This inspection took place on 14 and 16 May, 2018 and was unannounced.

Ascot Lodge is a small ‘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.

Ascot Lodge is registered to provide accommodation with nursing and/or personal care for up to 18 older people. At the time of the inspection there were 16 people living in the home. Accommodation includes a TV room and dining room, 12 single bedrooms and two double bedrooms which can all be found across four floors. The home had been adapted for people with limited mobility. There is an enclosed garden and patio at the rear of the building and a small car park at the front.

At the time of the inspection 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in September, 2017 we identified breaches of Regulations 10, 11, 12, 17 and18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Ascot Lodge was awarded an overall rating of ‘Requires Improvement’. Following the inspection we issued a warning notice regarding Regulation 17 and asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found that people who lived at Ascot Lodge did not always have their dignity and respect preserved. People's privacy was not always maintained and care was not always provided in a dignified way. During this inspection we found that people were treated with dignity and respect. People and relatives we spoke with expressed their satisfaction with the provision of care which was provided. We found that improvements had been made and the registered provider was no longer in breach of this regulation regarding ‘Dignity and respect’.

At the last inspection we identified that the registered provider was not complying with the principles of the Mental Capacity Act, (MCA) 2005. Consent was not gained in line with the MCA. People living in the home were not being appropriately assessed, assessments were not decision specific and 'best interest' processes were unclear. During this inspection we found that improvements had been made and the registered provider was no longer in breach of this regulation regarding ‘Need for consent’.

At the last inspection we found that the registered provider was in breach of regulation in relation to ‘Safe care and treatment’ This was because people were exposed to unnecessary environmental risks and the delivery of care and support was not always safely managed. We found the environment posed significant risks to people who were being supported, medication management systems were unsafe and accidents and incidents were not being sufficiently monitored. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe care and treatment’.

At the last inspection, we found that staff were not receiving adequate supervision or annual appraisals. Staff expressed that they felt supported but were not receiving formal supervisions or appraisals to help develop them further in their roles. During this inspection we found staff received regular supervisions and annual appraisals were taking place. The registered provider was no longer in breach of this regu

The inspection took place on Monday 25 and Tuesday 26 September, 2017 and was unannounced.

Ascot Lodge Nursing Home is situated in a residential area of Southport. The home is close to local amenities and local public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes two lounges, 12 single bedrooms and two double bedrooms which can be found across four floors. The home has been adapted for people with limited mobility. There is an enclosed garden and patio at the rear of the building and a small car park at the front.

At the time of the inspection 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.

At the previous comprehensive inspection which took place in September 2016 the home was rated ‘Good’. This inspection took place due to a number of concerns which had been reported in relation to the safety of care and treatment being provided at the service.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We are taking a number of appropriate actions to protect the people who are living in the home.

There were a number of identified concerns in relation to the environment and the health and safety standards within the home. The safety of people living within the home was being compromised and health and safety audit systems were not being effectively carried out.

Care records were not being reviewed to ensure that they were an accurate reflection of the support that a person required. This meant that there was a risk that staff, less familiar, with the person may not provide the right level of care and treatment.

During the inspection we found the area of ‘staffing’ to be a concern. Routine supervisions and appraisals were not taking place and were not being carried out in line with the provider’s policy.

Audits were not being effectively completed and action plans were not being followed up on. This meant that people were exposed to unnecessary risk as the quality of service delivery was not being monitored. Accidents and incidents were being recorded however there was little evidence to suggest these were being investigated, analysed or lessons were being learnt.

Specific policies and procedures were available to guide staff practice. However, some of the policies and procedures which were in place did not reflect current legislation, policy or best practice guidance.

Staff were seen to be attentive and offered kind and compassionate care. However, people who used the service were not always treated with dignity and respect. People’s privacy was not protected whilst personal care was being delivered. People were not always kept comfortable within their own bedrooms.

During the inspection we found that people’s private and confidential information was not being securely stored away. We found sensitive information available throughout the home which should have been protected and not available for others to read.

The feedback we received about the range and level of activities was poor and observations supported this. There was no activities timetable in place and there was no activities co-ordinator in post.

There was evidence to suggest the home was not operating in line with the principles of the Mental Capacity Act, 2005 (MCA) When able, people must be involved with the decisions which are taken in relation to the care and treatment which is provided, records we reviewed suggested that the principles of the MCA were not being routinely followed.

The management of medicines was not always safe. We found that people did not always get their medicines as prescribed. Weekly and

This unannounced inspection of Ascot Lodge Nursing Home took place on 13 & 14 September 2016.

Ascot Lodge Nursing Home is situated in a residential area of Southport and is close to local amenities and public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes two lounges, 12 single bedrooms and two double bedrooms. A nurse call system is in place along with facilities to accommodate wheelchair access and for people with limited mobility. There is an enclosed garden and patio at the rear of the premises and car parking space to the front.

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 said they felt safe living at the home and were supported in a safe way by staff. This view was supported by relatives we spoke with.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. An adult safeguarding policy and the Local Authority’s safeguarding procedure was available for staff to access.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

Systems were in place to ensure medicines were managed safely. People told us they received their medicines on time. Staff were trained to administer medicines safely to people.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults.

There were adequate numbers of staff on duty to provide care and support to people when they required it and wished to receive it. Calls for assistance were answered promptly.

Staff received training and support so that they had the skills and knowledge to care for people safely and in accordance with their individual need. People we spoke with and relatives confirmed this when discussing staff expertise.

People’s care needs were recorded and care documents provided information for staff to follow to ensure people received the care and support they required.

Risks to people’s health and wellbeing had been assessed and measures were in place to minimise risks to people’s safety. Risk assessments and associated care plans were reviewed each month to reflect people’s changing needs.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff made referrals to healthcare professionals for advice and support at the appropriate time.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and genuine warm engagement between people living at the home and the staff throughout the inspection.

People told us they enjoyed the meals. The provision of more fresh produce was discussed on inspection along with the provision of more social activities for people to join in with. The management team has responded positively advising us of the purchase of more fresh food and introducing a new activities calendar.

There was a maintenance programme and arrangements in place for checking the environment and equipment was safe.

The culture within the service was open and transparent. Staff told us management was both approachable and supportive and that they felt listened to and involved in the development of the service.

A procedure was established for managing complaints. Complaints received had been responded to and appropriate actions had been taken.

Quality assurance systems were in place to ensure people received a well-managed service. T

This unannounced inspection of Ascot Lodge Nursing Home took place on 28 January 2015.

Ascot Lodge Nursing Home is situated in a residential area of Southport and is close to local amenities and public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes a lounge, dining room, 12 single bedrooms and two double bedrooms. A nurse call system is in place. Facilities are in place to accommodate wheelchair access and people with limited mobility. There is an enclosed garden and patio at the rear of the premises and car parking space to the front. Ten people were living at the home at the time of our inspection.

A registered manager was not 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.

Although staff told us that people’s needs could fluctuate on a daily basis, they said the staffing levels were adequate to ensure people’s safety was maintained and needs were met in a timely way. People living at the home said staff responded to requests and call bells promptly.

People told us they felt safe in the way staff supported them. The staff we spoke with knew about adult safeguarding and were aware of how to report any concerns they may have. They were familiar with what whistle blowing meant and said the home had a whistle blowing policy.

People told us they received their medication when they needed it. We observed staff administering it to people safely. Some medication needed to be stored in a fridge. The fridge temperatures were checked daily but on some days the temperatures readings were outside the recommended range. Nursing staff had not received medication refresher training. The medication reference book was out-of-date by six years. You can see what action we told the provider to take at the back of the full version of this report.

People’s risk assessments were not always being followed. No risk assessments had been undertaken for people who used bedrails. You can see what action we told the provider to take at the back of the full version of this report.

Recruitment practices were not safe. Staff had started working at the home before references had been obtained and before they had been formally checked to see whether they were suitable to work with vulnerable adults. Staff did not receive regular supervision and appraisal. Staff training was not current or up-to-date. You can see what action we told the provider to take at the back of the full version of this report.

Building work was taking place at the time of our inspection and measures had been taken to minimise the disruption on people living at the home.

People had access to health care when they needed it, including their GP, community mental health nurse and chiropodist.

Arrangements were in place for families to provide consent to various aspects of their relatives care, including consent to the care planning and use of certain items of equipment. Staff had not received awareness training regarding the Mental Capacity Act (2005) and had a limited understanding of how it applied in practice. We made a recommendation regarding this.

Staff were caring and kind in the way they supported people. They treated people with compassion and respect. They ensured people’s privacy when supporting them with personal care activities. People had a choice in the gender of staff they wished to receive support from.

Information about people’s personal histories was not detailed in the care records. This lack of person centred information meant no information was available about the person’s relationships, working life or hobbies for staff unfamiliar with the person to get to know them or plan activities to meet their needs. There was no evidence that recreational activities took place at the home. We made a recommendation regarding this.

The food at lunchtime was plentiful and wholesome. However, we found that some people did not have adequate support to ensure they had sufficient to eat and drink. You can see what action we told the provider to take at the back of the full version of this report.

The registered manager had recently left the service. There was a lack of clarity amongst staff as to who was providing leadership and management at the home. The nurse in charge did not have access to most of the information we needed to confirm the quality monitoring arrangements at the home. Some personal confidential records were not stored securely. You can see what action we told the provider to take at the back of the full version of this report.

The inspection team was made up of an inspector and an expert by experience.This was an unannounced inspection of Ascot Lodge Nursing Home. The inspection set out to answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and well cared for at Ascot Lodge Nursing Home. Effective recruitment processes were established and necessary checks were carried out as part of this process. This helped to ensure staff were suitable to work with vulnerable adults.

The home was clean, hygienic and odour free.

Measures were in place to ensure the environment was safe and suitable for the people who were living there. We did, however, find that some improvements were needed to the fabric of the laundry room to ensure good infection control measures were in place. The provider [owner] has provided us with dates when this work will be carried out. Following a check of the home by the fire authority, we saw the provider had been given by the fire authority an action plan to complete. At the time of the inspection we saw that the provider was working through the required actions to ensure the service was compliant with fire safety. Two follow up visit are planned by the fire authority to ensure the required actions have been completed. We have asked the provider to keep us informed of timescales for completion of this work in accordance with the dates stated on the action plan. These measures are needed to ensure people’s safety.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection there was a Deprivation of Liberty Safeguard [DoLS] in place to keep a person safe. DoLS is part of the Mental Capacity Act [2005] and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People’s health and care needs were assessed with them and/or with a family member and/or health professional. People and family members told us the staff communicated well with them about their care needs and also preferences around daily living and how they wish to be treated. Care plans reflected current care needs and people told us they had been asked if they were in agreement with the care provision.

Where specialist support was needed, for example, with a person’s nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people’s health, well-being and independence

Is the service caring?

The people we spoke with told us the staff were kind and helpful. People’s comments included, “The staff look after me well”, “They make sure I get the meals I like”. Relatives supported this view and said the staff were very good.

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people’s comfort and dignity at all times.

Staff had a good knowledge about people’s care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

Family members told us staff communicated well with them and they were consulted about their relative’s care and involved in making decisions when needed.

People who lived at the home and their relatives were able to complete an annual satisfaction survey to enable them to provide feedback about the home. We could see where a change had been made in response to comments received.

Is the service responsive?

People and family members knew how raise a concern if they were dissatisfied with something. A relative said they knew if they had concerns they could come straight to the staff and/or manager and they would be listened to.

From our discussions with people and family members and through looking at a number of care records we could see that people’s plan of care was revised to meet any change in need. For example, deterioration in a person’s medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

The home had systems in place to regularly monitor the quality and safety of the service provided. Records we looked at demonstrated that actions were taken where changes were needed to ensure people’s safety. We discussed with the manager the frequency and detail of the audits [checks] on the service to help improve the auditing systems in the home.

Staff told us they were able to speak with the manager and their views and experience were taken into account.

At the time of our inspection the home did not have a Registered Manager in place. We informed the manager of the importance of being registered with the Care Quality Commission [CQC]. They agreed to submit the application as soon as they were able to do so.

The service worked in partnership with key organisations, including the local authority and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

Staff we spoke with were knowledgeable about seeking people’s consent especially when the person concerned was unable to communicate verbally.

People living in the home spoke positively about the care they received. One person told us; “The food is excellent, you always get a choice. There are great parties for us and our families at birthdays and Christmas. The staff are very kind.”

During our visit we found the atmosphere in the home was relaxed. We observed care and support being delivered and there was good communication between people and staff. Relatives we spoke with were knowledgeable about the care plans in place to support their family member and told us staff discussed how the care was delivered.

We checked the care records of three people and they included care plans related to the medication they required. We looked at the medication administration records (MAR) for those people and found that they were in keeping with the care plans.

People living in the home told us there were enough staff on duty to meet their needs, in a timely manner. Comments included; “Mornings are very busy but staff always have time for you,” and “If I need help at night they come quickly.”

On this inspection we found the home now carried out regular audits [checks] in key areas such as infection control, the administration of medicines and the records kept about the care and support provided to people living in the home.

People and their families were involved in care planning for example in signing consent forms and in contributing to the care plans about how they wished to be supported. Relatives told us they were contacted if there were any changes in the care and that staff were always available to talk to when they visited.

We observed care being delivered and there was good communication between people and staff. Those people who could not communicate verbally were approached sensitively and the staff we spoke with were knowledgeable about their care needs

The staff we spoke with were knowledgeable about how they would identify abuse and described appropriate actions they would take if they had any concerns. They told us about the safeguarding training they had received and knew where the home's safeguarding policy, procedures and key contact details were located. .

During our visit we saw that the home had systems in place to support staff to be suitably skilled to meet people's needs.

We saw that incidents and accidents were recorded, however it was not evident what the outcome had been and if any changes had been made to prevent them happening again. The records we looked at showed appropriate assessments and monitoring had been undertaken of potential risks associated with the home environment.

This unannounced inspection of Ascot Lodge took place on 15 & 16 July 2015.

Ascot Lodge Nursing Home is situated in a residential area of Southport and is close to local amenities and public transport links. It provides accommodation and nursing care for up to18 people. Accommodation includes two lounges,12 single bedrooms and two double bedrooms. A nurse call system is in place. Facilities are in place to accommodate wheelchair access and people with limited mobility. There is an enclosed garden and patio at the rear of the premises and car parking space to the front. Seven people were living at the home at the time of our inspection.

There was no registered manager in post as they had left some months prior to 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.’ A new manager was in post and was in the process of applying with the Care Quality Commission for the position of registered manager.

Relatives told us they felt the care home was a safe place for their family member.

We found medicines were administered safely to people. People received their medication at a time when they needed it.

Recruitment checks were undertaken to ensure staff were suitable to work with vulnerable people.

Safeguarding procedures were in place but staff did not always follow the agreed protocol for reporting an alleged incident.

Sufficient number of staff were employed to provide care and support to help keep people safe and to offer support in accordance with individual need. This was confirmed by people we spoke with who lived in the home and their relatives. Our observations showed people were supported safely and in a timely manner by the staff.

Staff had completed risk assessments to assess and monitor people’s health. We saw this in areas such as, falls, nutrition, mobility, continence management and pressure relief. These recorded staff actions to help keep people safe.

Arrangements were in place to maintain the safety of the home. This included health and safety checks of the equipment and building.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

A staff training plan was in place. This showed staff received training to ensure they had the skills and knowledge to support people. Staff told us they were supported through induction, on-going training and appraisal.

The manager advised us that a number of people needed staff support to make decisions about their daily life and care needs. This was in accordance with the Mental Capacity Act (MCA) (2005) Code of Practice though this was not always clearly recorded in people’s care files.

Staff obtained people’s consent prior to assisting them and encouraged people to maintain their independence.

People’s nutritional needs were monitored by the staff. Menus were available and people’s dietary requirements and preferences were taken into account.

People’s care needs were recorded in a plan of care and support was given in accordance with individual need. Care documents showed regular reviews had been conducted, with any changes in circumstances being clearly recorded, to ensure staff had up to date information about the needs of everyone living at the home.

There was a good rapport between the staff and people they supported. Staff were kind, respectful, caring in their approach. Staff took time to listen and to respond in a way that the person they engaged with understood.

People could take part in social activities and were given the opportunity to go out with the staff if they so wished.

Staff demonstrated a good knowledge of people’s individual care needs, choices and preferences. This helped to ensure people’s comfort and wellbeing

A process was in place for managing complaints and this was displayed in the home. People and relatives told us they would speak with the manager if they had a concern.

Staff were aware of the home’s whistleblowing policy and said they would use it if needed. They said the management listened and were confident they would respond appropriately.

Arrangements were in place to seek the opinions of people and their relatives, so they could provide feedback about the home. This included satisfaction surveys and residents’ meetings.

We received positive feedback about the manager from staff, people who lived at the home and relatives. Staff told us communication had improved greatly since the last inspection and there were now clear lines of accountability in the home.

We saw the manager had made a number of improvements in accordance with the provider action plan which was submitted to us following the last inspection in January 2015. The manager had introduced a number of internal audits and safety checks to monitor the quality of the care and standards to help improve practice. The new manager and the changes being made would suggest the service was actively addressing the concerns we found at the last inspection and on-going improvements now need time to embed.