The inspection took place on 28 August 2018, it was unannounced.

At the last inspection in June 2017 the service was rated requires improvement in the safe and well-led domains. Staffing levels required adjusting to ensure the service remained clean and quality monitoring was not effective and there was no registered manager in place. At this inspection we found the issues had been addressed. There were enough staff to keep the service clean and quality monitoring systems were in place.

Ash Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.

Ash Lodge Care Home provides accommodation and care for up to 22 people who have mental health needs. The service is two houses joined internally. There are communal lounges and garden patio areas for people to use.

The service has 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.

Staff understood their responsibilities to protect people from harm and abuse. Accidents and incidents were monitored. Infection control was maintained. Medicines were safely monitored and minor issues with people's medicine administration record (MAR) charts were robustly addressed. Risks to people's health and wellbeing were monitored. People's care was monitored and health care professionals were contacted for their help and advice to maintain people's wellbeing.

Staffing levels provided met people's needs and they remained under review by the management team. Staff undertook training, supervision and received an annual appraisal to maintain and develop their skills. Robust recruitment procedures were in place.

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

Staff treated people with compassion and supported them in a kind and caring way. People’s privacy and dignity was respected. Advocates (independent representatives) were available locally to help people raise their views.

People’s dietary needs were met. The food served looked appetising and nutritious. People who required monitoring of their dietary needs had this in place.

People’s care records were personalised and staff were aware of their preferences for their care and support. People’s communication needs were known by staff. The provider had a complaints policy in place, issues raised were used as learning to improve the service provided.

The registered manager had an ‘open door’ policy in place so people living at the service, staff or visitors could speak with them at any time. Resident, relative’s and staff meetings were held to gain people’s views of the service provided. Quality monitoring systems were robust. The provider reviewed their policies and procedures to ensure they were up to date.

The inspection took place on 2 June 2017 and was unannounced. At the last inspection on 11 June 2015 the registered provider was rated ‘Good’ and was compliant in all areas we assessed.

Ash Lodge Care Home is situated on a main road into Hull city centre. It is close to local amenities including shops, pubs, library, swimming baths and a park. The home is owned by a partnership and offers support up to 22 adults who have mental health needs. At the time of the inspection, there were 20 people using the service.

The service 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. The registered manager also managed another service within the organisation. This meant they divided their time during the week between the two services.

During this inspection we had concerns about some aspects of the environment caused by domestic shortages and overall governance.

The dining room and some bedrooms required cleaning. External areas leading from both ends of the dining room required sweeping and tidying and more bins were required for the disposal of cigarettes ends. We found domestic and catering hours were insufficient.

There was no structured quality monitoring system. Some checks were carried out, for example on medication, everyday maintenance jobs, and care plans, which had been checked during their input into a new computer system. However, there had not been any environmental checks recorded and no evidence the registered manager and registered provider were aware of the issues we found with cleanliness and specific furniture. The environment was suitable for people’s needs, however some items of furniture needed replacement. This related to two settees, some bed bases and mattresses, a wardrobe and a dining table; these were ordered on the day of inspection. There had not been any questionnaires to people in 2016 apart from to four relatives and there was no action plan to record negative comments so it was difficult to see if they had been addressed.

You can see what action we have asked the registered provider to take regarding staffing and governance in the full version of this report.

We found staff knew how to keep people safe from the risk of harm and abuse. The registered provider had policies and procedures to guide staff and they had completed safeguarding training. Staff completed risk assessments for people and there were plans in place to help minimise risk whilst still ensuring people had control of their lives.

The recruitment process had some shortfalls in regards to ensuring people had references in place prior to the start of employment. The registered provider told us they would address this straight away. Other employment checks were carried out appropriately.

Staff supported people to be independent and ensured they gained consent prior to carrying out tasks. People who used the service all had the capacity to make their own decisions. Staff were aware of mental capacity legislation and had completed training in this.

Staff supported people to access community health professionals and monitored their general and mental health, offering advice when required and an escort to appointments.

People’s nutritional needs were met. Menus provided people with a nutritious diet with choices and alternatives. Drinks and snacks were served throughout the day and people who used the service could help themselves to hot and cold drinks in the dining room.

People’s needs were assessed prior to admission and the registered manager formulated a care plan for each person. These helped to guide staff in supporting people in the way they preferred to be cared for. Some minor amendments were required to ensure a

People told us they were happy living at Ash Lodge and confirmed that they were listened to. They also told us their privacy was respected. Comments included; "I love it here and have no concerns", "I get up when I want to and go out everyday" and "The staff are very nice and always knock before they come in my room."

People who used the service told us they were happy with the level of care and support they received and told us that other people visited them such as their community psychiatric nurse.

We saw the menu offered was varied, healthy and nutritious. People told us how good the food was especially since the new cook had been in post. Comments included; "The food is marvellous", "It's very good" and "We get enough and staff ask us what we would like."

We saw the environment was clean and there were systems in place for staff to follow.

We saw that staff had undertaken appropriate training to ensure they fully understood the needs of the people they supported.

People told us they were able to express their views and also knew about the complaints procedure and what to do if they had any concerns. They also said they were kept fully informed with regard to any changes.

People told us that privacy and dignity were maintained and that their views were listened to. We spoke with two people who said, "I have my own key and I go out when I want to", "I am treated with respect and the staff always knock before they come into my room" and "I am very happy here."

People who used the service told us they were happy with the level of care and support they received and commented, "I have a care plan and I sat with my key worker to develop it."

People told us they felt safe within the home and had access to their finances. They commented, "Yes I feel very safe here" and "I have my own post office account and I pay my bills myself."

People told us that they received their medication safely and that staff supported them with this.

When we spoke with people who used the service they told us there were sufficient numbers of staff to support them and commented, "There are always staff around if you need them." People spoke highly of the staff and commented, "The staff are lovely" and "They are very polite and help you."

People told us they knew about the complaints procedure and what to do if they were to have one.

People told us they felt safe in the home and staff helped them to sort out any problems. They said they were free to go out and about in the community. They said they had a choice at mealtimes and generally liked their meals.

Comments were, “I like living here – everything is fine”, “There are people around you day and night – it’s better than living on your own”, “The staff are great”, and “I prefer it here to the last home and the staff look after us well.”

People told us that they were able to make choices and decisions within their everyday lives. They said that the staff were friendly, pleasant and always polite, the environment and food were of a good standard.

People also said that they felt safe in the home and their views were listened to and complaints were acted upon quickly.

This unannounced inspection took place on 5 and 11 June 2015. At the last inspection on 28 August 2013, the registered provider was compliant with all the regulations we assessed.

Ash Lodge Care Home consists of two adjoining three storey buildings situated on a main road into Hull city centre. It is close to local amenities including shops, pubs, library, swimming baths and a park. The home is owned by a partnership and is registered with the Care Quality Commission to provide care and accommodation for 22 adults who have mental health needs.

The service has 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.

We found staff were recruited in a safe way; all checks were in place before they started work and they received an induction. Staff received training and support to equip them with the skills and knowledge required to support the people who used the service. There was sufficient staff on duty to meet the needs of people’s health and welfare needs.

People were able to discuss their health needs with staff and had contact with their GP, attended routine health checks and accessed other health professionals as required. The service made appropriate and timely referrals to healthcare professionals and their recommendations were followed.

We found the nutritional and dietary needs of people had been assessed and the people we spoke with told us the choice and quality of food available was very good.

We looked at how the service used the mental Capacity Act 2005 and Deprivation of Liberty code of practice to ensure that when people were deprived of their liberty or assessed as lacking capacity to make their own decisions, actions were taken in line with legislation.

People lived in a safe environment. Staff knew how to protect people from abuse and they ensured equipment used in the service was regularly checked and maintained. Risk assessments were carried out and staff took steps to minimise risks without taking away people’s rights to make decisions.

The registered provider had policies and systems in place to manage risks, safeguard vulnerable people from abuse and for the safe handling of medicines. Medicines were ordered, stored administered and disposed of safely. Only members of staff who had received training in the safe handling of medicines were involved in the administration of medicines.

Care plans had been developed to provide guidance for staff to support the positive management of behaviours that may challenge the service and others. This guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

We observed staff treated people with dignity and respect and it was clear they knew people‘s needs well.

People who used the service spoke positively about the care they received. They told us, comments and complaints were responded to appropriately and there were systems in place to seek feedback from them and their relatives about the service provided. A complaints policy was in place and we saw that when complaints had been made, appropriate action had been taken to resolve these.

A quality monitoring system was in place that consisted of stakeholder surveys, reviews, assessments and audits.