The inspection took place on 7 and 8 January 2019 and was announced. We announced the inspection as we inspected the Ascot House Care at Home service as part of the same inspection. This was to allow us to see how the service supports people with rehabilitation and follow up care received from the care at home service. We also needed to ensure there was someone available to facilitate the inspection.

Ascot House is an intermediate care service provided by Trafford Council and Pennine Care. It provides therapy led rehabilitation for adults. Intermediate care is a service which helps people to recover from illness or an accident, to regain independence and to remain in their own homes. Ascot House is registered to provide accommodation for persons who require nursing or personal care, for up to 45 people. There are 45 single rooms across five individual units. Nine of the rooms are used as step-down beds for people waiting for residential care or additional care and support packages at home. There are lounge and kitchen facilities within each unit and areas for rehabilitation and exercise to be undertaken. The service aims to provide a 21-day turnaround for rehabilitation to enable people to return to their own home. At the time of inspection, the service was supporting 26 people for rehabilitation and nine people in the step-down beds.

At out last inspection, we rated the service overall requires improvement, as medication was not always safely managed and there was a lack of supervision for staff. At this inspection, we found there had been improvements made and the service is now rated as good in all of our key questions.

A registered manager was 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 felt safe being supported at the service. Staff had received training in safeguarding vulnerable people from abuse and were confident any concerns they raised would be listened to and acted up on. People felt comfortable to raise any concerns they had with the staff team.

Staff were recruited safely. Appropriate checks were in place to ensure staff were suitable to support vulnerable people.

People had the risks they presented assessed and reviewed, when there were changes. People were supported with equipment to help them reduce levels of risk and as their mobility improved.

The safety of the premises was monitored both internally and externally. Regular checks were in place for fire safety, gas, electric, the passenger lift, equipment and legionella.

People were assessed to ensure they were suitable to receive rehabilitation at the service. Assessments ensured people were fit for discharge from the hospital and could understand what would be required from them in terms of regular exercise plans with the therapy team. Staff were able to read information about people before they arrived at Ascot House and could arrange equipment to be ready for their arrival.

Health needs were still met when people stayed at Ascot House. People were registered with a local GP service to monitor their health and make referrals to other services if necessary. Weekly multi-disciplinary meetings were held to discuss people’s progress and plan for returning home. District nurses worked in the service to complete nursing roles, such as to administer insulin or attend to dressings.

Staff received training appropriate to their job role. Staff enjoyed the training and were able to complete additional qualifications to enhance their knowledge. Staff received an induction into the service which accompanied the training. Many of the staff had work for the organisation for many years.

People had their nutritional needs catered for and monitored whi

This inspection took place on the 15 and 20 November 2017 and was unannounced. Our last inspection of the service was on the 14 and 23 January 2016 we rated the service ‘Good’. We found the service to be good in safe, effective, caring and well led domain. We rated the responsive domain requires improvement.

Ascot House is an intermediate care service provided by Trafford Council and Pennine Care, it provides therapy led rehabilitation for adults. Intermediate care is a service which helps people to recover from illness or an accident, to regain independence and to remain in their own homes. Ascot House is registered to provide accommodation for persons who require nursing or personal care for up to 45 people. There are 45 single rooms across five individual units. Nine of the rooms are used as step down beds for people waiting for residential care or additional care and support packages at home. There are lounge and kitchen facilities within each unit and areas for rehabilitation and exercise to be undertaken. The service aims to provide a 21 day turnaround for rehabilitation to enable people to return to their own home. At the time of inspection, the service was full.

A registered manager was 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 did receive their prescribed medicines on time and medication was stored safely. However, medicines quantities were not always correctly managed.

Quality assurance systems were in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. However, these systems had failed to ensure medicines were safely managed.

Staff were aware of the signs and symptoms of abuse, how to report concerns and who they would report to. There was a whistle blowing policy in place and staff were aware of the policy and were also aware of the safeguarding policy.

There were robust policies, procedures and risk assessments in place in relation to health and safety and fire safety.

Staff were kind and caring to people living at the service. They were knowledgeable about the person and their needs and followed agreed plans of care and exercise plans.

Staff received training appropriate to the service and staff were given the opportunity to continue their own personal development. However, some staff felt the service needed to improve on the number of supervisions they received.

People and their representatives were very complimentary of the service and what it achieves to enable people to return to their own home.

Recruitment processes were robust and safeguarded against unsuitable people obtaining employment at the service.

Care plans, risk assessments and exercise plans were detailed and gave staff the information they needed to support people.

At this inspection we found one breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the management of medicines. You can see what action we have told the provider to take at the back of the full version of this report.

Ascot House was last inspected in June 2014 when it was found to be meeting the regulatory requirements which applied to a home of this kind.

The current inspection took place on 14 January 2016 and was unannounced. The inspector returned to complete the inspection on 21 January 2016.

Ascot House is a residential home for older people provided by Trafford Metropolitan Borough Council. The home accommodates up to 35 people in single rooms. It is situated on a residential estate and has a small car park to the front of the premises. The home provides assessment and rehabilitation services and is provided by the Council in partnership with the Pennine Care NHS Foundation Trust which provides the therapy services which people receive whilst staying at the home. In addition a small number of respite places are available.

There is a registered manager at 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 that the home was safe and that the people who lived there felt safe. Relatives also felt that people who lived in the home were safe. Medicines were properly managed and the home was clean with steps taken to prevent the spread of infections. Most people thought the food was good and that there were sufficient staff to provide the personal care they required.

The staff team working at Ascot House were considered to be kind and treated the people who lived there with dignity. People were encouraged to develop their independence whilst staying in the home so that after a period of reablement and rehabilitation they would be able to move on with success. The home had a stable staff team and supervisory and management staff worked together to cover all the tasks required.

There were few social activities available in the home so sometimes people complained that they were bored. Visiting times for relatives were advertised as limited because of the therapy activities arranged in the home.

One inspector carried out this inspection. We met the registered manager. We talked with four people staying in Ascot House, and one relative who was visiting on the day of our inspection. We talked with several staff, and we observed how staff interacted with people in the home. We also looked at care records and other files.

We set out amongst other things to answer five key questions: "Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well-led?"

The evidence that supports this summary can be found in our full report.

Is the service safe?

We saw that the service was set up to keep people safe who were there for assessment or rehabilitation. A range of mobility aids was provided and people were encouraged to use them and reminded if they forgot, for example, their walking stick.

Staff had been trained in safeguarding and knew how to respond to an incident or allegation of abuse. Those incidents which had occurred had been correctly reported and appropriately handled by Ascot House.

There was at the time of our visit one person who was subject to an authorisation under DoLS (the deprivation of liberty safeguards). This meant they were assessed as lacking in capacity to understand why they were in Ascot House and to decide to stay there. This person received constant supervision to ensure they were safe and they were prevented from leaving the building.

Is the service caring?

Because Ascot House had a transient population staff did not build up lengthy relationships with individuals. Nevertheless, we saw that they were thoughtful and sympathetic towards people and tried to ensure they were comfortable. One family member wrote to thank the manager: "[my relative] received such kind care and all the staff seemed to go an extra mile to help." Another relative told us: "The care is excellent. This place has looked after [my relative] really well. Everybody's very kind."

In one respect we observed that care could be better: two people complained they had only had one bath during their stay. We discussed this with the registered manager.

Is the service responsive?

The service had responded to one recent complaint by ensuring that all staff were aware of it. The service responded to issues with the way people had been treated in hospital by raising safeguarding concerns with the hospital concerned. The staff responded to the various needs of people in Ascot House by ensuring they received appropriate care and treatment. District nurses attended those who required nursing care. Other professional or medical care was accessed as necessary.

Is the service effective?

The whole purpose of Ascot House was to enable people to move on, either back to their home or to suitable accommodation. One person said: "I'm surprised to say they have turned me round." There were time limits for the length of stay, although we learnt these could be exceeded on occasion, while the right future accommodation was arranged. We learnt that people who had moved on and their families were pleased with the outcome of their stay in Ascot House.

Is the service well-led?

The registered manager had been in post for about two years. She was supported by the service provider manager who worked in the same building and had access to the resources of the provider, Trafford Metropolitan Borough Council. Councillors conducted regular monthly visits and reported what they found. Regular audits were made, and all staff including the manager had regular supervision to enable them to reflect on what was going well and what could be done better.

We spoke with five people receiving care and treatment across three units, spent time observing care and reviewing records. We spoke with staff on the day of our inspection as the manager was on annual leave; we spoke with the registered manager by phone when they returned from leave.

People told us: “Staff are very pleasant and always there to help. They knock on doors and ask if I’m alright.” “I don’t like getting up early and the staff respect this." “Staff always put drinks where I can reach them. I get plenty to drink and I like the food.” “The food at the beginning of my stay was tasteless but gradually I forced myself to eat it. Staff now know what I like and dislike and offer me an alternative.” “I can walk a bit now without the Zimmer Frame thanks to the staff.”

We observed care staff engaging positively with people, physiotherapist and occupational therapists encouraging people to participate in planned exercises.

We observed staff serving lunch, staff offered people a choice of lunch, and people were offered salad.

We observed during our inspection all the medication units were securely stored or attached to the wall. Medication was stored in a new location following concerns raised at our previous inspection. During our inspection we observed staff administering medication and saw medicines were handled appropriately

We found the provider has taken steps to provide care in an environment that was suitably designed and adequately maintained.

People who used the service told us that staff respected their privacy and dignity and provided the right level of support for them to maintain their independence as much as possible. One person said, "The staff do speak to me with respect and some staff go over and above."

The care plans we looked at provided evidence that people using the service had their needs assessed and strategies put in place to protect them from accidental harm. A visiting professional told us, "The staff are good at managing risk."

The six people we spoke with told us that they felt safe during their stay in the home. Two people told us, "I feel safe. I am a very satisfied customer" and "I would speak to staff if I had any concerns". A visiting relative said, "I can’t fault the service at all. X has improved greatly since coming in. When you ask for something you get it done. I would recommend it to anyone."

We found the home to be clean and hygienic. Three people who used the service told us that they were satisfied with cleanliness in the home.

We found evidence that people who used the service had their medicines administered safely. However, we found that one of the three medicine trolleys had not been securely fixed to the wall in one of the units.

We found further concerns in relation to fire safety. None of the bedroom doors had been fitted with self closing devices. This placed people using the service at risk of smoke inhalation in the event of a fire.