This focussed inspection took place on 1 September 2017 at 11pm. The inspection was unannounced.

Ashbourne Court Care Home is registered to provide accommodation with personal care for up to 16 people, some of whom may be living with dementia. At the time of our inspection there were 15 people living at the service, 3 of whom were staying at the service for a period of respite care.

We carried out an unannounced comprehensive inspection of this service on 9 December 2017. After that inspection we received concerns in relation to the staffing levels provided at night. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashbourne Court Care Home on our website at www.cqc.org.uk

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. The registered manager was not present during the inspection.

Sufficient staff were deployed to meet people’s needs safely. One staff member was working a waking night shift and had access to a second staff member should they require additional support.

People had risk management plans in place which gave guidance to staff on the support people required. Although staff knew the needs of permanent residents well, they were not always aware of the support people required who were staying at the service for a period of respite. The manager has assured us they are changing the system to enable staff to have a handover at the start of a night shift so they are aware of the needs and risks for people on respite.

Emergency protocols were in place to ensure that people would continue to receive a safe service in the event of an emergency. Staff understood the systems in place and were aware of evacuation procedures.

The service was last inspected on 9 December 2016 were no concerns were identified.

This inspection took place on the 9 November 2016 and was unannounced.

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.

Ashbourne Court Care Home is registered to provide accommodation with personal care for up to 16 people. At the time of our inspection there were 14 people living at the service, some of whom were living with dementia.

During our inspection of January 2016 the provider was found to be in breach of five Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found there was insufficient staff to support people’s needs, effective infection control systems were not in place, lack of activities for people that reflected people’s needs and preferences, use of disproportionate restraint and records of people’s care were not accurate.

We carried out this fully comprehensive inspection to see what action the provider had taken in response to the shortfalls we had previously identified. We found during this inspection that the provider had made the improvements needed and was now meeting the regulations.

The Provider Information Return (PIR) we received from the provider contained limited information about the service. We have made a recommendation that the provider ensures the PIR is completed in full to provide all information in the five domains about how the service provides safe, effective, caring, responsive and well led care for people.

People and their relatives told us they felt the service was safe. Relatives told us that staff were very kind and they had no concerns in relation to the safety of their family member. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff commencing their duties undertook induction training that helped to prepare them for their roles.

There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred and discussed these with staff so lessons could be learnt.

The provider ensured that full recruitment checks had been carried out to help ensure that only suitable staff worked with people at Ashbourne Court.

Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them. People’s relatives and visitors were welcomed and there were no restrictions of times of visits.

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Ashbourne Court is a residential care home providing accommodation, personal care and support to up to 16 people. The home is located in a quiet residential area. The accommodation is set over two floors with a stair lift available. At the time of our inspection there were 11 people living at the home.

The inspection took place on 13 January 2016 and was unannounced.

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 and associated Regulations about how the service is run.

The service did not deploy sufficient staff to meet people’s needs. People assessed as being at risk of falls were left unattended whilst staff carried out domestic tasks. Staff were not always available to offer reassurance to people and we observed people spent significant amounts of the day asleep. People were not provided with a range of activities which reflected their hobbies and interests.

Systems were not in place to ensure people were protected from the risks of infection control. Procedures to ensure adequate and appropriate cleaning equipment was available were not in place.

People’s legal rights were not always protected. Two people’s bedroom doors were locked at night with other rooms being locked during the day preventing them from re-entering them.

Staff did not always receive the appropriate training to ensure they had the relevant skills to meet people’s needs. Not all staff had received training in supporting people living with dementia and this was evident in their practice.

Regular audits of the service were not completed to monitor the quality and effectiveness of the service. There was a complaints procedure in place and we saw that complaints had been responded to in a timely manner. However, systems were not implemented to ensure that concerns raised did not reoccur. Staff and people were not routinely involved in decisions about how the home was run.

Records of the care people received were not always completed by the staff who had delivered the care. This meant that people were at risk of not receiving the care they required.

Medicines were managed safely. Staff took the time to explain to people about their medicines and where appropriate gave them choice about when to take them.

Appropriate recruitment checks were undertaken when new staff were employed to ensure they were suitable to work with people living in the service. Staff received regular supervision to support them in their role.

People were protected from the risk of harm or abuse as staff members understood their responsibilities in safeguarding people. A contingency plan was in place to ensure people’s care could continue safely in the event of an emergency.

People told us that the quality of food was good and that they were given choices at every meal. People were supported to maintain a healthy diet. However, staff were not always available to offer support and reassurance at mealtimes.

People were supported to maintain good health and had regular access to a range of healthcare professionals. People’s needs were assessed prior to them moving into the service and care plans reflected this information.

People and their relatives spoke highly of the registered manager and staff team. Relatives told us they were able to visit at any time and were always made to feel welcome.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us that their right to privacy was maintained at all times and the advice and support they received from the manager and staff were given in a way that maintained their dignity. People said they were involved in the planning of their care

We found evidence in records and feedback from staff and senior management which suggested that robust actions had been taken to respond to the concerns that, people’s privacy, dignity and independence had not always been met.

During our inspection we spoke with three people who used the service, two relatives, three members of staff and the Registered Manager. We also observed care being given throughout the inspection as not everyone at the service was able to express their views verbally.

We found that, although people had choices about what they wanted to do and where they wanted to go, they did not always have choices at mealtimes. We saw that people were treated with dignity and respect by staff. One person told us “Staff speak to me nicely.”

People and relatives we spoke with felt the staff were caring. One person told us “Staff are so kind.” A relative told us “My uncle is well looked after.”

We found that the home had effective infection control policies and procedures and that the home was clean and tidy at the time of our inspection.

All of the staff that we spoke with told us that they felt supported at the service. We saw that staff attended regular meetings and that a record was kept of these meetings. We saw that staff were kept up to date with the services mandatory training and had appropriate one to one supervision and appraisals.

The home had systems in place that monitored the quality of the service and to identify when things needed to be improved. We saw that this included auditing the health and safety of the home.

We found that people who used this service were not able to answer questions . Therefore, the information contained in this report is mainly from relatives of people who used the service.

Relatives of people said staff consulted with them about the care and support of the person who used the service. Relatives signed the care plans on their relative’s behalf. This meant that relatives were involved in deciding their relative’s care and gave their consent for care to be carried out. Four people did not know if they had a care plan. This could be because they had forgotten, as we found up to date care plans for them. One relative said, “My relative has a care plan which I sign on their behalf”.

Relatives told us the staff spoke to them in a polite way and addressed them in the way they preferred. A relative said, “I know my relative has a care plan. I was asked to sign it on their behalf and I have signed it. I am very involved in my relative’s care”. One person said, “The food is very nice and nicely cooked . It is well done. They know what I like and do not like”. Another person said, “I get enough food”.

We found the provider encouraged relatives to be involved in the care and welfare of people who used the service. Relatives were encouraged to express their views and were involved in making decisions about their relative’s care, treatment and support. People were provided with suitable nutrition to maintain their wellbeing.

People who used the service told us they were involved in the planning of their care; that their named care worker discussed their support options and treatments with them and their family.

People who used the service said they were provided with the service user guide, and a contract of residency outlining costs and services which either they or their relatives signed.

Some people told us they could not remember if they had an assessment prior to being admitted into the service. Some people said someone from the service came to see them and asked a lot of questions, which they and their relatives answered.

People told us they knew whom to speak to if they had to make a complaint. They said any comments or concern raised were listened to and dealt with to their satisfaction.