This inspection of Ashleigh House took place on 28 March, 6 and 24 April 2018. It was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. During this period we also received information from the registered manager, such as an action plan and discussed the expected changes to the service with them and the area manager.

We last inspected this service in 28 September 2015, and found the service was complying with all the regulations and we rated the service as ‘Good.’

In November 2017 owners of Salutem Healthcare replaced the directors of Pathways Care Group Limited and took over the operation of the service. This change of leadership also meant that the provider has become a part of a wider Salutem Healthcare consortium. Pathways Care Group Limited remains listed, as an active legal entity on Company House and thus remains appropriately registered with CQC. However, some of their documentation contains information about this new company, as does the website.

During this inspection we found the service needed to take action to ensure they met all the fundamental standards we inspected against.

Ashleigh House is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashleigh House is registered to provide care and accommodation for up to 30 people who are living with dementia or a mental health condition. On the day of our inspection there were 15 people using the service.

Whilst reviewing the information for the service we found that since the last inspection the provider’s website had changed and stated that Ashleigh House provided 20 places for people living with dementia and people with a mental health condition in to two 10 place units. However, we found this was not the case as 27 places were available for people with mental health needs. The provider rectified the website immediately.

The registered manager told us that the service was being redesigned and would offer services for people living with mental health conditions who needed 24 hour support and then progressive step-down and transition services, which were aimed at supporting people to move to their own accommodation. The regional manager also discussed future plans for the service such as employing a clinical nurse lead and opening a day unit that provided drop-in services, a meal on a Sunday, access to welfare and citizens advice for local people living with mental health needs. The intention they told us was to offer wider services so that outreach and supported living provision could also be offered from Ashleigh House.

We discussed with the regional manager and registered manager the need to submit an application to vary their conditions of registration so the number of available places could be reduced to 27. As some of the people at the service were also living with a learning disability that this needed to be added their service user bands. They undertook to do this immediately.

The service had a manager who became the registered manager in September 2015. 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.

On the first day of the inspection we found that the lift had been out of order for a year. Also the local NHS Trust’s infection control team had visited the previous year and required a number of changes to the environment to be made immediately, which included replacing flooring. We found that although some of the damaged flooring had been replaced other areas such as stairs needed immediate attention. The outside of the building was t

One inspector carried out this follow-up inspection. During the inspection, we spoke with the manager, three members of staff, four people who used the service and one relative.

This was a responsive inspection due to concerns raised and we looked to see if the service was safe and well led.

The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We looked through three care files out of a possible 14. This was due to concerning information stating that note keeping was poor and new staff were not able to follow care plans which put people at risk. We found the care files provided enough information to make sure people were supported in the way they wanted. Staff employed by Ashleigh House had the right qualifications, skills and experience.

We asked to see the services policy on behaviour that challenges, due to people who used the service having early onset dementia and mental health conditions. Ashleigh House did not have a policy for behaviour that challenges, they did have a policy on aggression towards staff but this did not cover the support for someone showing behaviour that challenges which is not always aggression.

Is the service well-led?

Minutes from staff meetings were available for us to see. Due to a number of issues within the home, staff meetings had not taken place as regularly this year. This was something the manager was aware of and told us they were going to rectify.

In the last 18 months, 26 staff had left the service's employment. Four of these staff had left due to their own choice, 22 staff had been released following unsuccessful probation periods or dismissed due to misconduct. The manager told us that removing some staff from the home had a positive impact on the remaining staff. New staff had been recruited correctly but there were gaps in staff training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our inspection they had one DoLs safeguarding authorisation in place.

What people told us:

We spoke with four people who used the service, one relative, the manager and three members of staff. People who used the service said “I really like it here, I can do what I want,” and “I can get a cup of tea or something to eat whenever I want,” and “All the staff are fine.” Another person said “You get plenty of choice and can go where you want, I prefer to eat downstairs and I do.”

The relative we spoke with said “It’s always welcoming with a nice and friendly atmosphere,” and “I can come whenever I want, they have nice safe, friendly staff.”

Staff we spoke with said “I have not been here long, but I really enjoy it,” and “It’s a lovely place to work, all the staff and clients are lovely.” and “People who live here like to do their own thing but I try to think of things we can do together like movie quizzes.”

An adult social care inspector visited this service which helped us gather evidence against the outcomes we inspected to help answer the five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The summary was based on our observations during the inspection, we spoke with people who used the service and staff who worked there, and looked at records.

Is the service caring? – People told us they were given choices about how their care was provided and that these were respected by the service. We spoke with three people who used the service who were complimentary about the staff at the service and stated they could raise any issue and staff were very quick to respond.

Is the service responsive? – The service held regular meetings with people who lived at Ashleigh House and people were asked about their views on the quality of the service. The service had good relationships with other health and social care professionals and we saw that the service was quick to request support for people’s physical and mental health if it was required.

Is the service safe? – The service had safeguarding policies and procedures in place and the manager and staff we spoke with knew how to respond to any concerns that were raised with them. Three people we spoke with all said they felt safe at the service. One person said; “I feel safe here, I talk to the staff if I feel low or lonely”. There were good systems in place for ensuring medication was stored, administered and disposed of safely. One staff told us; “It’s a lot easier now we have a new system in place, I feel much more confident with it”.

Is the service effective? – We saw that care plans had a person centred format, and they showed how people’s views and preferences about their care had been recorded. People were supported to give their consent so information the service held about people was used appropriately with staff and other professionals on a need to know basis.

Is the service well-led? – The manager had a system of seeking views from people who used the service and held meetings with the staff team and provided training and support through regular supervisions. The manager also reviewed incident reports at least weekly and checked the quality of recording in peoples care plans.

What people told us –

We spoke with four people who ilved at Ashleigh House and observed staff and the manager have lots of positive and supportive conversations with people throughout the day.

Comments from people included; “I love it, I’m happy living here”;

“It’s sound here”;

“The staff have got our interests at heart”;

The staff are nice”;

“I do feel safe here, I can tell the staff if I’ve got a problem”;

“We can make our own breakfast, lunch and supper, it’s great”;

“There is plenty to do it’s just whether I can be bothered to get off my butt and do it!”.

We spoke with three people and they all said they were happy with the service. One person said “The staff are hellish, they help me and I go to the shop myself for chocolate. Staff help me clean my room”.

Another person said they had help from staff and “We do things like bingo, pool competitions and have trips bowling. The staff and the manager are alright”.

We saw that staff were supported to carry out their roles and there were enough qualified, skilled and experienced staff to meet people’s needs. The provider followed the correct procedures regarding the risk of infection. The provider had systems in place to monitor the quality of service provided.

There were systems in place for checking the safety and quality of the service. We saw that people living at the home were fully involved in the planning and cooking of meals and they were encouraged to be as independent as possible in the kitchen. One person was supported to have a vegan diet and the home enabled him to get specific foodstuffs for his diet.

Records were held securely and people had signed to show they were involved in their care plans and risk assessments. One person told us; “I love it here it’s a home from home”.

Staff members had a good knowledge of infection control procedures. We saw the environment whilst still being homely, had equipment available such as personal protective equipment and colour coded mops to reduce the risks from poor infection control, however we discussed with the registered manager that the laundry equipment was not adequate to address infection control regulations.

We did not speak to people who used the service during this inspection regarding records.

We found that provider had accurate records in place to ensure that people were protected form the risks of unsafe or inappropriate care.

We spoke to two people who lived at the care home. They were both satisfied with the service at Ashleigh House. One person said "I'd like a designated smoking room as they had one where I used to live" they also said "I have done my care plan with my key worker but it was a while ago". The person also said "I've had a review with my social worker but it was a while ago" and "I'm happy here, I'm not well enough to go anywhere else".

The other person we spoke with said they were “As happy as they could be. There were no major things wrong.” They felt that the staff looked after their needs and if they needed anything they would get it for them. They knew they had a care plan but were not involved in it through their choice. They also told us that they were going on an outing to the cinema that afternoon.

We previously visited Ashleigh House on the 27 September 2012. During this visits we found that care and treatment was not planned and delivered in a way that ensured people's safety and welfare.

At this visit we found that a review of all care plans had been initiated and the manager told us that of the eleven care plans five were to satisfaction. We examined six care plans and found that three were not fit for purpose. One person’s care plan had no risk assessments to address risks identified and reviews and updates had not been carried out. In the case of the other two people care plans and risk assessments had not been updated or reviewed.

The people living at the home told us they were happy with the service. One person told us “the staff are good here” another person told us “it’s alright here” and “I can talk to the staff here”.

One person said that “it would be better if we had a proper covered area to smoke outside”. Another said “things have changed for the better in the last few weeks, I feel happier and safer”. We were also told by a visiting social worker; “the atmosphere today compared to a few weeks ago, is totally different. Staff are smiling again and I can see a real change.”

We spoke to a visiting social worker who told us “I had no concerns until a few weeks ago. My client had previously had excellent support from staff”.

People told us about activities that they did such as dominoes, painting and cooking. We also saw activities which were due to take place which included a nature walk and a DVD night. Both staff and service users told us that activities were just beginning to be organised properly but needed better co-ordination.

People told us that staff were starting to encourage service users to be more independent for example prompting them to cook their own food and to tidy up their crockery and cutlery after they had eaten a meal or snack. One person said that they “didn’t have a bad word to say about any of the staff” and they felt they kept them safe.

The inspection took place on 28 September 2015. The inspection was unannounced.

Ashleigh House is a residential care home for up to 30 people based in Darlington. The home provides care to people living with dementia and people with mental health problems. It is situated to the north of Darlington, close to local amenities and transport links. On the day of our inspection there were 14 people using the service.

The home 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.

We spoke with care staff who told us they felt supported and that both the registered manager and area manager were always available and approachable. Throughout the day we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other. The atmosphere was calm and relaxed and we saw staff interacted with each other and the people who used the service in a very friendly, positive and respectful manner.

From looking at people’s care plans we saw they were written in an easy to read and person centred way and made good use of photographs to describe their care, treatment and support needs. These were regularly audited and updated. The care plan format was easy for service users or their representatives to understand and we could see that some family members and people had signed their care plans.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: the mental health crisis team and care managers.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes.

When we looked at the staff training records they showed us staff were supported to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended both face to face training and eLearning opportunities. They told us they had regular supervisions with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were robust recruitment processes in place.

We looked at how the service administered medication and how they did this safely. We looked at how the records were kept and spoke to the area manager about how staff were trained to administer medication and we found that medication administering process was safe.

During the inspection we witnessed staff have positive rapport with the people who used the service and the interactions that took place were natural. The staff were caring, positive, encouraging and attentive when communicating and supporting people.

We observed people were encouraged to participate in a range of activities that were personalised and meaningful to them. For example, we saw staff spending time engaging people with people on a one to one basis on an activity and others being supported to go out and be active in their local community.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a selection of choices of drinks and the menu that also offered choice.

We found the building and outside garden area and smoking area met the needs of the people who used the service.

We saw a complaints procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services.

We found an effective quality assurance survey took place regularly and the results were on display. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service, their representatives and other healthcare professionals were regularly asked for their views.