Ashcroft care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This inspection took place on the 25 and 26 October 2018 and was unannounced. Ashcroft Care Home is a nursing home that provides 53 places for older people and people with Dementia. There were 49 persons in the home at the time of our inspection.

The service was last inspected 10 November 2015 and the rating for that inspection was Good.

There was a registered manager in post who was available throughout the 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 received safe care. Staff were aware of their responsibility to keep people safe. Risks were assessed and managed to reflect people’s current needs. Staffing levels were sufficient. Safe recruitment was followed to ensure staff the staff employed were suitable to care for people. People received their medicine as prescribed and this was administered by staff who were competent. The provider was following relevant guidance for infection control. Systems were in place to monitor accidents and incidents to identify any lessons learned and make improvements where required.

People received extremely good care that was effective to their needs. People were supported by staff who were knowledgeable and suitably trained. There was a strong emphasis to ensure people receive sufficient to eat and drink. People’s healthcare needs were monitored to ensure their day to day needs were met. The service involved people in decisions about their care. People used equipment and technology to ensure they could do things independently. The service was working within the principles of the Mental Capacity Act (MCA). The service had an MCA champion who ensured people were given choices about who could provide their care and staff understood the requirements about consent and people’s capacity.

There was a strong person-centred culture throughout the service. Staff were sensitive to times when people needed caring and compassionate support. People were extremely positive about the caring nature of staff. People were treated with dignity and respect and their choices and preferences were adhered to.

Care was tailored to meet individual needs. People were supported without exception to lead meaningful and independent lives. Information was provided in formats that were accessible to people. Complaints and concerns were comprehensively recorded and fully Investigated with lessons learned and action taken appropriately.

The service was extremely well led, with a clear focus on person centred care, which empowered people and their relatives to make decisions about their care. Care planning involved people and their families to make their wishes known and enabled them to be as independent as possible. The quality assurance systems in place effectively monitored the service. The registered manager responded positively and was proactive to change and improving the service.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and four relatives and asked them for their views. We also spoke with seven care workers and various senior staff and managers employed at the service. We also looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people who were able to gave consent to their care and treatment. A person told us, “If I say I want something different they come and talk with me about it. Up until now everything I have asked for I have had. They have been very good.”

We found people were provided with a varied and nutritional diet. A person who used the service told us, “There is plenty to eat, it (the food) is lovely.” Another person told us, “I can have a snack later, but don’t very often before dinner.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person who used the service told us, “I have to take lots of tablets. They (staff) always say it is tablet time is that alright?”

We found there were sufficient staff to meet people’s needs. A relative told us, “There are enough staff here, they all have their own tasks so they can care for everyone.”

We found the provider maintained records that were accurate and fit for purpose. A relative told us, “Staff write daily notes, they have shown these to me.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke with five people who used the service who told us that they were happy with the care they received.

We spoke with one visitor who told us they were acting on behalf of their relative. They told us, “I visit regularly, I hear staff and managers speak so respectfully to people here, staff talk to people as if they were a member of their own family, they are very caring.”

We observed staff supporting people safely in accordance with their plans of care.

We looked at records for three people and saw that people using the service or their relatives and advocates, were consulted about the care and treatment they receive.

We inspected the service on 10 and 11 November 2015. Ashcroft Nursing Home is registered to provide accommodation for up to 53 older people with nursing and or dementia care needs. On the day of our inspection there were 51 people living at the home.

The home had a registered manager who was available during 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, and their relatives, told us that they felt safe and well looked after.

Staff met people’s needs effectively and people told us that they were all kind and caring. Staff told us that they enjoyed working at the home and they were very knowledgeable about people’s needs, preferences and life experiences. Staff respected people’s privacy and dignity.

Staff had a good understanding of what constituted abuse and told us that they would be confident to recognise and report it. Senior staff, including the registered manager, were aware of their roles in relation to reporting allegations to appropriate external agencies.

The premises were well maintained to keep people safe.

There were sufficient staff on duty to meet people’s needs effectively and staff were recruited through safe recruitment practices.

Overall, medicines were stored and administered safely. However records for medicines prescribed ‘as and when required’ needed to be reviewed to ensure they contained sufficient information for safe and consistent administration.

Staff received a thorough induction when they first started working at the home and training opportunities were good. Staff were very positive about the training they received. Training equipped them with the knowledge and skills to support people safely and effectively in line with their specific health needs. Staff felt well supported, formally and informally and had a good understanding of their roles and responsibilities.

People’s rights were protected under the Mental Capacity Act 2005 and there was evidence that they had been involved and consulted about all aspects of their care and support. Relatives told us that they had also been actively involved in sharing information with staff about people’s needs and preferences.

People were provided with sufficient food and drink to maintain their good health and wellbeing. The standard of food provided was very good. Health professionals worked closely with the home to ensure people’s health care needs were met. Communication between staff and outside agencies was good.

People enjoyed a range of activities both at the home and in the community. People were actively involved in the day to day tasks associated with the running of the home.

People who used the service and their relatives were involved, or had opportunities to be involved, in the development of the service. People told us that they felt listened to and would be confident to make a complaint or raise a concern if they needed to. Staff knew the complaints procedure and we saw that it had been used effectively to improve the service.

There were opportunities for people to share their views about the running of the home and we saw that when suggestions for improvements had been made these had been acted upon. Everyone we spoke with thought that the home was well led by the management team and the providers were working with the registered manager to ensure that individual roles and responsibilities were clarified and strengthened. There were systems in place to monitor the quality of the service provided although information identified was not always reviewed by the registered manager.