We undertook an unannounced inspection on 30 January 2018.

Ashleigh House is a ‘care home’. People in care homes receive accommodation and nursing or 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 accommodates up to 10 people with mental health needs in one adapted building. At the time of our inspection, nine people were using the service.

At the last inspection on 1 December 2015, the service was rated Good.

At this inspection, we found the service remained Good.

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.

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

People received care appropriate to the identified risks to their health and well-being. People’s care delivery was planned and reviewed to ensure staff met their needs. The provider ensured people had access to information to access the services they required.

People were supported to manage and take their medicines. Staff managed medicines safely in line with best practice.

People were cared for by staff who were supported in their roles. Staff learnt from incidents and accidents. People experienced high standards of care and support. The quality of care underwent checks and improvements were made when needed.

Staff had the knowledge and skills to perform effectively in their roles. People received care from staff who had attended training and refresher courses to keep their knowledge up to date.

Staff delivered people’s care in a manner which promoted their freedom.

There were enough members of staff to meet people’s needs. People enjoyed positive working relationships with staff who provided their care.

Staff provided people with the support they required.

People had access to healthcare services when needed and their dietary needs were met. Care delivery was in line with the requirements of the Mental Capacity Act 2005.

People were involved in making decisions about their care. People consented to care and treatment which staff provided in line with their wishes and preferences. Best interests meetings were held to support people who were unable to make decisions about their care.

People had opportunities to share their views about the service. The provider acted on people’s feedback to improve service delivery. People knew how to make a complaint.

The registered manager maintained a visible presence at the service. People and staff knew the registered manager and were highly positive about the manner in which they managed the service. Staff enjoyed good teamwork and felt supported by their colleagues. Staff had access to guidance when needed and were confident the registered manager took their concerns about people’s well-being seriously.

People’s quality of life was improved because of the close working partnership between the registered manager and other agencies.

This inspection took place on 11 December 2015 and was unannounced.

Ashley House is a residential home that provides accommodation and support to up to ten people with mental health needs in the London Borough of Lewisham. At the time of the inspection there were eight people living at the service.

There was a registered manager in post. 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.

People received their medicines as prescribed and safely. The service had robust systems in place to ensure the safe management of medicines. Staff received ongoing training in safe handling of medicines.

People were protected against the risk of abuse by staff that had clear knowledge on how to identify the different types of abuse and how to report their concerns. The service had clear risk assessments in place that identified known risks and guidelines in place to mitigate the risks. Risk assessments were regularly reviewed to reflect people’s changing needs.

Care plans were person centred and where possible people were encouraged to contribute to the development of their care plan. Care plans were regularly reviewed and contained detailed information about all aspects of the care provided. Care plans accurately reflected people’s changing needs.

People did not have their liberty restricted unlawfully. The service demonstrated good practice in protecting people’s liberty and following the Mental Capacity Act 2005 and Deprivation of Liberty

Safeguards. These aim to make sure that people in care homes, hospitals, and supported living are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and lawful manner.

The service had undertaken the appropriate checks to ensure people were supported by staff deemed suitable to work within the service. The service provided new employees with robust inductions, which were extended should staff require additional support and training. Staff received regular support, supervisions and appraisals to help them reflect on their work and identify training and development needs. People were supported by sufficient numbers of staff, who received ongoing training in all mandatory areas to meet people’s needs

People received care and support from staff that treated them with dignity and respect. Staff sought peoples consent prior to delivering care.

People had access to sufficient food and drink to meet their nutritional needs and were supported to access health care professionals to support and maintain their health care needs.

People were encouraged to participate in a wide range of activities both in the service and when accessing the local community.

The registered manager operated an open-door policy, whereby people, staff and visitors could meet with the registered manager to discuss any areas of concern or seek guidance and support. The registered manager valued people, staff input, and acted swiftly to concerns and complaints.

The service carried out regular comprehensive audits of the service and actively sought feedback of the delivery of care by way of team meetings, house meetings, review meetings and quality assurance questionnaires.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People were protected from the risk of abuse. Staff were knowledgeable in recognising signs of abuse and were aware of the reporting procedures to the local safeguarding team. Staff were aware of their responsibilities under the Deprivation of Liberty Safeguards (DOLS).

Risks to individuals and to others using the service were identified upon admission to the service and plans were put in place to minimise and manage these risks.

Is the service effective?

Individual care plans were in place outlining to staff the care and support needs of people who used the service. These plans identified the physical health, mental health, social, financial and cultural needs of people who used the service. People were supported by staff in line with their care plans.

A care co-ordinator from the local NHS mental health trust told us they felt people received the care and support they required. They said staff kept them updated on a person’s progress.

Staff received the training required to ensure they had the skills and knowledge to support people who used the service.

Is the service caring?

People who used the service told us they liked staying at the service. One person told us, “it’s home.” People told us they liked the staff and the staff supported them where required.

People were involved in decisions about their care. We saw that, when they wished, people signed their care plans and risk assessments to indicate they were in agreement with the plans in place.

People met with their key worker (a member of staff dedicated to their care) monthly to discuss any additional support needs or concerns they had.

Is the service responsive to people’s needs?

Staff were responsive to people’s needs and we saw care and support was delivered in line with their interests and preferences. The activities offered at the service were tailored to meet people’s interests and help people to engage in the service.

People were aware of how to complain and who to speak to if they had concerns. We saw that complaints made had been responded to quickly, including explaining to people why certain processes were in place. People had the opportunity to discuss the service and identify any concerns or suggestions through regular meetings for people who lived there.

Is the service well-led?

There were processes in place to monitor the quality of the service. Any areas for improvement were identified and addressed.

Staff reported that the manager was accessible and they felt comfortable raising any concerns or suggestions with them. Staff felt listened to and involved in decisions about the service. There were regular staff meetings to discuss any changes to service provision and to give information to the team about changes in practice.

We carried out this visit following concerns that were expressed to the Care Quality Commission (CQC) about the quality of food being provided to people using the service; and also concerns regarding the staffing levels.

We observed the lunchtime meal. People were given a choice of soup, sandwiches or a hot snack, or a mix of all of them. We asked four of the people if they were satisfied with their food. They all said that they were.

We reviewed the staff rota. It showed there were two staff rostered to be on duty during the day, and one sleeping in at night. At the time of our visit, there were two staff on duty, as per the rota. One of these was the manager however, who often worked as part of the rostered staff team.

We found that staff did not receive regular supervision, largely because the manager did not work in a supernumerary position and therefore did not have the time to hold regular supervision meetings. We also found that staff were not given the opportunity to attend training relative to the client group they cared for.

At a previous inspection on 22 January 2013 we found that there were not enough staff to support the people using the service and provide the management and leadership required. The provider recognised that additional staff were required to meet this shortfall. However, at an inspection on 07 June 2013 the provider had been unsuccessful in recruiting appropriately skilled and experienced staff.

At this inspection on 25 September 2013 we found that the provider had successfully recruited a senior support worker and there were enough qualified, skilled and experienced staff to meet people’s needs. We saw that shifts were appropriately staffed and there were enough staff to cover annual leave, training and sickness.

There were nine people living at Ashleigh House at the time of our inspection. During our inspection we spoke with three people using the service and with three staff.

People’s care was planned and delivered in line with their care plans and in a way which met their needs. The provider had reviewed and updated the information provided to people at the home, service commissioners and family members, to ensure that it accurately described the services provided at the home and was not misleading.

We found that, since our previous inspection on 22 January 2013, the provider had implemented changes to the consent process, which meant that staff asked people for their consent before they provided care and acted in accordance with their wishes.

People were being provided with a choice of suitable food and drink, and healthier options were available. People told us “the food’s okay” and “I like it”. We saw evidence that where people had identified dietary or health needs staff tried to support them to make healthy eating choices.

At our previous inspection in January 2013, the provider told us that vacant staff posts would be recruited into, to fully meet the needs of people using the service. However, these posts had not been recruited at the time of this inspection. This meant that the manager continued to cover vacant support worker shifts, and either had fewer hours available for his required supervisory and management duties or had to work long shifts.

We spoke with four of the nine people living at Ashleigh House and with three members of staff at our inspection.

One person told us that he felt settled and two people said they liked the home because it was "peaceful”.

Staff were aware of how people wanted their care to be given and of their personal preferences. Overall, care was planned and delivered in line with people’s individual care plans, although there was a lack of documentary evidence that people were always asked for their consent before any care was given or their information was shared with other people.

We saw staff responding to people's questions and requests in a respectful and timely way, and encouraging them to make their own choices.

People told us that the staff were friendly and helpful. However, although the provider had identified the need to recruit two support workers, these posts had not been advertised. We found that the manager was often acting as a duty support worker, and therefore had fewer hours available for his supervisory and management duties.

We found that people were not always being provided with a choice of suitable and nutritious food and drink, suitable to their identified needs, and that the social activities provided at the home were limited.

We also found that much of the information provided to people at the home, and to service commissioners and family members was out of date and, therefore, potentially misleading.

People we spoke with told us they were happy and satisfied with the service. They told us they were well looked after and the staff were friendly and supportive.

People told us that they were happy with the care at the home. They said that they were well cared for and that the staff were friendly and supportive.

However, on our visit on the 14th June 2011 we found a number of concerns with the care being provided at the care home. For these areas we have asked for immediate improvement.