We inspected Ashton Lodge in January 2019 and this inspection was unannounced. Ashton Lodge provides care for to up to 54 adults. Accommodation is provided over two floors.

Ashton Lodge 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.

We inspected Ashton Lodge in June 2016 and rated the home as ‘Requires Improvement’ overall. At the following inspection in September 2017 we rated the home as ‘Inadequate’ overall with breaches of the legal requirements. In April 2018 improvements had been made so the home was rated ‘Requires Improvement’ overall with Inadequate in well led.

At this inspection in January 2019 improvements had been made resulting in an overall rating of ‘Requires Improvement’ with Good in caring. At the previous inspection there had been three breaches of the legal requirements. In dignity and respect, person centred care and in the governance of the home. At this latest inspection there were no breaches of the legal requirements.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a registered manager in place when we inspected the home. 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 some issues which had the potential to put some people at risk of harm. A person’s oxygen was not being stored safely. The use and storage of the oxygen had not been risk assessed and was not being fully monitored to ensure the person using the oxygen and others were safe.

People who needed to be supported to be transferred using a hoist were at risk of becoming ill through cross contamination of the slings used in this process, as people did not have their own slings. We found staining on one of these slings and they were bunched together. We also found some recent errors with people’s medication. Some people had not received their medicines as prescribed. Some medicines were also not stored safely and some which were being used were out of date.

When we raised these issues with the registered manager they took swift action to start addressing them.

People had risk assessments in place and care plans to advise staff about how to meet people’s needs. However, we did find that improvements were needed in how the service managed and risk assessed people who were at risk of self-neglect. Systems and plans were not in place to manage these situations.

Staff recruitment checks helped ensure people were safe around new staff. However, staff did not have a full employment history in place despite this being brought to the provider’s attention at previous inspections.

Various safety checks were being completed of the equipment used and of the building to check people were safe. This included a recent fire safety inspection from the fire service.

Staff knowledge about what abuse could potentially look like was limited at times. Also, staff were not clear on how to report concerns outside of the home. We made a recommendation about improving staff knowledge in this area.

The management team completed various competency checks on staff when they started at the home and during their working life at the home. This was to ensure staff were per

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Ashton Lodge 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.

Ashton Lodge provides personal care and accommodation for older people. Many people living at the home were living with some form of dementia. Ashton Lodge is registered to provide care for up to 54 adults. At the time of this inspection 51 people were living at the home. Ashton Lodge comprises of a building offering accommodation over two floors.

There was not 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. There had not been a registered manager since 25 July 2017.

The previous provider’s nominated individual had taken over the management of the home following the last inspection. However, there were no provider level quality monitoring visits, to review the quality of the care being provided. The service had benefited from involvement from the local authority following the last inspection and rating of Inadequate. However, the service had no other plans in place to provide an independent review of the service. When this level of involvement provided by the local authority ends, it was unclear how the service will continue to develop. Especially without a registered manager in place.

Staff did not always treat people in a respectful way which promoted their dignity and wellbeing. Although improvements had been made in this area following our previous inspection staff were not consistently treating people in a respectful way.

Improvements had been made to promote people’s social needs. Activities were being provided daily. People who spent all their time in their rooms received some support and time from staff, although we questioned if these people needed or would benefit from more support from staff.

Despite this we found that the service was not always trying to meet people’s individual social needs. The management of the home was not always identifying people’s interests, past hobbies, and achievements. They were not using this knowledge in a meaningful way to actually promote people’s social needs. Staff were not spending time chatting and engaging with people on a regular basis.

These issues constituted a breach in the legal requirements. There were breaches of Regulation 17, 10, and 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These are continued breaches from the last inspection. You can see what action we told the provider to take at the back of the full version of the report.

People now had risk assessments in place which identified their needs and the risks they faced. However, these assessments did at times lack details about how people’s long term conditions were being managed and how they affected people on an individual basis. One person’s risk assessment had not been updated following a change to their needs. There was no new plan of action for staff to follow to help reduce the risks which they fa

The inspection took place on 31 August and 1 September 2017.

Ashton Lodge is registered to provide care to 54 people some of whom are living with dementia and long term conditions. The accommodation is set over two floors. Originally an old school, the building has been extended over the years.

There was not 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider was considering applying to become the registered manager. We will be monitoring this. The provider was present at the home and working with the acting manager. Another manager from one of the providers other homes was also present, supporting the service.

At this inspection we found seven breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We brought the inspection forward due to a substantiated safeguarding concern.

People did not have robust and clear risk assessments in place which identified the risks which they faced, with a plan for staff to follow to mitigate these risks. The provider was aware of this issue and there was a plan to re-write these documents. However, this issue was raised at our last inspection and action to improve these documents had only just started.

The staff had a good understanding about how to protect people from potential abuse and harm. However, the existing management team did not have a full understanding about when certain safeguarding events, should be reported to the Local Authority and CQC.

We identified some concerns with potential infection control. Staff were not always following safe and appropriate practice to prevent the spread of infection. There were times when we identified hygiene issues in the communal bathrooms.

There were various safety checks which the service was completing in relation to ensuring the equipment within the home was safe to use. However, the service did not have an effective emergency plan in place for staff to follow, if there was an emergency within the building. Recr

This inspection took place on 30 June 2016 and was unannounced. When we inspected the service in November 2013 we found that the provider was meeting all their legal requirements in the areas that we looked at.

Prior to this inspection we had received concerns in relation to the infection control procedures in the service and the care people were receiving. We had also received concerns regarding the environment and the cleanliness of the kitchen.

Ashton Lodge provides accommodation and care for up to 54 people with a variety of social and physical needs, some of whom may be living with dementia. At the time of our inspection there were 40 people living at the service with one person having recently been admitted to hospital.

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.

An appropriate level of cleanliness was not maintained throughout the service.

People's needs had been assessed and care plans took account of their individual needs but lacked detail with regards to their preferences, choices and individuality. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current care needs.

There were personalised risk assessments in place however they did not offer robust guidance to staff on how individual risks to people could be minimised and the care provided to some people was not consistent with the assessments in place.

There were mixed opinions with regards to the activities provided at the service. There were limited activities on the day of our inspection and some staff we observed did not engage people in social conversation.

People told us there were sufficient numbers of staff on duty. However we observed there were significant periods of time when people were not supported by having a member of staff available. This was mainly observed during early morning, within the communal lounge areas of the service.

The registered manager completed quality monitoring audits and it was clear how these were used to drive improvements in the service however they did not routinely consider the experiences of people living in the service.

Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

Medicines were managed safely and medicines audits were completed regularly.

Safe recruitment processes were in place and had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff were trained and had the skills and knowledge to provide the care and support required by people. New members of staff received an induction.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were supported to make choices in relation to their food and drink and a varied menu was offered. People's health care needs were being met and they received support from health and medical professionals when required.

Staff were friendly and respectful. People's privacy and dignity was promoted throughout their care. People were provided with information regarding the services available.

The management team were approachable and staff felt supported in their roles.

People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.

When we visited Ashton Lodge on 5 November 2013 we spoke with six people who use the service and five staff members including the manager. People told us they liked living at Ashton Lodge and the staff treated them well. One person said, “It's ok living here.”

We observed people were engaged in an armchair exercise by an outside facilitator which they enjoyed. Interactions between people and staff were positive. We found that staff treated people with respect and upheld their dignity. For example, staff called people by their preferred name. When providing assistance to people they made sure that they explained what they were about to do.

We found that people looked comfortable in the company of staff and there was a relaxed atmosphere in the home.

The system in place to maintain appropriate standards of cleanliness and hygiene in the home had been reviewed to ensure that people lived in a clean hygienic environment.

We found that risk assessments to identify any potential risks of the premises being unsafe or unsuitable had been undertaken to ensure people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The complaints process had been reviewed to ensure that the complaints system was effective and complaints were investigated within the agreed timescale and to people’s satisfaction.

This inspection of Ashton Lodge on 21 August 2013 was carried out in response to information of concern received by the Care Quality Commission (CQC). The information alleged that people were unkempt with continence care needs not being met and personal preferences about daily living not respected.

We found that people were satisfied with the care and support they received. They said staff respected their privacy and dignity. Everyone said the care provided was good. One person said, “They (Staff) have a hard job here and they do a great job….they do keep me comfortable.” Another person said, “I have nothing I could complaint about, I am very well cared for.”

The people who were living at Ashton Lodge when we visited on 9 August 2012 told us that the staff were ‘marvellous’ and that it was ‘wonderful here’. Others told us that the home was ‘very good’ and praised the choice of meals and availability of tea and coffee making facilities during the day in one of the four lounges. Some people had varied levels of verbal communication, however they demonstrated through speech, facial expressions and gestures that they were satisfied with the care and support they received. People looked well cared for and were encouraged to remain independent.

During our visit on 21 November 2011, people we spoke with were complimentary about the care that was provided. They told us that they were given a choice at mealtimes and they were able to change their minds if they wanted to.

Some people told us that the staff were friendly, treated them with respect and spoke politely. One person said, “Staff are usually quick at responding to us if we call out, but it can at times take a little while if they are dealing with others”. A visiting relative told us they had found the care to be excellent.

When we visited Ashton Lodge on the 21 and 23 May 2013 we spoke to six people who use the service, a relative and a healthcare professional. We also spoke to four staff members, the manager and the proprietor. We found that people were satisfied with the care and support they received. They said staff respected their privacy and dignity. Everyone said the care provided was good. One person said, “I like living here. I would not change it.” Another person said, “We are well looked after.” We spoke with a relative who said the care was “good”.

We found that appropriate standards of cleanliness and hygiene in the home were not maintained. People were not protected against the risks associated with unsafe or unsuitable premises. An effective complaints system was not in place to ensure that complaints made were fully investigated and so far as reasonable practicable, resolved satisfactorily.