About the service.

At the time of the inspection there were eight people with a learning disability living at the Ashurst House. The service was a large home, bigger than most domestic style properties. It was registered to support up to eight people. This is larger than current best practice guidance. However, the size of the service was not having a negative impact on people as the building design fitted into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. One person described the service as, “It’s the best thing in the world living here”.

The provider and registered manager had oversight of the service. They checked that the service met the standards they required and worked to continually improve the support people received.

People were involved in everything that happened at the service. Staff knew people well and supported them be independent. Staff were caring and treated people with dignity and respect. People told us they felt safe at the service and they got on well with the staff.

Assessments of people’s needs and any risks had been completed. People had planned their support with staff and took managed risks. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager. People were not discriminated against and received care tailored to them.

People were supported to be as independent as they wanted to be and took part in tasks and activities they enjoyed at the service and in the community. People chose the staff they wished to support them each day.

People were supported to remain as healthy as possible. Staff supported them to health care appointments and for check-ups. People’s medicines were managed safely. People were supported to plan and prepare balanced meals, of food they liked and met their cultural needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when people were at risk of being deprived of their liberty.

Staff felt supported by the registered manager and were motivated. The registered manager was always available to provide the support and guidance staff needed. Staff worked as a team and supported people in a consistent way. Records in respect of each person were accurate and held securely.

There were enough staff to support people in the way they preferred. Staff had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and shared the providers vision for the service. Processes were in place to recruit safely.

The service was clean and well maintained. The building had been adapted to meet people’s needs and make them feel comfortable. People used all areas of the building and grounds and were involved in planning the refurbishment.

A process was in place to investigate and resolve any complaints or concerns received.

The registered manager had informed CQC of significant events that had happened at the service, so we could chec

This inspection was carried out on 21 March 2018. The inspection was unannounced.

Ashurst 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.

Ashurst House accommodates up to eight people who have learning disabilities and physical disabilities in one building. There were eight people living at the service when we inspected. Five people lived on the ground floor and three people lived upstairs. The service had a stair lift in place which was used by one person to safely use the stairs.

There was a registered manager employed at the service. 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.

At the last inspection on 16 February 2016, the service was rated Good.

Ashurst House was designed, built and registered before ‘Registering the Right Support’ and other best practice guidance had been published. Ashurst House had not been operated and developed 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 should be able to live as ordinary a life as any citizen, but this was not always the case for every person living at the service.

Risks had not been appropriately assessed and mitigated to ensure people were safe.

Medicines were not always managed safely. Records had not always evidenced that people had received their medicines as prescribed.

There were enough staff deployed to meet people’s needs in the mornings. However, staffing levels had been reduced; there were less staff on shift in the afternoons which meant there were times in the day where people did not have adequate supervision. We made a recommendation about this.

The provider operated safe and robust recruitment and selection procedures to make sure staff were suitable and safe to work with people.

Staff knew what they should do to identify and raise safeguarding concerns.

The service was clean, tidy and equipment had been properly checked. Shower heads had not always been cleaned in accordance with the legionella policy. We made a recommendation about this.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always maintained adequately and kept securely.

People were encouraged to make their own choices about every day matters. Where people may not have the capacity to make decisions and choices about their care, there was no evidence that capacity assessments and best interests meetings had taken place.

People were supported to have enough to eat and drink. People had choices of food at each meal time. People were enabled to make their own breakfasts, drinks and snacks. Staff had not followed good practice guidance to ensure meals were appetising. Food records did not always identify what was eaten.

People continued to be supported to maintain good health. Staff ensured people attended scheduled appointments and check-ups such as with their GP or consultant overseeing their specialist health needs.

One person was not always receiving care and support which met NICE guidance in relation to prevention and interventions for people with learning disabilities whose behaviour challenges. We made a recommendation about this.

Staff had received training to carry out their roles and further training had been planned. Staff received support to carry out their roles. Staff received regular supervision with

This inspection took place on the 16 February 2016 and was unannounced.

Ashurst House provides care and accommodation to up to eight adults with a learning disability. People had a variety of complex needs including mental and physical health needs and behaviours that may challenge. There were eight people using the service at the time of our inspection.

The service 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. A senior member of staff was in day-to-day charge of the service whilst the provider was actively recruiting a new manager.

CQC 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).

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff.

Staff had been trained to recognise and respond to the signs of abuse. Discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy and how to use it. They were confident they could raise any concerns with the registered provider or outside agencies if this was needed.

Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

Staff respected people in the way they addressed them and helped them to move around the service. We saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served and at other times during the day.

Staff were knowledgeable about the needs and requirements of people using the service. Staff involved people in planning their own care in formats that they were able to understand, for example pictorial formats. Staff supported them in making arrangements to meet their health needs. They had access to health services and referrals for additional support were made when people needed it.

Medicines were managed, stored, disposed of and administered safely. People received their medicines in a safe way when they needed them and as prescribed.

People received the support they needed to eat and drink. They had a choice of meals from a varied menu. Mealtimes were a relaxed and pleasant experience for people.

People’s care was planned and delivered in a personalised way. The service had been organised in a way that promoted a personalised approach to people’s activities. People were involved in making decisions about their care and treatment and had been supported to decide how they would like to be occupied, for example social activities and going out. People were given individual support to take part in their preferred hobbies and interests.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. The risks to individuals, for example in moving safely around the service, had been assessed and action taken to reduce them. Staff understood how to keep people safe. The registered provider had taken action to ensure the premises were safe and met people’s needs.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People knew how to make a complaint if they needed to. Complaints were responded to quickly and appropriately and people were given feedback in a way they could understand.

There were systems in place

During our inspection we sat with people that used the service, listened to their comments and observed facial expressions and interactions with staff. We spoke with staff as we observed the usual daily routines of the home. The inspection was assisted by the manager and area manager for the company.

People indicated that they liked living at Ashurst House. We observed people being involved in discussions about the help they needed and their preferred day to day routines. We saw that people had enough to do and could join in with activities if they wanted to. We observed that the staff were kind, caring and on hand to help when needed.

People were asked for their consent before any care or treatment was given.

People received care and support that was well planned and sensitively delivered.

People benefited from the homely environment.

We found that there was a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.

Effective quality assurance procedures ensured that people were provided with a good service.

People indicated that they liked living at Ashurst House. We observed people being involved in discussions about the help they needed and their preferred day to day routines. We saw that people had enough to do and could join in with activities if they wanted to. We observed that the staff were kind, caring and on hand to help when needed. People said they liked the food and there was a choice of menu. One person said they "liked the food" and another person said that they "enjoyed the outside activities".

People told us that the care and support they received was very good and there was plenty for them to do.