We inspected this service on 5 and 19 April 2018. The inspection was announced as support was provided to people who may have found an unannounced visit challenging.

The provider is required as a condition of their registration to have a registered manager in post. A new manager started at the service in September 2017 and had applied to the CQC to become the 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.

Ashlar House had 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 and autism using the service can live as ordinary a life as any citizen. At the time of our inspection, seven people lived at the service.

At our last inspection in February 2017 we rated the service as ‘Requires Improvement’ over all. We made a recommendation for the provider to formalise their system of audits to ensure risks, around the health and safety of the environment and recording of medicines, were not overlooked. At this inspection we found the quality assurance systems continued to be ineffective and have again rated the service ‘Requires Improvement’ over all.

People did not consistently receive person-centred care. Person centred care is when care and support is planned with the person and taking on board their preferences and choices. Records did not demonstrate people were involved in discussions about their care, had consented to this or been involved in setting their goals and outcomes. Regular care reviews were not completed. Some people’s carers noted they were not consistently involved in discussions about the person’s care. There were limited records to show people received adequate stimulation relevant to their needs and choices. Some concerns were raised that people did not receive adequate stimulation and that activities were not person-centred.

The assessment of risk and systems in place to prevent and control the spread of infection were ineffective. The provider did not have an infection prevention and control lead and we found the service was unclean and in need of redecoration and refurbishment.

When people had complex health care needs, which placed them at increased risk, care plans had not been completed.

Staff told us they received supervision however there were only two records of supervisions for the entire staff team. The provider and manager did not have oversight of how often supervisions were being completed. They were unable to confirm who had received support in relation to their well-being, role and professional development which was not in accordance with the provider’s own policy. Staff had not received an appraisal within the last 12 months. Some staff reported a lack of effective communication between them and management.

The provider had not implemented effective systems to monitor the quality and safety of the service. Audits were limited in their scope and had not consistently highlighted the issues we found during our inspection.

The provider’s representative and manager took some actions to address our concerns and reviewed some of the documentation between days one and two of our inspection. They were open and honest with us throughout the inspection and it was evident they wanted to make the necessary improvements for the benefit of the people who used the service.

Staff continued to be recruited in a safe manner and care was provided by a consistent team. The service used regular agency staff and completed checks to ensure they had the necessary skills and knowledge to safely support people. The pr

This was an announced inspection carried out on the 1 and 6 February 2017. At the last inspection in July 2014 we found the provider met the regulations we looked at.

Ashlar House provides care and support for up to eight people with autism. Care is provided on three floors in singly occupied rooms. There are a number of communal areas for dining and relaxation. There is also a garden area to the front and a small courtyard to the rear of the home.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service some months previously. A new manager had been appointed and was in the process of making their application to become the 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 and associated Regulations about how the service is run.

People told us they felt safe and well looked after at the home and there were enough staff to meet their needs. We saw there was a positive atmosphere in the service and people who used the service had developed very good relationships with the staff team. People had thorough management plans in place to manage risks, which staff understood and followed to ensure people’s safety.

There were systems in place to safeguard people who used the service and to ensure people were protected from abuse. Staff knew how to report any suspicions of abuse or poor practice and felt confident anything reported would be acted upon. Recruitment procedures were robust to ensure that staff were suitable and fit to be employed.

Overall there were systems in place to ensure people received their medication safely. However, one person’s medication needed to be reviewed to ensure up to date instructions were in place.

Some areas of the home were in need of cleaning and décor and furnishings were looking worn and in need of replacement and renewal.

People received care and support from staff that had the skills and knowledge to understand their role. Staff training was updated regularly and staff had regular supervision that helped identify training needs and improve the quality of care.

The management team and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had made appropriate referrals to the relevant authorities to ensure people's rights were protected. However, one authorisation to deprive people of their liberty had expired at the time of our inspection. This was immediately addressed by the manager.

People received timely access to healthcare; a range of other professionals were involved to help make sure people stayed healthy. People’s nutritional needs were met well.

People were supported by staff who treated them with kindness and were respectful of their privacy and dignity. Staff understood people's individual needs in relation to their care and communication.

There was opportunity for people to be involved in a range of activities that met their social and cultural needs. People were supported to pursue social interests relevant to their needs, wishes and interests. Arrangements were in place for people to maintain links with the local community, friends and family.

Systems of quality assurance were in place to monitor whether the service was providing high quality care. However, these had not always been effective to ensure continuous improvement in the service. Issues we identified through the process of our inspection had not been picked up from the audits in place. We made a recommendation that systems of audit need to be formalised to ensure risks are not overlooked.

Due to their complex needs, some people who used the service were not able to tell us about their experiences. Staff spoken with said people who used the service were given appropriate information and support regarding their care or treatment.

All the people that we spoke with said they were happy at Ashlar House. One person said, "It's great, it's the best place ever." People said they were supported to live their lives as independently as they wished.

People we spoke with said they were involved in their care plans and any decisions made for example they helped decide where to go on trips.

We observed that people were treated respectfully and that staff were attentive to maintaining the privacy and dignity of those they cared for.

We saw that there were effective cleaning procedures in place which reduced the risk of infection. People told us they liked the people caring for and supporting them. People told us that it was always clean and tidy and everyone helped to do the cleaning.

There was an effective complaints procedure.

Some people who used the service had complex needs which meant that they were not able to tell us their experiences. Those who were told us they were happy with all aspects of service.

People told us they were happy with the care and treatment they were receiving. One person said, “We get looked after very well and another said, “They look after you pretty well here.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This was an announced inspection, which meant the provider was informed 24 hours beforehand to ensure management and residents would be available in the home, as some people went out for the day. During the visit, we spoke with three people living at the home, one relative, four support staff and the Registered Manager.

The home had a Registered Manager who had been registered since February 2012. A Registered Manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

Ashlar House is registered to provide accommodation for people who require personal care for up to eight people with autism. Care is provided on three floors in singly occupied rooms, some of which are spacious. Each person’s room is provided with all necessary aids and adaptations to suit their individual requirements. There are well appointed communal areas for dining and relaxation. There is also a garden area to the front and a small courtyard to the rear of the home.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. People were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements for staff to respond appropriately to people who communicated through their behaviour/actions.

The Registered Manager had been trained to understand when an application should be made, and in how to submit one. This meant that people were safeguarded and their human rights respected. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Suitable arrangements were in place and people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The support plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and staff knew people well. The support plans included risk assessments. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. People were supported to attend meetings where they could express their views about the home.

A wide range of activities were provided both in-house and in the community. We saw people were involved and consulted about all aspects of the service including what improvements they would like to see and suggestions for activities. Staff told us people were encouraged to maintain contact with friends and family.

The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the Registered Manager and the company’s director’s monthly report which included action planning. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.