The inspection took place on 19 October 2016 and was unannounced.

Ashcroft House Nursing Home provides accommodation and nursing care for up to 31 older people. There are gardens to the front and the rear of the premises. A large car park area is located at the front. The service is located close to the centre of Formby and near to Formby train station

There was a registered manager in place. 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 at the home. Each care file included a dependency tool to calculate the level of need for each individual. This was used to inform staffing levels to ensure there were sufficient staff on each shift. There were enough staff on the day of the inspection.

The recruitment process was robust to help ensure suitable staff were employed at the service.

Appropriate policies were in place with regard to safeguarding and whistle blowing. Staff had received training in safeguarding and those we spoke with were aware of the issues and confident of the reporting procedure.

Medication systems were robust and medicines were managed safely at the service. Individual and general risk assessments were in place. Equipment was fit for purpose and was regularly serviced and maintained to ensure it was in good working order.

The induction programme helped ensure new employees were equipped with the skills, knowledge and competence to work at the home. Training was on-going and mandatory training was refreshed regularly.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.

People’s nutritional and hydration needs were assessed and recorded appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals.

People we spoke with felt the care was good and staff were kind and caring. We observed good interactions between staff and people who used the service throughout the day. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people’s dignity and privacy.

People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes. Staff had undertaken appropriate training in end of life care and people’s end of life care plans were thorough and comprehensive.

Care files we looked at evidenced that care was delivered in a person centred way, taking into account people’s preferences, likes and dislikes. People we spoke with said staff responded quickly to call alarms. There was a programme of activities at the home and people were encouraged to participate if they were able to. Some one to one interaction was undertaken with people who were unable to participate in group activities.

There was an appropriate complaints policy and this was displayed throughout the home. Concerns were responded to in a timely and appropriate manner and the service had received a number of compliments and thank you cards.

People told us the staff and management were approachable. Staff felt the manager was supportive towards them. Regular team meetings were held, and staff were given supervisions on a regular basis. Residents’ and relatives’ meetings were also held.

We saw evidence of regular checks and audits that took place at the service to help ensure continual improvement with regard to care delivery.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We saw the staff training matrix and observed all staff members had undergone safeguarding training. This helped ensure procedures were robust and staff understood how to safeguard people who used the service.

There were systems in place which helped ensure staff learnt from any accidents or incidents and so reduced the risk to people and also helped the service to improve. A whistleblowing policy was in place at the nursing home and one staff member told us, "If I needed to, I would not hesitate to use it."

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made.

Is the service effective?

People who used the service had their care needs assessed with them. We saw in care plans that their choices and preferences had been recorded. People who were able to talk to us told us they were involved in writing their care plans. People who used the service received regular surveys which allowed them the opportunity to express how their care needs should be provided.

People who used the service had their mobility needs assessed regularly. The nursing home had been adapted to meet people`s needs and so allowed people to move around safely. We noted visitors saw people in private in their rooms if they wished or in communal areas.

Is the service caring?

We spent time in communal areas and observed staff members who were patient with people when providing support. There was a calm atmosphere at the nursing home and we noted good interaction between staff members and people who used the service.

One person who used the service told us, "We are well looked after here. The food is always lovely." A family visitor told us the care was, "Absolutely excellent. No doubt about it."

Is the service responsive?

We were told by the provider that an activities co-ordinator was employed at the nursing home on a part-time basis. This helped ensure people were regularly involved in daily activities. One person who used the service told us, "We were playing bingo yesterday which we all enjoyed."

The procedure for making a complaint was observed on the entrance wall and a copy was also present in people`s rooms. The Registered Manager told us, "My door is always open and people are free to walk in and talk to me about anything they want to."

Is the service well-led?

We saw evidence that the provider worked well with other agencies. This included GPs and community nurses which helped ensure people received appropriate care when they needed it.

We saw that a quality assurance system was in place at Ashcroft House Nursing Home. Regular audits were conducted and we saw that any identified shortfalls were addressed. As a result, the quality of service continued to improve.

During our inspection we spent time with people and invited them to share with us their views and experience of living at Ashcroft House. The people we spoke with were satisfied with the care and support they received. They said there was sufficient staff available to meet their needs. One person said, “The staff are all very nice and helpful. They are very good to me.” Another person told us, “If I need to see a doctor the staff either ask the doctor to see me here or take me to an appointment.”

We also spoke with a family member who was visiting at the time of our inspection. They told us they were more than happy with the care and said, “The staff are brilliant.”

People told us they enjoyed the food and were offered plenty of drinks throughout the day.

Assessments and care plans were in place for each person and they were regularly reviewed to take account of people’s changing needs. People and family members said staff communicated well. Care plans were signed by either the person or their relative/representative.

A complaints procedure was displayed in the foyer and any complaints or concerns received were responded to in an effective and timely way.

During our inspection of the home we spoke with four people and invited them to share with us their experience of living at Ashcroft House. People living at the home described the staff as kind and caring. They said there were plenty of staff on duty each day and they received very good care. People told us the food was good and one person said “It is like good home cooking”.

We observed that care plans were linked to the assessments and provided staff with clear guidance on the care needs of each person. Social and recreational needs for people living at the home were taken into consideration. We heard from people living at the home and staff about the various activities provided, including trips outside of the home.

Arrangements were in place to monitor the quality of the service provided. A full service audit was conducted each month which took into account issues such as staffing, complaints or compliments, environmental monitoring and care documentation.