Ashbourne Nursing Home is a privately owned care home providing nursing and personal care for up to 42 older people. It is situated in the village of Norden, two miles from Rochdale town centre. At the time of the inspection 39 people were accommodated at the home.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff were safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. Staff were trained in the prevention and control of infection to help protect the health and welfare of people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business contingency plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home. Plans of care were individual, person centred and reviewed regularly to help meet their health and social care needs.

We saw that people could attend activities of their choice and families and friends were able to visit when they wanted.

Staff were trained in end of life care to offer support to people and their family members at the end of their lives.

Audits, surveys and meetings helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive. There were systems to audit the quality of service provision.

This was an unannounced inspection which took place on 18 and 19 October 2016. The service was last inspected on 27 October 2015 when we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us making four requirement actions and two recommendations.

We received action plans from the provider that stated they would be compliant with the requirement actions by 31 March 2016. We undertook this inspection of 18 and 19 October 2016 to re-rate the service and to check they were compliant with the requirement actions.

Ashbourne Nursing Home provides accommodation for up to 41 people who have personal care needs, including those with dementia. There were 38 people living in the service on the day of our inspection.

The service did not have a registered manager in place 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. A new manager had been appointed, however they had only been in post seven weeks. They were in the process of registering with us.

During this inspection we found improvements had been made and the provider had met all the requirement actions from the previous inspection.

At our inspection of 27 October 2015 we found the service had not considered any risks the environment may pose to people who used the service, staff members and visitors. We also found that where risks associated with people’s care and treatment had been assessed control measures to reduce the risks had not been identified or put in place. During this inspection we examined four care files and found improvements had been made. We saw that risk assessments had been completed for health related issues and for the environment.

Concerns raised by us at our inspection of 27 October 2015 in relation to the recording of accidents and incidents had been addressed. During this inspection we found new documentation was in place which evidenced what actions had been taken and learning from these.

We looked at all the records in relation to fire safety. We saw a risk assessment was in place, regular checks of fire systems were in place and fire drills were undertaken on a regular basis. At our inspection of 27 October 2015 we found personal emergency evacuation plans (PEEPs) were not in place for people who used the service. During this inspection we found each person within the service had a PEEP which should ensure they were evacuated effectively in an emergency situation.

All the staff members we spoke with told us they felt staffing levels were adequate to meet the needs of people who used the service. Records we looked at confirmed the staffing levels the manager told us were required daily.

We reviewed the systems and processes in place to ensure the safe management of medicines. We have made a recommendation that the service considers current best practice guidance in relation to the administration of creams.

Wheelchairs, hoists and moving and handling equipment had been serviced to ensure it was safe to use. Records showed that staff members had received training in moving and handling procedures.

Although the manager had not commenced supervisions and appraisals with staff members (as they had only been in post for seven weeks) they were able to show us a supervision and appraisal pack they had developed and were due to put in place.

People who used the service had access to healthcare professionals. We saw that people had been referred to dieticians, speech and language therapists and had access to their GP.

At our inspection of 27 October 2015 we found the environment did not suitably meet the needs of those people living with dementia due to a lack of pictorial s

During our visit we spoke with four people who lived at the home, six people visiting their relatives and a visiting social care professional. People spoke positively about the care and support provided at the home. People told us; “It’s nice having friends to spend time with”, “Very caring”, “Consistent care” and “No question about it, they [the staff] look after you”.

From our observations we saw staff were patient and supportive when assisting people. Staff appeared to have a good understanding of people’s individual needs and routines.

We also spoke with the manager and two members of staff. Staff told us that they were fully supported in their role and that they had a good rapport with families.

Care records provided detailed information about the individual needs and wishes of people. Where able, people had signed their records to evidence their involvement in planning their care and support. Staff spoken with understood their responsibilities where a person lacked capacity to make decisions for themselves so that the person was kept safe.

Staff worked closely with other agencies so that people’s social, emotional and physical needs were effectively met. One staff member said they had a ‘good relationship’ with those agencies involved in people’s care and support.

Relevant checks had been carried out to show that new staff had been safely recruited. Improvements were required in some staff records so that information clearly showed what actions had been taken when appointing and inducting new staff.

Sufficient nursing and support staff were available to meet the specific needs of people. Two people we spoke with said, “I’ve no grumbles, the staff are wonderful” and “I feel the care is very good”.

Systems were in place for the reporting and responding to any complaints or concerns raised about the service. Relatives spoken with felt they were able to approach the manager if they had any issues or concerns they wished to discuss.

Up to date records were maintained in relation to the management and conduct of the service.

During our inspection we spoke with five people living at Ashbourne Nursing Home and the relatives of two people. People told us, “I’m very comfortable”, “If I need anything I just ring the bell and the staff come to help me” and “I’m very settled here, this is my home now”.

People also commented about the staff and the care they received. They told us, “They [the staff] give 100%”, “The staff are very helpful, nothing is too much trouble” and “They [the staff] know what they are doing”.

Two of the visitors we spoke with said they had no issues with the care provided for their relative and felt staff were supportive and responded promptly to any requests. All of the visitors spoken with said they were made “very welcome”. One visitor said “The carers are wonderful”.

Staff were seen to support people in a gentle, supportive and respectful manner. People were offered encouragement and care tasks were explained. Staff were attentive and appeared to have a good understanding of people’s individual care needs.

Activities were provided each day offering people variety to their daily routine. We were told that communion was held regularly at the home, the hairdresser visited weekly and the delivery of newspapers and magazines were arranged upon request.

This was an unannounced inspection which took place on 27 October 2015 and 12 November 2015. The service was last inspected on 06 January 2014 when we found it to be meeting all the regulations we reviewed.

Ashbourne Nursing Home provides accommodation for up to 43 people who have personal care needs, including those with dementia. There were 40 people living in the service on the day of our inspection.

The service had a registered manager in place 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.

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.

The service had not considered any risks within the environment that may affect people who used the service, visitors and staff members. We also saw that where risks associated with people’s care and treatment had been assessed the appropriate control measures to reduce the risks had not been identified or put in place. For example one person at risk of falls had sustained 19 falls within an eight week period and appropriate control measures were not in place to reduce the risk of serious injury. This meant that sometimes people who lived in the service were not safe.

We found that people who used the service did not have Personal Emergency Evacuation Plans (PEEP’s) in place. This meant that in the event of an emergency situation such as fire people may not be evacuated effectively.

We looked at the management of medicines within the service and found that safe systems and procedures were in place in relation the receipt, storage, administration and disposal of medicines. However we found the staff signature list that was in place required updating as it did not reflect the current staff team.

Staff we spoke with and records showed that they had received training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). However, further records identified that the registered manager had not followed the requirements in relations to DoLS for those people who were being restricted within the service.

Records we looked at showed that the service had determined one person lacked capacity without undertaking a capacity assessment and relatives were signing to consent to care and treatment without the correct authority in place.

We have made a recommendation that the service considers current best practice around supporting people with dementia to remain independent.

Care plans in place within the service were not person-centred. They did not contain clear instructions for staff on how to support people and they did not evidence that the person had been involved in them. We saw care plans were not updated to reflect changes in people’s needs or support level’s. There was no evidence to show that people’s religious and cultural needs were being addressed.

Quality assurance systems that were in place within the service were not sufficiently robust to identify the health, safety and welfare concerns that we found during our inspection. We saw that some monthly audits had not been completed since August 2015 and those that had been completed did not evidence what had been audited.

We saw interactions from care staff that were calm, respectful and valued people. We saw people were given choices and support and encouragement was offered. However during our inspection we found that people’s privacy and dignity was not always maintained. We have made a recommendation that the service considers its own policies and procedures in relation to this.

Training records we looked at and staff we spoke with confirmed they had received training in safeguarding and were able to tell us how they would identify concerns and raise them with a senior member of staff.

The service followed safe recruitment procedures when employing new staff members. Policies and procedures were in place for them to follow.

People who used the service had access to a range of healthcare professionals such as GP’s, dieticians and speech and language therapists in order for their health care needs to be met.

People who used the service spoke highly of the activities co-ordinator and described them as going ‘above and beyond’ their duties to support people. We saw evidence of activities that had occurred in recent times such as birthday celebrations. Although no activities were being carried out on the day of our inspection the hairdresser was in the service.

Staff meetings were held on a regular basis for both the day shift and the night shift. We saw that topics discussed included infection control and training and staff were able to put items on the agenda for discussion.

Policies and procedures were in place within the service for staff to follow good practice. We saw that these were accessible to staff.