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Inspection carried out on 8 February 2018

During a routine inspection

We carried out a comprehensive inspection of Ashdown Lodge on 8 and 9 February 2018. The inspection was unannounced.

Ashdown Lodge 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.

Ashdown Lodge is registered to provide personal care and accommodation for up to 13 older people and people who have dementia. At the time of the inspection there were 13 people living at Ashdown Lodge.

There was a registered manager in post. 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.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in August 2017.

We had received information prior to the inspection that people had been subject to abuse and placed at risk of avoidable harm. People told us they felt safe and we did not find any evidence that people had been subject to abuse.

However, we identified medicines were not always safely managed. Systems processes and practices to safeguard people from abuse and the assessment of risks, monitoring and management of people’s safety require improvement.

Quality assurance and information governance systems at the service were not yet fully operational. There was no on-going development plan in place to help the service continuously learn and improve. This meant quality, safety issues or potential risks were not always recognised or identified and action was not always taken when needed.

Care homes and other health and social care services are required by law to notify the Care Quality Commission, (CQC), of important events that happen in the service. This enables us to check the action the service took and if necessary request additional information about the event itself. However, not all of the relevant notifications had been submitted.

There was lack of adaptations inside and outside the home to support people with dementia to be comfortable and remain as independent as possible.

People had consented to their care and staff respected this. However, not all staff could explain their understanding of the Mental Capacity Act 2005 (MCA) and link the principles of this legislation with their everyday practice.

Staff knew people well and understood how people liked to be supported. However, people’s care plans did not contain enough information about them to enable staff to provide care in a person centred way. This meant there was a risk that people might not be supported in a personalised and meaningful way.

The service promoted a supportive, open and inclusive culture and staff told us that they felt supported. However, we found there was a lack of formal policies and procedures to protect and promote staff well-being and equality and inclusion rights in the workplace.

The above areas of practice have all been identified as requiring improvement.

Staff received an induction and had on-going training, supervisions and appraisals. However, some staff told us they felt they needed more training in order to be able to effectively meet some people’s specific individual needs. This meant people were at risk of not achieving the most effective outcomes from their support. We have made a recommendation about staff training on the subject of dementia and behaviours that may challenge.

The service had enough staff to meet people’s needs safely and followed safe recruitment practices. Staff had received infection control and food hygiene training and followed best practice guidance in these areas. Regular health and safety check