We carried out our inspection visit on 24 January 2017.

Ashby Court provides nursing and personal care for up to 60 older people and people with dementia and physical disabilities. The accommodation is on two levels and there is a separate unit called the ‘Forget-me-not unit’ for people with advanced dementia on the first floor. On the day of our inspection there were 50 people using the service.

The service had a registered manager. 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 told us they felt safe and that staff met their needs. Staff were clear on their role to keep people safe and how to report any concerns that they may have.

There was a recruitment policy in place which the provider followed. We found that all the required pre-employment checks were being carried out before staff commenced work at the service.

People were protected from avoidable risks. Risks associated with people’s care were assessed and managed to protect people from harm. Regular safety checks had been carried out on the environment and the equipment used for people’s care to ensure that they were safe.

People received their medicines as required. Medicines were administered safely by staff who were appropriately trained and competent to do so.

Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported. Their competence to do their role was regularly assessed.

People were not always supported in line with the requirements of the Mental Capacity Act 2015. Where people were assessed as lacking the capacity to make informed decisions it was not clear how best interest decisions had been made on their behalf.

People enjoyed the meals provided and where they had dietary requirements, these were met. Records did not reflect that people were offered adequate drinks to maintain their health and wellbeing.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. Dignity and respect for people was promoted.

The care needs of people had been assessed and were regularly reviewed to ensure they continued to be met. Staff had a clear understanding of their role and how to support people who used the service.

People were supported to pursue their interests and access the community.

Complaints were addressed in line with the provider’s policy. People were given opportunities feedback about the service they received.

People and staff felt that the registered manager was approachable and action would be taken to address any concerns they may have.

Systems were in place to measure the quality and care delivered so that required improvements could be identified and addressed.

People using the service told us they made decisions about their care and support. People’s rights and choices were respected and complimented the staff that supported them. We observed the interaction between staff and people using the service was positive. One person told us that they would not hesitate to complain if they were unhappy and said: “I do feel very safe, cared for and they [staff] listen to me.”

Visiting relatives were satisfied with the quality of care and support their family member and they received. One relative told us they were involved in assessment and care planning processes to make sure the decisions made were in the best interest decisions for their family member. They said: “Overall, I am very happy with the care that Ashby gives to my … [family member]. It is marked by kindness and affection and that is invaluable for .….. and for me.”

People lived in an environment that is suitably designed, adequately maintained and decorated to a good standard. Bedrooms were personalised, furnished and equipped to promote people’s privacy and independence. Access to all areas including the garden was safe and secure.

Since our last inspection we found staff received timely support, supervision and training to ensure people received the care and support tailored to their needs.

We were unable to speak with people using the service and staff because the provider had identified a potential health risk. The provider had taken steps to discourage visitors to the service whilst medical advice was sought.

The provider had made improvements with regards assessment of people’s care needs, care planning and management of risk. People’s views and where appropriate their family members were consulted to ensure people’s needs, routines and preferences were known. Records showed people’s health and care needs were met and monitored. Concerns were reported promptly and medical support accessed when required.

Staff had received training to do their job role. Improvements were needed to ensure care delivered was to an appropriate standard through systems to support, supervise and appraise staff.

Records maintained with regards to people who used the service, staff and the management of the service were kept accurate, up to date and stored securely.

People we spoke with were positive about their experiences of the service they had received. People were complimentary about the care and support they received. One person said “I’m very happy with the care I get.”

People had a range of assessments and care plans which detailed the care and support they needed. People were supported to access health care services when required. People’s health and care needs were monitored and reviewed regularly by staff. People received their medicines on time from trained nurses. People had access to a range of health and social care professionals that ensured their health, safety and wellbeing.

People told us about the daily lifestyle, interests and how they liked to spend their day. One person said, “I decide what I do and how I spend my day.” Another person said “I like doing the crosswords and puzzles, it’s my hobby.”

People told us they had opportunities to make comment about the service. People were aware of how to express concerns or make a complaint about the service and were confident that the concerns would be addressed quickly.

During our visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences were. The SOFI tool allowed us to spend time watching how staff support people, practices within the home. We observed whether people had positive experiences with regards to the support they received promotion of people’s rights and independence. Overall we found people were supported positively by staff that ensured their care needs were met and their wellbeing promoted.

People were supported by staff that received regularly training, support and supervision.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, health and safety. People using the service and their relatives had opportunities to comments and give their views about the quality of services experienced.

We spoke with several people using the service who told us they were happy with the quality of care and support provided including meeting their medication and health care needs. The home ensures appropriate equipment and aids are provided that promote people’s safety and wellbeing. People were aware of the information held at about them, were involved in developing their plans of care and the review meetings.

There are good choices of meals daily and special dietary requirements are met.

People who use the service and visiting relatives found staff were confident and trained to provide the care that they needed and in a respectful manner.

People said they had opportunities to take part in activities organised by the home and receive visitors at any time. People are supported to continue their interests and hobbies including having their daily newspapers, painting or watching particular television programmes.

The cleanliness and décor within the home is good and people using the service have been kept informed and consulted about the refurbishment programme due to take place this year.

Staff were observed interacting with people well and providing encouragement and support. Staff are trained and deployed effectively to provide consistent and quality care that promotes people’s wellbeing. Staff are knowledgeable and confident in meeting people’s individual needs.

The management of records in relation to people who use the service, staff, safety and the management of the home is good. All records are maintained accurately, kept up to date and secure.

People who use the service and their relatives are involved in the development of the service. They are consulted and have the opportunity to express their views and concerns, which are listened to and addressed quickly. Some of the comments we received included:

“We sat with the manager and our mother when doing the care plan and review, as she has dementia we wanted to make sure the care was right for her”

“I’m looking forward to the refurbishment in August, they even asked me what colour I would like my room painted”

“I think the carers are wonderful, especially …. and …., they just know what I like”

“It’s probably one of the more expensive homes but well worth it”

“Feel satisfied with the care provided”

“There’s always a choice and if you’re really hungry, seconds!”

“The one thing that you won’t find here are funny smells, like in other homes”

“It’s always very clean here, the rooms are cleaned, bedding and my laundry is done and returned to my room”

“The nurses give out the medication so I don’t have to worry. They have got the doctor our for me when I was poorly”

“You can’t fault the care here, the staff are all wonderful and I do have my favourites”

“They have good manners, polite and confident to assist people even those who can become aggressive, challenging or reluctant”

The local authority that commission services and carry out contract monitoring visits gave us positive feedback about the quality of care provided at the home.

The Local Involvement Networks (LINks) members were consulted about this home but no responses were received.

This inspection took place on 7 and 8 January 2015 and was unannounced.

Ashby Court Nursing and Residential Care Home is a care home that provides residential and nursing care for up to 60 people. The home specialises in caring for older people including those with physical disabilities, people living with dementia or those who require end of life care. At the time of our inspection there were 54 people in residence.

A registered manager was 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 who used the service told us that their care needs had been assessed and they were satisfied with the care and support received. People were well cared for, felt safe with the staff that looked after them and protected them from harm and abuse.

Staff were recruited in accordance with the provider’s recruitment procedures that ensured staff were qualified and suitable to work with people who used the service. People were supported by staff in a timely and sensitive manner because there were sufficient staff on duty that worked in a co-ordinated manner.

People received their medication as prescribed and their medication was stored safely.

People lived in a comfortable, clean and a homely environment that promoted their safety, privacy and wellbeing. All areas of the home could be accessed safely including the outdoor space.

People were supported by staff who had a good understanding of their needs and had received training to carry out their role effectively. Communication between all the staff was good. Staff told us they had access to people’s care records and were supported by the registered manager, which meant all staff were kept up to date as to the needs of people.

The management team and staff knew how to protect people under the Mental Capacity Act, 2005 and the Deprivation of Liberty Safeguard (DoLS). Although best interests meetings took place with the person or their representatives and other healthcare professionals those discussions were not always recorded clearly. The registered manager assured us they would address this immediately. The registered manager told us that they had looked after people who were subject to a DoLS. However, at the time of our inspection visit no one was subject to a DoLS.

People were provided with a choice of meals that met people’s preferences and dietary needs. There were drinks and snacks available throughout the day and night. We saw staff supported people who needed help to eat and drink in a sensitive manner. The catering staff were provided with up to date information about people’s dietary needs and requirements.

People told us that staff treated them with care and compassion. Throughout our inspection we saw people’s dignity and privacy was respected, which promoted their wellbeing.

People were supported by staff and their visitors to take part in hobbies and activities that were of interest to them, including observing their religious beliefs. Visitors were welcome without undue restrictions. This protected people from social isolation.

People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care. People had access to advocacy services if they needed support to make comments or a complaint. There was a clear management structure and procedures in place to ensure concerns were addressed.

People using the service, their relatives, staff and health and social care professionals were encouraged to develop and share their experience of the service.

Staff were supported and trained for their job roles to ensure their knowledge, skills and practice in the delivery of care was kept up to date. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The registered manager understood their responsibilities and demonstrated a commitment and clear leadership to continually improve the service. The registered manager was supported by the deputy manager and senior staff. They had an ‘open door’ policy and welcomed feedback from people who used the service, relatives, health and social care professionals and staff. The registered manager works with the commissioners such as the local authority that monitors the service for people they fund to ensure people received care that was appropriate and safe.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment which was well maintained and safe. Audits and checks were used to ensure people’s safety and their needs were being met. The quality of service provided was monitored and action was taken to address any deficiencies found. The provider’s internal inspections provided further monitoring and assurance that people received quality care.