of the shortfalls found at inspection. For example, in relation to some people’s health needs, complaint records, fire drills and staff recruitment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s medicines were managed safely. Staff attended regular training to update their knowledge and skills. They attended regular supervision meetings and told us they were very well supported by the registered manager. A staff member told us, “I’m definitely supported.”

People were supported to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People had enough to eat and drink and menus were varied and well balanced.

Staff were kind and caring in their approach. They had a good understanding of people as individuals, their needs and interests. Most people needed some support with communication and were not able to tell us their experiences; those who could told us they were happy, and we observed people were happy and relaxed with staff.

People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants and trips to places of interest. A relative told us “We are invited to parties twice a year, often barbeques and buffets. We all know each other, and it is lovely to meet up and chat.”

The environment was well maintained. A new shower had recently been fitted. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks on equipment were all up to date.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was good, (published 7 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.


We have identified three breaches of regulation in relation to staffing, reporting incidents and the governance of the service. The provider had failed to ensure there were always enough staff to meet people’s needs. The provider had failed to submit notifications and the provider had failed to ensure that systems to assess, monitor and improve the quality and safety of the service were sufficiently robust.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the pro

Inspection areas


Requires improvement

Updated 22 August 2019

The service was not always safe.

Details are in our safe findings below.



Updated 22 August 2019

The service was effective.

Details are in our effective findings below.



Updated 22 August 2019

The service was caring.

Details are in our caring findings below.



Updated 22 August 2019

The service was responsive.

Details are in our responsive findings below.


Requires improvement

Updated 22 August 2019

The service was not always well-led.

Details are in our Well-Led findings below.