What life was like for people using the service:

The service continued to provide high quality, person centred care. Potential risks to people’s health, safety and welfare had been assessed and there was guidance in place for staff to follow to reduce the risks. Staff supported people to take positive risks to live their lives to the full.

Information from audits, incidents and quality checks were used to drive improvements and provided person centred support. Staff received training, supervision and were informed about new national guidelines to keep their practice up to date to meet people’s individual needs.

Staff understood people’s communication needs and had worked with people to provide positive behaviour support, to understand what people were trying to communicate. People were supported to be as independent as possible and learn new skills.

People were supported to take part in various activities that they enjoyed. Staff understood how this enabled people to have a good quality of life. The service was promoted links with the community and invited them to parties and celebrations.

More information is in the detailed findings below.

Rating at the last inspection:

Good (report published 15 July 2016).

About the service:

Ashingham House is a residential care home that accommodates up to 10 people living with learning disabilities or autistic spectrum disorder. At the time of the inspection eight people were living at the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidelines. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary life as any citizen ‘Registering the Right Support’ CQC policy.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service continued to meet the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

This inspection took place on 10 June 2016 and was unannounced.

Ashingham House is a privately owned service providing care and support for up to ten people with different learning disabilities. People may also have behaviours that challenge and communication needs. There were nine people living at the service at the time of the inspection. The service is a large detached property set in its own grounds in a rural area. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The

service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.

There was a registered manager working at the service and they were supported by a deputy 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 carried out an unannounced comprehensive inspection of this service on 30 March 2015. Three breaches of regulations were found. We issued requirement notices relating to, safeguarding service users from abuse, person centre care and dignity and respect. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had fully met the regulations.

Safeguarding procedures were in place to keep people safe from harm. The registered manager had taken steps to make sure that people were safeguarded from abuse and protected from the risk of harm. People told us and indicated they felt safe at the service; and if they had any concerns, they were confident these would be addressed quickly by the registered manager or the deputy manager. The staff had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures. This was a shortfall at the last inspection. The breach in the regulation had now been met.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. Each person had a care plan which was personal to them and that they or their representative had been involved in writing. The care plans contained the information needed to make sure staff had guidance and information to care and support people in the way that suited them best.

At the last inspection physical interventions being carried out by staff were not approved and did not match service user’s direct support needs. This was a shortfall. The breach in the regulation had now been met. There were plans in place for behaviours that challenge and positive behaviour support techniques had been put in place, which were successful and the incidences of behaviours had reduced.

People were now empowered to have as much control and independence as possible. How people received there medicines had been changed since the last inspection. Each person had a medicine cabinet in their bedrooms and staff gave them their medicines in a way they preferred and suited them best. People were supported to be as independent as possible and their dignity was respected when they were given their medicines and in all other areas of their care. This was a shortfall at the last inspection and the breach in the regulation had been met.

People who were not able to use speech to communicate were given different choices about the meals they received. People were being supported to develop their decision making skills to promote their independe

This inspection took place on 30 March 2015, was unannounced and was carried out by one inspector and a specialist advisor.

Ashingham House is a privately owned service providing care and support for up to ten people with different learning disabilities. People may also have behaviours that challenge and communication needs. There were nine people living at the service at the time of the inspection. The house is a large detached property set in its own grounds in a rural area. Each person had their own bedroom which contained their own personal belongings and possessions that were important to them. The service had its own vehicle to make sure people were able to access facilities in the local area and pursue a variety of activities.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. We received information from the service informing us that four people had applications granted to deprive them of their liberty to make sure they were kept as safe as possible. There were five applications still being processed by the DoLS office. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Safeguarding procedures were in place to keep people safe from harm. On three occasions these procedures had not been followed by the registered manager. The staff had not consulted with the local authority safeguarding team when incidents had occurred, which they should have done as part of the procedures. The registered manager took action to address this issue when we raised it.

People told us and indicated that they felt safe at the service; and if they had any concerns, they were confident these would be addressed quickly by the registered manager or the deputy manager. The staff had been trained to understand their responsibility to recognise and report safeguarding concerns and to use the whistle blowing procedures.

People were not always empowered to have as much control and independence as possible. When people received their medicines they were not given the choice of where and how they preferred to have their medicines. People were not supported to be as independent as possible and their dignity was not respected when they were given their medicines.

People who were not able to use speech to communicate where given limited choices about the meals they received. People were not being supported to develop their decision making skills to promote their independence and have more control. People were offered and received a balanced and healthy diet. People looked healthy and had a wide range of foods available. When people were not eating well the staff made sure they were seen by dieticians and their doctor.

Staff were caring and respected people’s privacy. People received the individual care and support they needed to keep them as safe as possible. People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team.

The care and support needs of each person was different and each person’s care plan was personal to them. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way. However, plans for behaviours that challenged did not support positive behaviour. Specialist behavioural support had not been accessed to support people and staff in using approved techniques to manage  behaviours that challenged.

Staff had the support they needed to make sure they could care safely and effectively for people. Staff had received regular one to one meetings with a senior member of staff. Staff had completed induction training when they first started to work at the service and had gone on to complete other training provided by the company. The training records were up to date and reflected the amount of training the staff had received.

There were regular staff meetings. Staff said they could go to the registered manager at any time and they would be listened to. A system of recruitment checks was in place to ensure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed. There was enough staff to take people out to do the things they wanted to. People were involved in activities which they enjoyed.

The complaints procedure was on display in a format that was accessible to people. Feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff told us that the service was well led and that the management team were supportive and approachable. They said there was a culture of openness within Ashingham House which allowed them to suggest new ideas which were often acted on. Quality assurance systems were consistently applied. Audits and health and safety checks were carried out.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We reviewed all the information we hold about this provider, then carried out a visit on Saturday 16th November 2013. We observed how people were being cared for, talked with staff, checked the provider’s records and looked at records of people who used the service.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff. People expressed themselves by using sounds, gestures, body language and pointing to objects and pictures. They indicated that the staff treated them with respect and that they felt reassured to be in their company. They indicated that they received the health and personal care they needed and that they were comfortable in their home.

People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs.

We made an unannounced visit to the service and spoke to people who use the service, specialist community services, the manager and to staff members.

There were 8 people living at Ashingham House when we did the inspection.

Some of the people living in the home were unable to verbalise to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We saw that the staff were friendly with the people and they seemed relaxed in the home.

People told us and indicated that they received the care and support that they needed at Ashingham House.

People who use the service indicated that they were happy at the home. Some people were participating in activities which they indicated that they enjoyed.

Staff told us that care plans had enough information about how to look after people in the best way. They said that they thought the training they received was adequate to meet the needs of the people.

The staff we spoke to had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw staff responded in a caring and positive way.