The inspection took place on 31 October 2016 and 1 November 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Ashbourne House Care Home in October 2014, at which time the service was compliant with all regulatory standards inspected.

Ashbourne House is a care home in Oldham, providing accommodation and personal care for up to 35 older people. There were 31 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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.

There were sufficient numbers of staff on duty in order to safely meet the needs of people who used the service. The registered manager assessed people’s dependency to ensure there were sufficient staff to meet people’s needs.

All areas of the building were clean and well maintained, including external areas. Where refurbishment was required, we saw this had been incorporated into an existing action plan.

Staff demonstrated a good knowledge of safeguarding principles and what they would do should they have any concerns. People who used the service and their relatives confirmed they felt safe.

Effective pre-employment checks of staff were in place, including Disclosure and Barring Service (DBS) checks, references and identity checks.

The storage, administration and disposal of medicines was safe, in line with guidance issued by the National Institute for Health and Care Excellence (NICE) and supported by clear lines of accountability and auditing.

Risk assessments identified individual needs and staff displayed a good knowledge of the risks people faced, such as tripping, and how to reduce these risks.

People received the treatment they needed via prompt and regular liaison with external healthcare professionals such as GPs, nurses and specialists.

A training matrix was used to ensure staff refreshed their knowledge regularly. Staff had received training in Safeguarding, First Aid, Fire training, Moving and Handling, Deprivation of Liberty Safeguards/Mental Capacity Act, Equality and Diversity, Infection Control, Medication, Health and Safety and Dementia Awareness.

Staff received regular supervision and appraisal as well as the opportunity to raise any issues at regular team meetings.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service was working within the principles of the MCA.

The atmosphere at the home was welcoming and vibrant. The strong consensus of opinion from people who used the service, relatives and external stakeholders was that staff always behaved patiently and in a dedicated manner. We observed people who used the service interacting with staff in a relaxed and comfortable manner with staff during our inspection.

Staff had recently been trained in end of life care and external professionals confirmed the service was well prepared to provide such care, although no one was receiving end of life care at the time of our inspection.

Person-centred care plans were in place and staff also had regard to individualised signs on each person’s door, which gave their name and one thing special to them. We saw regular reviews of care plans took place with the involvement of people and their family members.

Group activities took plac

An adult social care inspector carried out this inspection. The focus of the inspection was

to answer five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with 3 people who use the service, 4 visitors, the

registered manager, the registered provider and 5 care staff. We also reviewed records

relating to the management of the home which included, 5 care plans, daily care records,

medical administration records and 6 staff records.

Below is a summary of what we found. The summary describes what people using the

service, their relatives and the staff told us, what we observed and the records we looked

at.

Is the service safe?

The premises were clean, well maintained and had procedures in place for responding to foreseeable emergencies to reduce the risks to people at the home. We found systems were in place to reduce risks within the home, for example for the safe storage of medication.

We saw safe techniques were used by staff when helping people with mobility difficulties.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job. A person living at the home told us “There is always someone around and if you call for help they respond to you in time.”

Is the service effective?

People's needs were being met at the home. We found that people's needs were assessed and care files included information about people's diagnosed health conditions and also their preferences. This meant they received care that protected their welfare and safety.

People and their relatives told us the food was good and there was a choice at meal times. One person said, "Mum is always pleased with the food."

Is the service caring?

People told us they were happy with the care they received at the home. One person said, "It is absolutely brilliant, can’t fault it. The carers, cooks, cleaners and handyman are all lovely." We observed that staff providing people's care were gentle and encouraging.

People appeared to be treated with dignity and the staff could tell us what they were able to do to maintain a person’s dignity. One told us, "I always knock on the door before entering and ensure curtains are closed.” Another told us “Dignity is about talking to people and asking them about what they would like.”

Is the service responsive?

People’s records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a general practitioner or district nurse.

People who lived at the home and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive and she was always around.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and care at the home. Records showed incidents and accidents, complaints and quality audits were reviewed by the manager.

Staff had an induction programme and appropriate recruitment checks were in place. Staff felt listened to and supported by their senior carer or manager.

People using the service, their relatives and other people involved with the service had completed satisfaction surveys and records showed action was taken where any improvements were required.

Ashbourne House was able to accommodate a maximum of 35 people. At the time of our inspection there were 30 people living there. During our inspection we spoke with four people living at the home, two visitors and members of staff.

One person living at the home told us the “The staff are very kind and always polite. I’m well looked after here”. Another told us “I like to stay in my room, I’m happy with my own company and have everything I need”. Two people living at the home told us they couldn’t manage to live independently but felt “safe” at Ashbourne House.

Approximately three times each year people living at the home, relatives and stakeholders were asked to complete satisfaction questionnaires. The vast majority of responses we reviewed were positive. One relative commented “Staff couldn’t do a better job. All the staff were excellent”. A GP who visited the home described the standard of care as “often to a higher standard than would be expected”.

The provider had a complaints policy in place. One person using the service told us “I’ve no complaints. If I did have I’d tell the staff and they’d sort it out”.

During this inspection we found that the provider had responded to concerns found at our inspection of 9 July 2012.

The care records we saw had been reorganised and provided clear information about people’s care and support needs. This information was updated regularly. People were involved in their care planning and were appropriately asked to consent. If it was thought that they may not be able to make their own decisions a mental capacity assessment was carried out.

Staff files had also been reorganised and contained clear up to date information about all aspects of their employment.

We spoke with three people living at Ashbourne House Care Home during our inspection. People said they were happy with the care workers and with the care they received. One of the people we spoke with told us they had no idea what was in their care plans, but added "I'm not bothered as the girls seem to know what to do". Another said of the manager "She's great. I'd never move".

People told us that those that are able to go out alone. One person said "They (the care workers) always ask what we'd like to do" and said they usually liked to watch television.