This was an unannounced inspection visit which took place on 21 September 2017.

Ash Lodge Care Home provides nursing and personal care to a maximum of 54 adults. The service consists of two separate units over two floors; the nursing unit on the ground floor and the dementia care unit on the first floor. On the day of our inspection there were 53 people at the home.

At the last inspection in November 2014 the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager; however she was not present on the day 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.

People who lived at the home were kept safe because staff were trained to identify signs of abuse and understood reporting procedures. Potential risks of harm to people had been identified and guidance for staff was in place to support people safely. There were enough staff to support people and staff had been recruited safely. People received their medicines as they were prescribed.

People were supported by staff who had the training and skills to consistently meet people's changing needs. Staff had regular supervision and support to reflect on and develop their care practices so that people benefitted from quality care. Staff understood the importance of seeking people’s consent before care was delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us they were happy with the choice and quality of the meals provided and staff understood the need to support people who were poorly or living with dementia to eat and drink sufficient amounts to maintain their health. People were supported to access health care professionals without delay to maintain their health.

People described the staff as very caring, attentive, polite and patient. People enjoyed the fact that staff spent time with them. People's privacy and dignity was protected by staff and people were encouraged to maintain their independence. The development of care practices to support people approaching the end of their life showed a compassionate response to people’s needs.

People were supported by a dedicated activities team who provided a variety of regular events for people to enjoy. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and that the registered manager would strive to resolve these.

Staff spoke positively about the management of the home and felt supported by the management team. There were several different platforms used in which people could voice their opinions on the service and we saw the management team used feedback and comments to continually improve the service. Everyone including external professionals told us the home was welcoming, had a nice atmosphere and was well organised. The registered manager and provider had continued to monitor the quality of the service and had further developed aspects of the service to provide better outcomes for people.

There were 53 people living in the home on the day of our inspection. We sampled five care files, five staff files; spoke with the manager, five staff, and 12 people that used the service and /or their relatives. One relative said, “This place is wonderful. I can’t thank them enough for the loving care they have given my relative.”

People were involved in decisions about their care and were asked for their consent before care and treatment was given. One person said, “People talk to me about what I want but I don’t always know what they mean. They are patient and explain it another way.” Another person said, “I know about my treatment and the tablets I have to take. Staff give me my medication at the same time every day they are good like that. They always explain what they are doing and ask if that’s ok.”

Care plans were personalised and risk assessments were in place. Staff had the information they needed to meet people's identified needs. People’s needs had been assessed by a range of external health professionals so that their health care needs were monitored and met.

People received their medicines as prescribed by their doctor to ensure their health needs were met.

Staff were trained and supported in their roles. Staff knew how to protect the people living there so that they were safeguarded from harm.

Robust audit systems were in place for monitoring and improving the quality of the service, when needed, for people who lived in the home.

There were 49 people living at the home on the day of our inspection. No one knew we would be inspecting that day.

During our inspection we spoke with six people who lived at the home, six relatives, five staff and two additional people who had come to look at the home to find out about the service provided. One person told us, “I have lived here for a long time and it is quite okay”. Another person said, “Very nice home. The staff are kind and look after me”.

As some people had complex needs and were not all able to tell us about the service they received we used different methods to help us understand their experiences, including observation. We observed good interactions between staff and people living there.

We saw that people were treated with respect and dignity. People's needs had been assessed by a range of health professionals including dieticians and speech and language staff. This meant that people's health care needs had been monitored and met.

Staff had received training to help them recognise abuse and inform them of who they should report to if they had a concern.

Recruitment processes ensured that staff employed were suitable and safe to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run to benefit the people who lived there.

This was an unannounced inspection, which took place on 5 and 6 November 2014. We last inspected this service on 10 October 2013 there were no breaches of legal requirements at that inspection.

Ash Lodge Care home provides nursing and personal care to a maximum of 54 adults. The service consists of two separate units over two floors; the nursing unit on the ground floor and the dementia care unit on the first floor. At the time of our inspection 54 people lived at the home.

There was a registered manager in post 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 and their relatives consistently told us they were happy with the care delivered and they felt safe. Staff had been trained in adult protection and understood that they had responsibility to take action to protect people from harm. They demonstrated awareness and recognition of abuse and knew how to report concerns to outside agencies. The manager consistently reviewed accidents, incidents and safeguarding concerns to reduce the possibility of people being harmed.

The manager had undertaken training in the Deprivation of Liberty Safeguards DoLS). She understood her role and responsibilities and had followed the guidance where some people’s liberty had been restricted. Applications had been submitted to the supervisory body so that the decision to restrict somebody’s liberty is only made by people who had suitable authority to do so. The manager had ensured that where people lacked the capacity to make decisions about their care and treatment, appropriate capacity assessments were in place. We saw that staff obtained people’s consent before providing them with support by asking for permission and then waiting for a response, before assisting them.

Risks to people’s health and wellbeing were known by staff and well managed. The manager and staff team maintained close links with external health care professionals to promote people’s health. People told us they were informed about their health needs and kept up to date so that they had choices about treatments.

People told us that they received their medication on time and in a way that they wanted. Supplies of anticipatory pain management medicines were in place for people on end of life care. People’s medicines were managed by staff who had training to do this safely. People and their relatives said staff supported them with their health care needs. The manager had worked proactively to ensure people had access to services to maintain and promote their health and well-being.

People were cared for by staff who knew them well and who they described as kind, caring, respectful and patient. We saw that staff respected and responded to people’s individual needs and saw positive interactions between staff and people that lived at the home as well as their families. People, relatives and staff said there were sufficient numbers of staff available to meet people’s needs. Relevant checks had been undertaken on staff before they worked at the home.

The provider had sourced external trainers to provide a rolling programme of training that was tailored to develop the skills and knowledge of staff. Staff had access to regular support and supervision to ensure they could discuss their practice as well as their training needs.

People told us the quality and variety of meals was good and we saw that drinks and food was available throughout the day. People had direct support to help them eat, and links with health care professionals to support people’s dietary in-take were evident.

People told us they enjoyed a variety of group and individual interests and activities. This included planned trips out with staff and parties and celebrations in the home’s bar. Staff completed their own fundraising events to raise money for various events. All relatives we spoke with told us they were actively welcomed and encouraged to remain involved in the home and that they felt their relative had an enhanced quality of life since living at the home.

People told us that staff listened to them and they knew how to raise concerns. The manager responded to people’s complaints and took action to improve the service as a result of complaints. The views of people and their relatives had been regularly sought via meetings and surveys to obtain their feedback.

There was a consistent and effective system of monitoring the service provided. People confirmed that a number of improvements had been made since the manager took up post and stated their admiration for her, the provider and the staff team. We saw the manager had worked in partnership with external organizations to support the provision of care. They participated in a ‘Shaping Our Age’ research project about involving older people in improving their well-being. The results of the discussion groups showed that people at Ash Lodge who participated were positive about their experiences at Ash Lodge. This demonstrated there was a commitment to defining the quality of the service from the perspective of the people using it.