We inspected Ashchurch View on the 15, 19 and 21 November 2018. Ashchurch View provides accommodation, nursing and personal care to 60 older people and people living with dementia. It also provides short term respite for people. At the time of our visit 55 people were using the service. Ashchurch View is located in Ashchurch near to the town of Tewkesbury. This was an unannounced inspection.

We last inspected the home on 6 and 8 September 2017. At the September 2017 inspection we rated the service as “Requires Improvement”. We found the provider was meeting all of the requirements of the regulations at that time, however due to changes in the staffing and management teams this had had an impact on the level of engagement people received. At this inspection, we found similar concerns in relation to staffing and the support and stimulation people received. The provider was aware of these concerns and had a long term management plan in place to improve the quality of care people received.

A registered manager was in post at the service, however they had recently started maternity leave. The provider had employed a peripatetic manager to provide day to day management support at Ashchurch View. This manager had just started their employment with the provider. 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 did not always receive person centred care or meaningful engagement from care and nursing staff. People went long periods of time without stimulation or support. Care staff did not always feel they had the time to support people with their emotional needs. When people were anxious they did not always receive effective and timely support. People’s life histories and interests did not always inform their care plans and the activities they would enjoy.

People, their relatives and staff raised a number of concerns in relation to staffing levels at Ashchurch View. The provider was taking action to address staffing concerns, including staff sickness and staff turnover. During our inspection the provider and manager took effective action in response to concerns raised in relation to the deployment of staff to ensure people were kept safe, this included the implementation of a short term action plan.

Care and nursing staff did not always feel supported and did not feel their professional development needs were met. The provider had plans to implement effective training and supervision support. Staff did not always feel they had the communication they needed to ensure people’s day to day needs were being met.

People were cared for in a clean, safe and well-maintained home. The provider and manager carried out effective checks to ensure the service was appropriate for people’s needs. Nursing and care staff followed recognised infection control procedures.

People were protected from the risks associated with their care. Care and nursing staff knew how to assist people with their needs and ensure their health was maintained. People’s prescribed medicines were mostly managed well, however some nursing staff (including agency staff) did not work to the provider’s expectations.

Staff understood their responsibilities to protect people from harm and to report any safeguarding concerns. Staff provided people with choice and worked to protect and maintain their legal rights.

People had access to a good variety of food and drink. Care and nursing staff treated people with dignity and ensured they had their nutritional support and their prescribed medicines. Catering and care staff were aware of and met people’s individual dietary needs.

People’s relatives felt their concerns and views had not always been listened to and acted upon due to changes wi

Ashchurch View is a large purpose built care home set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People’s bedrooms have a private toilet and shower facility. People have access to a secure garden, coffee area and activities room as well as a hair salon.

This inspection took place on 6 and 8 September and was unannounced. Ashchurch View provides accommodation for 60 people who require nursing and personal care. 54 people were living in the home at the time of our inspection. This service was last inspected in November 2015 and was rated Good overall. At this inspection we found the service was rated Requires Improvement overall. We will be asking the provider for a report on the actions they plan to take to achieve a rating higher than ‘Requires Improvement’

There was no registered manager in place as required by their conditions of registration. 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. There has been a new manager in place since May 2017. The manager had submitted an application to CQC to become the home’s registered manager to ensure the provider would meet their registration requirements.

Information of concern around the inconsistency of staffing levels in Ashcurch View had been raised prior to our inspection. CQC had initially acted by requesting confirmation and assurances from the provider that people were being cared for by a sufficient number of staff. This inspection was prompted in part by these concerns and to follow up on the actions the provider stated they were taking.

There had been recent changes in the staffing and management of the home. People had been supported by agency staff and staff had remained flexible to ensure they remained safe in the home. The manager was actively recruiting a permanent staff team to ensure people there were sufficient and familiar staff deployed to meet their needs.

People’s support needs and risks had been assessed and were managed well. Their care records had been reviewed however improvements were needed to ensure the care people required and had received would always be recorded. People received their medicines in a safe and timely manner and were referred to health care services when their needs had changed.

Quality assurances systems were in place to monitor the quality of the service being provided and actions were being taken by the manager when they had identified areas that required improvements. Further improvement was needed to ensure management actions would always be recorded to enable effective monitoring and evaluation of action taken to improve the home.

People told us they enjoyed living at the home and they felt safe. We observed that staff were courteous and polite towards people. Staff understood the importance of respecting people’s dignity and privacy. Staff supported and encouraged people to make their own decisions and choices.

Staff had been trained to carry out their role and were knowledgeable about good care practices and their responsibilities to protect people from harm and abuse. Staff felt supported by their seniors and new managers. Plans were in place to ensure staff received one to one support meetings to discuss their role and self-development. Adequate recruitment processes were in place to ensure people were cared for by suitable staff, some improvement was needed to ensure people’s needs were continually being met in a timely manner.

The manager was taking action to further develop the activities for people. Additional staff had been recruited to develop a range of activities to be available in the home and community. Concerns from

This inspection took place on 13 November 2015 and was unannounced. Ashchurch View provides accommodation for 60 people who require nursing and personal care. 58 people were living in the home at the time of our inspection. This service was last inspected in July 2014.

Ashchurch View is a large purpose built care home set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People’s bedrooms have a private toilet and shower facility. People have access to a secure garden, coffee area and hobbies room as well as a hair salon.

A registered manager was in place as required by their conditions of registration. 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 enjoyed living at Ashchurch View. They were positive about the care and support they received from staff. People’s individual needs were assessed, planned and reviewed. However people’s risk assessments were not always updated and recorded accurately. People did not have evacuation care plans to guide staff with their support requirements. Assessments to people’s ability to make decisions about their care and treatment had not been recorded in detail.

People received additional care and treatment from other health care services when needed. People were supported to have a well-balanced and nutritional diet. A programme of activities was in available. People were encouraged to make decisions about their day. Detailed mental capacity assessments and records of power of attorneys were not always evident where people lacked mental capacity to make decisions about their care and support.

People told us staff were kind and compassionate but they would like staff to sit and chat with people. The staffing levels of the home were being reviewed with the provider. Further recruitment was in place to ensure people’s needs were being met. Staff told us they felt supported and trained to carry out their role. However, whilst most staff had received relevant training and individual support sessions, this was not always recorded.

People and their relatives spoke highly of the staff and the registered manager. Relatives told us any day to day concerns, which they had raised, were always dealt with immediately. The registered manager valued people’s feedback and responded to any concerns. Complaints were managed effectively and actions were put in place to prevent the concern reoccurring.

Monitoring systems were in place to ensure the services were operating effectively and safely. Internal and external audits were carried out to continually monitor the overall services provided.

This was a routine inspection, however we also looked into a number of safeguarding incidents that had occurred prior to our visit. These incidents had been reported by the provider in line with Local Authority protocols. We checked how people were protected from harm and whether staff received the right support and training to enable them to meet people's needs. During the inspection we responded to a concern raised by a relative. We focused on five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?:

Below is a summary of what we found. Some people had complex needs which meant they were not able to tell us about their experience in any detail. As a result we used a number of methods to help us understand, which included observing staff interacting and supporting people.

Is the service safe?

Safeguarding procedures were robust and staff understood how to protect the people they supported. Appropriate safeguarding referrals had been made to the Local Authority and action taken to prevent recurrences. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that best interest meetings had taken place involving families. This meant that people would be protected.

Is the service effective?

People's health and care needs were assessed with them, or their families, if they were unable to participate.

People's health and care needs were assessed and reviewed. The home was divided into three separate house units, enabling people to move around freely and safely. Visitors told us that they were able to see people in private and that visiting times were flexible.

Is the service caring?

We observed people being treated with respect and dignity by the staff. People told us they felt safe. People's preferences, interests and needs had been recorded. We saw staff supporting people with kindness and patience. People commented, "The staff are lovely here".

Is the service responsive?

There were a wide range of activities offered to people, to choose from. We saw that complaints had been made and responded to appropriately. The manager was aware that there needed to be improvements made to ensure that visitors were clear how to raise concerns. People could be assured that complaints were treated seriously, investigated thoroughly and action taken as necessary. A relative said, "I visit my relative regularly and usually everything is fine, but I'm rather worried about something at the moment. I have told the manager who is dealing with it".

Is the service well led?

The home had been open for 19 months. The registered manager was involved with the opening of the home and had many years' experience. A registered manager is a person who has registered with the Care Quality Commission to manage the service and share the legal responsibility for meeting the requirements of the law with the provider. The service had quality assurance systems and records which show that home was keen to address any identified shortfalls. Staff were able to tell us about their roles and responsibilities and the ethos of the home. Each house unit had an identified staff team and Head of Unit, which helped to ensure that people had consistent care.

Not all people who used the service were able to tell us about their experiences due to their complex needs. We observed staff interacting with people. We spoke to six people, two relatives and five staff. The six people were spoke with all told us they were happy with the care they received. One person said "you wouldn't get better care anywhere else". All said they had no complaints at all. Two people said they were very happy to be here "it is such a lovely environment". The relative's we spoke with told us they had discussed some concerns with the registered manager and they were happy with the arrangements they had in place for allocating staff to each person.

Ashchurch View was a new purpose built environment over two floors. They environment had been divided into three units and two of these were operational. We found the furniture and fixings were of a very good quality.

The system the service had in place for the management of people's medication was safe.

The procedure for recruiting new staff was safe and ensured all the required checks were undertaken prior to them starting work.

Staff told us it was a good place to work as they were supportive of each other and they had a good management team in place.