We inspected A S Care unannounced on the 6 February 2018. We returned to complete our inspection on 7 February 2018.

A S Care 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 S Care accommodates up to 25 older people, some of whom have a mental health condition and some who are living with dementia. At the time of the inspection 22 people were using the service.

The overall rating for the service at our last inspection was Requires Improvement. The service has improved its rating from Requires Improvement to Good in the key questions ‘Is the service effective?’ And ‘Is the service well-led?’ The overall rating of A S Care has improved to Good.

People using the service told us they were safe and that they did not experience bullying. Staff had received training on how to identify potential abuse and know how to alert the appropriate person or external authorities should they have any concerns. To promote people’s safety, potential risks to people had been assessed and measures put into place to reduce risk that were understood and adopted by staff. Information to support people safely with ongoing health related conditions was documented. We found there were sufficient staff who had undergone a robust recruit process. Staff receiving ongoing training and support to ensure they continued to meet people’s needs safely. People were supported to take their medicine by staff and medicines systems were robust..

People’s needs were assessed and regularly reviewed to ensure people received effective care. Staff encouraged and supported people to eat a healthy diet. People's dietary requirements along with their likes and dislikes with regards to food and drink were recorded within their records. People were supported to access a range of health care professionals and staff worked in partnership with external agencies to ensure and promote people’s well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 in ensuring people's human rights were protected. Where people lacked the capacity to make their own decisions, we saw decisions had been made for them in their best interest.

People using the service and their family members spoke positively about the caring approach of staff. They said staff were considerate of their needs and provided the care and support they needed. People and their family members told us their privacy and dignity was maintained by staff. We found staff interactions with people to be positive and supportive and saw positive examples of staff supporting people when they became anxious or distressed.

People had care plans which recorded the help and support they needed. People and family members in the main were aware of their care plans and where they were located. People and family members spoke positively about the individualised support they received. They told us their independence and choice was recognised and promoted. In some instances assistive technology and equipment was used to support people’s independence.

People and family members had raised with the provider and registered manager their wish to have greater access to activities both within A S Care and the wider community. The registered manager told us activities did take place, as confirmed by people we spoke with. An activity organiser encouraged people to take part in activities; however there was no dedicated budget and therefore the registered manager was reliant on fund raising to fund

We carried out an unannounced comprehensive inspection of this service on 6 February 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care on our website at www.cqc.org.uk

The service A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 22 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

This inspection took place on the 18 July 2017 and was unannounced.

A S Care 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.

When people needed assistance this was provided promptly and we saw there was a visible presence of staff in communal areas to promote people’s safety. Staff told us the increase in the number of staff on duty had enabled them to provide improved care and spend time with people, talking with them.

Medicine was safely managed in the service and records showed that the systems for medicine management were robust. Staff provided people with assistance where it was needed to take their medicine.

Where people were at risk, staff had the information they needed to help keep them safe. This included clear guidance within people’s care plans as to how staff were to meet the needs of people’s health conditions; and respond appropriately should they have any concerns about a person.

The service A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 23 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having ensuite facilities.

The service has a registered manager. However the registered person informed us that they were now working at another service, within the same organisation and therefore the registered manager will need to submit an application to CQC to cancel their registration for A S Care. The provider had appointed a new manager who had been in post for three months at the time of the inspection, they informed us they would be submitting an application to CQC to be registered as the manager for A S Care. 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 carried out an unannounced comprehensive inspection of this service on 23 and 24 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We carried out a focused inspection of this service on 15 December 2016 to check that they had followed their action plan and to confirm whether they met the legal requirements. We found the provider had not met the legal requirements. The provider submitted a revised action plan. The Care Quality Commission took enforcement action and the service was placed into special measures. We did this as the service had been rated as 'Inadequate' in a key question over two consecutive inspections.

You can read the reports of the focused and comprehensive inspection, by selecting the 'all reports' link for A S Care on our website at www.cqc.org.uk.

We carried out an unannounced comprehensive inspection of this service on 6 February 2017. We undertook this inspection to check whether improvements had been made and to confirm whether the provider now met their legal requirements.

We found some improvements had been made in the management of people’s medicines. Some staff had undertaken training in the safe management of people’s medicines. Systems for checking people’s medicine administration had been put into place and this was part of the sharing of information between senior carers as part of the handover between staff shifts. However, we found instances when people had not been administered their medicine as per the prescriber’s instructions. This is an area for improvement to ensure people’s safety; health and welfare are promoted and maintained.

We found there were insufficient staff to promote people’s safety and respond to their needs. People who required assistance experienced delays in receiving care and support from staff as staff were supporting other people. This had an impact on the safety of people using the service and meant people needs were not met in a timely manner. Insufficient staff also meant there was limited opportunity for people to be encouraged or involved in activities within the service. This is an area for improvement to ensure people’s needs are met in a timely and effective manner to maintain their safety, health and welfare. We spoke with the provider and manager, who had themselves, identified staffing levels needed to be improved, and they confirmed action would be taken.

People’s individual risks had been assessed with care plans having been put into place to minimise risk, these included clear information and guidance for staff to follow to promote people’s safety, health and well-being. Records

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.

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.

We carried out an unannounced comprehensive inspection of this service on 23 and 24 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused comprehensive inspection to check that they had followed their action plan and to confirm that they now meet legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care on our website at www.cqc.org.uk.

The provider submitted an action plan following the inspection of August 2016 advising us of the action they would take to address the breaches of regulations identified by the inspection of 23 and 24 August 2016.

A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 23 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

The registered manager at the time of our inspection was on planned extended leave. The provider had appointed a person to manage for A S Care who had been in post for a month at the time of the inspection.

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 provider had not made the required improvements. The provider had employed a quality assurance manager whose role was to monitor the quality of the service. The provider was unable to provide written documentation to support the outcome of the visits undertaken by the quality assurance manager. We found there to be no formal agreement as to the providers and quality assurance managers’ responsibilities and role in the governance of the service and the sharing of information or how the information would be used.

We requested the provider forw

This inspection took place on the 23 and 24 August 2016 and was unannounced.

A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 22 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

A S Care had a registered manager in post at the service at the time of our inspection. 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.

The registered manager at the time of our inspection was on planned extended leave and the deputy manager was on planned leave. The provider arranged for a manager of another service they owned to facilitate the inspection.

The provider did not have in place systems or processes to assess the quality and safety of the service being provided and therefore had not identified that improvements were needed. The leadership and management of the service were not effective. This directly impacted on the quality of support and care people received and meant they did not experience the best possible health and quality of life outcomes.

People’s opportunities to influence the development of the service were sought. We found no evidence that where comments were received, these had been acted upon by the provider. The provider and staff did not actively promote an open and inclusive environment for people, especially with regards to those living with dementia. People living with dementia were not supported by staff that had a good understanding of their needs and people’s care plans and records reflected this. Information written as to the care people required or received did not show an awareness on the part of staff as to people’s individual needs and how dementia affected people in all aspects of their day to day lives.

People did not receive person centred care; there were institutional approaches and practices to care being observed and documented, which meant people did not receive individualised care or care as detailed within their care plan. Our observations and the contents of records evidenced a lack of understanding as to the rights of people and demonstrated a lack of respect afforded to those living with dementia as their views were not listened to or acted upon.

Poor record keeping and communication contributed to staff not being effective in providing appropriate care and support, which included information shared amongst the staff team as to the needs of people as well as inconsistencies in the training, supervision and appraisal of staff.

People’s safety could not be assured as records were not always accurate and information staff had access to promote people’s safety, which included risk assessment and care plans did not contain sufficient or consistent information. Records that were to be accessed in an emergency were not always up to date having the potential to impact on people’s safety and welfare.

People’s records evidenced that the needs of some had been monitored, with appropriate referrals being made to health care professionals. Records reflected people’s care plans were in some instances followed and measures taken where concerns had been identified by staff. However, this practice was not consistent to protect and promote everyone who used the service.

Systems for the management of people’s medicine were not robust, which had the potential to put people’s health and welfare at risk. A procedure for the administration of people’s medicine was not in place. We found medicine administration records were not completed i

This inspection took place on the 30 September 2015 and was unannounced.

A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 23 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities. There is a garden which is accessible and provides areas of interest to the rear of the service.

A S Care had a registered manager in post at the service at the time of our inspection. 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 told us they felt safe in the home and staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service.

Where risk to people’s health had been identified, staff had the information they needed to help keep them safe. However, we observed one occasion where staff potentially put someone at risk by not using the appropriate support to assist someone when moving them from their chair into a wheelchair. This was addressed by the registered manager.

There were enough staff on duty to meet people’s needs; however staff had limited time to spend with people socially or to provide opportunities for people to take part in activities.

People said they thought the staff were well-trained. Records showed staff had an induction and introductory and on-going training.

People’s safety was promoted by systems and processes that audited and monitored the maintenance of the building and its equipment.

People’s plans of care contained information about the medicine they were prescribed. We found people received their medication as prescribed and that their medication was stored safely.

Staff were supported to provide effective care though training and their on-going supervision that was provided by the registered manager. People told us staff were caring and kind and that they had confidence in them to provide the care and support they needed.

People were protected under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA 2005 DoLS). We found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions themselves about receiving personal care and leaving the service without support.

People we spoke with were in the main complimentary about the meals provided at the service, however they along with visitors commented on the lack of variety and choice. Where people were at risk of poor nutrition, advice from health care professionals was sought and their recommendations followed.

People told us that if they needed to see a GP or other health care professional staff organised this for them or their relative. If staff were concerned about a person’s health they discussed it with them and their relatives, where appropriate, and referred them to the appropriate health care service.

People told us they made decisions as to their day to day lives, deciding what time they got up or went to bed and that staff respected their decisions. People’s plans of care included information about people’s preferences with regards to their care, however people we spoke with and visiting relatives, all had limited awareness of their plans of care. The registered manager told us they would promote people’s involvement in the plans of care.

People we spoke with told us that staff did respect them, however our observations were mixed. We observed examples of where staff missed opportunities to engage people in conversation and instances where staff entered people’s rooms without being invited in. We also saw where staff actively promoted people’s dignity and responded to people in a caring and sensitive manner.

People’s needs were assessed prior to them moving into the service and the information gathered was used in the development of plans of care. Plans of care included information as to people’s preferences, likes and dislikes and focused on the promotion of people’s independence, health and welfare.

The registered manager told us that they were currently advertising for an activity co-ordinator as the previous person had left. We found during our inspection that people had minimal opportunity to take part in meaningful activities or recreational interests. People we spoke with and their visitors expressed concern about the lack of activities within the service; this had been discussed in meetings and had been identified as an area for improvement within the registered manager’s monthly audits. A key part of people’s ability to take part in meaningful activities was the development of the environment to support in particular those people living with dementia.

People using the service and relatives said that if they had any concerns or complaints they would tell the registered manager or the staff.

We found the practice of seeking people’s views about the service to be inconsistent and found that the outcome of the process was not always, shared known or acted upon. People using the service and their relatives had the opportunity to comment on the service they received, however we found people’s awareness of this to be mixed. Meetings of residents took place regularly and minutes of these were available, however the people we spoke with were unaware that these meetings took place. Visitors also gave mixed responses as to their ability to influence the service.

We found audits were carried out by the registered manager, however where shortfalls were identified these were not always acted upon. The provider needs to ensure systems are in place that are effective and that improvements where identified are addressed to ensure the service is well-led.

We inspected five outcomes during this inspection. The outcome areas were: Care and welfare, medication, safeguarding people who use services from abuse, requirements relating to workers and assessing and monitoring the quality of service provision. All the outcome areas were compliant. We spoke with two people who use services during our visit. We saw the activity coordinator supported some people in promoting their independence and community involvement and escorted a group of people to the local church for activities. We saw two people attended health appointments with staff. Staff confirmed that one person who used services followed a spiritual lifestyle. We saw this was reflected throughout the persons care plan and staff ensured their preferences were met. One person told us she was well cared for and would like to go dancing. Another person told us the care was alright.

We inspected against five outcomes areas: care and welfare, safeguarding people, management of medicines, staff recruitment and selection and quality assurance, and found they were all non compliant. We found care planning was basic and improvements were required around staff awareness and training for safeguarding people from abuse and harm. We found staff were not administrating and managing medicines safely. The staff recruitment selection process was not robust. The provider had not monitored the quality of service that people received, and this had impacted on people that use the service.

We spoke with four people who used services, four staff on duty and a visitor. The visitor told us:"The home is always the same, and staff are always nice and friendly." One person said:" The staff are chatty and I am happy in my bedroom." We saw the activity coordinator promote people's welfare. They gave a manicure to one person and had organised a coffee afternoon with a group of people to sit together and talk in the afternoon. We heard staff singing with people, sitting and talking to them throughout our visit. Four people gave positive comments about the home except for one person who was unhappy with some aspects of the delivery of care. These concerns were raised with the manager during our visit for action. People said they were aware of how to raise concerns or to make a complaint. One person told us they had raised a complaint and this had not been recorded or acted on.

We spoke with four people living at the home and some visiting relatives. People told us the staff were nice and that they were given choices, such as what they wanted to eat. The staff were always available to accompany them to hospital appointments. Their likes and dislikes were established through one to one discussions with the activities coordinator. One person told us that activities did take place but they were happier doing a crossword rather than joining in. Another person was very happy because he had facilities to make a cup of coffee in his room and said “I would be lost without it."

Other people told us,

“I like being here."

“I feel safe here and they always have music on. I like music”.

When we visited the home had a friendly atmosphere and the residents appeared contented and settled. We talked to the manager in her office and residents popped in and out to say ‘hello’ and pass the time of day. The activities organiser held a quiz in the main lounge and this was well attended. We talked to one resident who said, “This is a nice place, the food is good and the staff are kind.”

Residents told us they were offered choices in their day to day lives. One commented, “We get up whenever we want and go to bed whenever we want.” They also said they felt safe at the home and knew who to speak to if there was anything wrong. One person told us, “If I was not happy I would tell the manager.” Another said, “I’d tell the activity lady because she’s always asking us if everything’s alright.”

Relationships between the residents and staff were good. One person said, “The staff are kind to me and help when I need them to.” Another commented, “I like all the staff here.” Staff worked well with confused residents, taking the time to find out what they needed and reassuring them when necessary.

Residents told us they liked the premises and in particular the home’s large and well-maintained gardens where they sit out in summer. One person told us, “I love living in this big grand house and I love the gardens – they’re beautiful.”