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Inspection carried out on 26 June 2018

During a routine inspection

This inspection took place on 26 June 2018 and was unannounced.

At the last inspection in May 2017 the service was rated ‘Requires Improvement’. There was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. We asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least ‘Good’. At this inspection we found that improvements had been made and the breach in Regulation had been met. Improvements had been made to maintain the standard of the environment.

Ashdene House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

Ashdene House provides care for up to 18 adults with a learning disability, in Ramsgate. At the time of our inspection there were 11 people using the service. Eight people lived in the house and three in a cottage within the grounds. A day centre unit in the grounds was used for various activities. During the day everyone spent time together or taking part in activities outside the service.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with CQC 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 told us and indicated that they felt safe living at Ashdene House. They were protected from discrimination, abuse and the risk of avoidable harm. Staff knew how to keep people as safe as possible. Risks to people were managed and monitored. People received their medicines safely from staff who were competent to do so. The registered manager reviewed accidents and incidents and checked to make sure people received the support of health care professionals when they needed it.

People were supported by staff who had been recruited safely. Staff knew people well, kept their knowledge up to date and met with the registered manager for one to one supervision meetings.

The service was clean and tidy and the garden was maintained. Checks were completed to make sure the environment and any equipment were safe and well maintained. People had access to private space and communal areas, including a garden. Visitors were welcome at any time.

People were involved, as far as possible, with planning their care and support. Their needs were assessed prior to moving to Ashdene House to ensure staff could meet their care and support needs. People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. They were supported by relatives and advocates when they needed additional help to make decisions about their care.

People were offered choices of healthy home-cooked meals. They were supported to stay as healthy as possible and staff worked collaboratively with health care professionals to promote this.

People were supported by staff who were patient, kind and caring. Their privacy and dignity were respected and their independence promoted. People, their relatives and staff had developed strong, trusting relationships. Staff understood the importance of confidentiality and made sure people’s records were stored securely.

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Inspection carried out on 2 May 2017

During a routine inspection

This unannounced inspection took place on 02 May 2017.

Ashdene House provides care for up to 18 adults with a learning disability, in Ramsgate. At the time of our inspection there were 12 people using the service. Nine people lived in the house and three in a cottage within the grounds. A day centre unit in the grounds was used for various activities. During the day everyone spent time together or taking part in activities outside the service.

The service was run by a registered manager with the support of a deputy manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was present on the day of the inspection.

People did not live in a service that was clean and hygienic. Furniture and carpets were dirty. Some areas of the service were in need of painting and decorating. The garden areas were overgrown with weeds. The service looked untidy and unkempt.

People told us and indicated they felt safe living at Ashdene House. People were protected from the risks of abuse and discrimination. Staff were trained to keep people safe and knew what to do if they suspected incidents of abuse.

Risks to people were identified, assessed and reviewed. Guidance for staff regarding how much support people needed to stay safe was recorded. People received their medicines safely and on time. Medicines were stored safely.

The provider had recruitment and selection processes in place to make sure that staff employed were of good character. There were sufficient skilled, knowledgeable and trained staff on duty to provide people with the care and support they needed. People were not rushed and staff had plenty of time to spend with them.

There were assessments in place to establish whether people had capacity to make decisions. When required meetings were planned with the relevant people to make sure decisions were made in their best interest. People were offered choices about what they wanted to do and how they wanted to spend their time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People’s health was monitored and staff worked with health and social care professionals to make sure people’s health care needs were met. People had enough to eat and drink and had a choice of home cooked food. People told us and indicated they were happy living at Ashdene House.

Staff interactions were positive. Staff spoke with people in a kind and caring way. Staff knew people well including their likes and dislikes. People were supported to maintain close relationships with family and friends. People’s privacy and dignity were respected and their independence was promoted by staff.

Staff were responsive to people’s needs. Assessments were carried out before people moved into the service to make sure they could meet people’s needs and provide them with the right level of support. People and their families were involved with planning their care and support. Each person had a care plan that was tailored to meet their individual needs. These were reviewed to ensure they reflected any changes in people’s care and support needs.

People enjoyed a variety of activities within the service. There was a complaints policy in place to make sure people and their relatives knew how to complain if they needed. People’s relatives

Inspection carried out on 31 October 2014

During a routine inspection

This was an unannounced inspection on 31 October 2014.

Ashdene House, in Ramsgate, provides care for up to 18 adults with a learning disability, mental health condition and / or a physical disability. At the time of our inspection there were 14 people using the service. 11 people lived in the house and three in a cottage within the grounds. The cottage provides accommodation for people whilst they receive support from staff with independent living skills. During the day everyone spent time together or taking part in activities outside the service.

The service is run by a registered manager who was present on the day of our inspection. 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’s needs were assessed and care and support was planned and delivered in line with their individual care needs. People were assigned a named key worker who was responsible for coordinating their day to day needs. Support plans contained personalised information about how each person preferred to be supported. Staff knew people well and appeared to have good relationships with people. The atmosphere was happy and relaxed.

People’s preferences, likes and dislikes had been recorded and support was provided in accordance with people’s wishes. People were supported, via a range of communication techniques, to be involved in decisions about their care which helped them to retain choice and control over how their care and support was delivered.

People were involved in a range of activities both within Ashdene House and in the community. Activities were structured for each person by an activities co-ordinator. Further new activities were being developed with people living at the service.

People were provided with a choice of healthy food and drink which ensured that their nutritional needs were met. People’s physical health was monitored as required and people were supported to see healthcare professionals such as GP’s, chiropodists, dentists and opticians.

People were protected from the risks associated with medicines because the provider had appropriate systems in place to manage medicines. The registered manager and staff had implemented additional processes to reduce the risk of medication errors.

Staff understood how to protect people from the risk of abuse. They had been trained in safeguarding people and were able to tell us how they would recognise signs of abuse. They understood how to report any concerns of poor practice or abuse and knew about the provider’s whistle-blowing policy.

Risks to people’s safety were identified and managed appropriately. Risk assessments were detailed and covered potential issues both inside Ashdene House and in the local community. The premises were of suitable design and layout to meet people’s needs and keep them safe.

The provider had recruitment and selection processes in place to make sure that staff being employed at the service were of good character. There was an effective training programme to make sure that staff had the skills and knowledge needed to carry out their roles. Staff were encouraged to complete additional training and were enthusiastic about pursuing their qualifications for their personal development. There were sufficient numbers of staff with the right mix of skills, knowledge and experience to meet people’s needs.

The provider had systems in place to monitor the quality of the service. The registered manager analysed audits to identify any patterns and trends and to continually improve the service delivered.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made where this was in their best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. They were in the process of reassessing people with a view to completing DoLS applications.

Staff were kind, patient and respectful and were aware of how to respect people’s dignity and privacy when providing care and support.

The complaints procedure was on display in a format that was accessible to people who used the service. Feedback from people, their relatives and healthcare professionals was encouraged and acted upon wherever possible.

Staff told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within Ashdene House which allowed them to suggest new ideas which were often acted upon.

Inspection carried out on 22 October 2013

During a routine inspection

We spoke with two people who used the service. Some people living at the service were not able to talk to us directly about their experiences due to their complex needs and communication difficulties, so we used a number of different methods to help us understand their experiences. We spoke with staff, spent time with people, read records, looked round the home and made observations of the care and support the people received. People we spoke with were positive about the service. People told us that the staff were nice. One person told us �It�s good here. I have friends.

We saw that the provider had systems in place to obtain consent from people in relation to the care and support they received.

People told us and records confirmed that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed. People said that they were happy with the care they received and got on well with the small team of staff.

We saw that the home was clean and tidy. There was a fresh atmosphere throughout. People living at the home and their relatives agreed that there were good standards of cleanliness. A relative commented �The home is well organised and clean.�

We found that there were effective recruitment and selection processes in place. The service had processes in place for the recruitment and management of staff, and the staff working there had had the necessary recruitment checks.

The provider had procedures in place for dealing with complaints, comments and suggestions.

Inspection carried out on 27 September 2012

During a routine inspection

We made an unannounced visit to the service and spoke to the people who use the service, the registered manager and staff members. There were 14 people using the service at the time of our visit.

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke to some people and also observed the interactions between the people and the staff. We observed how people responded and reacted with the staff and we observed to see if people indicated they were happy, bored, discontented, angry or sad.

People told us or expressed that they felt safe, happy, and well looked after.

Staff engaged with people in a warm and positive way and supported people where needed. We were told that the staff were �good�.

Reports under our old system of regulation (including those from before CQC was created)