Ashfield (Malton) (North Yorkshire County Council) is a service that provides accommodation for people who require residential care. The service can accommodate a maximum of 31 people and is situated in the town of Malton. It is close to local facilities and transport routes and has disabled access into the building. There is car parking facilities on-site for staff and visitors. At the time of our inspection there were 25 people who used the service, seven of whom were living with dementia.

This inspection was unannounced and was carried out on 25 April 2017. The inspection was to check that the registered provider was now meeting the legal requirements we had identified at our last inspection on 16 February 2016. We asked the registered provider to take action to improve their quality assurance system in relation to audits and record keeping.

During this inspection we found that the registered provider had taken action to improve practices within the service in line with their action plan from June 2016. We found these improvements were sufficient to meet the requirements of Regulation 17. This meant the service was now meeting legal requirements.

Improvements had been made to the quality assurance system including the safety of the service, the risks relating to the health, safety and welfare of people who used the service and the way feedback from people who used the service and staff was obtained. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We received positive feedback from people who used the service, visitors, relatives and staff about the changes taking place in the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 were well cared for. The registered provider carried out recruitment checks to ensure they employed suitable people and there were sufficient staff employed to meet people’s needs. Medicine management practices were being reviewed by the registered manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found that they received regular supervision and yearly appraisals, to fulfil their roles effectively.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said they enjoyed good food. People's health needs were identified and their independence was promoted. Staff worked with other healthcare professionals, to ensure these needs were met.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

This inspection took place on the 16 February 2016 and was unannounced. This service provides accommodation for older people who require personal care. The service can accommodate a maximum of 31 people. It is situated in the town of Malton and is close to local facilities and transport routes. There were 27 people living there on the day we inspected.

There was a registered manager employed at the service. 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.

Where people had identified conditions in their care plans the service had not always carried out a risk assessment or made sure that staff had a management plan in place which would guide them in the care of the person. The staff did know people well when we spoke to them. However, the information should be available for staff. We have made a recommendation about risk assessments and management plans.

Audits had not been carried out in all areas of the service so there was no formal means of identifying where improvements were needed. Record keeping was not consistent. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full version of this report.

Medicines were managed safely within the service. We observed medicines being given and saw that the member of staff did this with care. People's nutritional needs were met and people received nicely presented meals which they said they enjoyed. A choice of menu was offered with alternatives available if people did not like what was on offer.

Safe recruitment practices were used and staff had all necessary checks before being employed at this service. There were sufficient staff to meet people's needs on the day we inspected and rotas showed that these numbers were consistent. Staff were caring and showed this through being respectful and considerate of people. We saw different examples of positive interactions between staff and people who used the service during the inspection.

Staff knew people well and could tell us about them. We saw that people had access to a diverse programme of activities across the week. There was a dedicated activities room where crafts and other hobbies could take place.

Staff were aware of the Mental Capacity Act and able to tell us what it meant to deprive someone of their liberty lawfully. There were no deprivation authorisations in place at the service but the registered manager was going to review some people who used the service to be sure an authorisation was not necessary. Peoples consent was sought throughout the day and we saw that consents for care and support had been signed by people in their care records.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were seen to be treated with respect and dignity by the staff. People we spoke with told us they had felt listened too by the staff.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There was no one currently using the service who had a DoLS in place. People who required this to be put into place would be assessed, to help to protect their rights.

We were told that people received the care they needed but that when staffing numbers were low this could affect the quality of the care provided.

The provider had effective systems in place to deal with any emergency.

Is the service effective?

People’s health and care needs were assessed and support plans and risk assessments were in place. This helped to ensure that people’s needs were met. A person we spoke with said “I am looked after well. The staff get the doctor for me if I want them. I haven’t needed them lately.” We observed that the staff knew people’s individual needs well.

People were asked for their verbal or written consent in regard to the care and support they received from staff.

Systems were in place for the provider to monitor if the service was effectively meeting people’s needs. Staff received training to help to maintain and develop their skills.

Is the service caring?

People we spoke with said the staff were patient and kind. They told us they received the support they wanted to receive. People’s likes, dislikes and preferences were known by the staff.

We saw from the care records we inspected that people’s preferences, interests, aspirations and were recorded. Daily entries made by staff confirmed that care had been provided in accordance with people’s wishes.

Is the service responsive?

There was a complaints policy in place which people had been made aware of. A person we spoke with said “I talk to staff and I do say if I have a complaint.” The manager was available for people or their relatives to speak with if they wished to make a complaint or raise any issues." People told us that they believed any issues raised would be dealt with.

The staff told us how they would act on any changes in people’s condition, informing relatives or health care professionals, as necessary. Staff we spoke with told us how they covered staff absence and holidays to help to provide continuity of care for people.

Is the service well led?

Systems were in place to review, develop and monitor the quality of service being provided. However, the provider may wish to note that all the staff we spoke with raised issues about staffing levels. On some shifts we saw that there were a lot of staff on duty and on other shifts staffing numbers were low. Although the staff told us that people received the care they needed to receive the provider may wish to look at this.

Compliment, comment and complaints had been encouraged. A person we spoke with said “I would not want to move from here. They listen to my views.”

We spoke with people, their relatives and other visitors and observed care on the day of our inspection. People told us they felt respected and involved in their own care decisions. They commented they were supported by the care staff and they said they were always helpful. One person commented “Nothing is too much trouble, it doesn’t matter who you ask.”

We observed people being spoken with in a kind and supportive way. The care staff took time to listen and acted upon the request in an unhurried and professional way. We saw in the care records that care was person centred, which meant that everyone had a personalised plan which met their needs.

We observed care in the dining room over the lunch-time meal. People were supported in a timely way. They were offered choices and if they were undecided, the plated meals were shown. This helped people to be supported to choose the food they preferred to eat. One person commented that the food “Is really good here.”

At a previous inspection in January 2012 we found moderate concerns relating to inadequate staffing levels. We asked the provider to address these concerns. At this visit we found that these concerns had been addressed and there were sufficient people rostered for duty to provide safe care.

We found that suitable arrangements were in place to monitor the quality of the service provided. This included policies and procedures and quality monitoring systems.

Our inspection in June 2012 found there were problems with the assessing, planning and recording of individual’s care needs. We asked the provider to address these concerns.

We did not speak with people who used the service on this visit but in June they told us that they were treated with respect and that staff were considerate and caring. They liked living here. We made some observations on this visit. For instance people were being spoken to in a kind and unhurried way by the care staff. We saw people were appropriately dressed and looked comfortable and well cared for. We also saw people being supported to have their lunch and the care staff were sat next to them this helped them to interact positively with each other.

On this occasion we concentrated on checking whether improvements had been made. We looked at the way in which the home managed the care records and saw that better systems were now in place for assessing, planning and recording individuals needs. This helped to ensure people received appropriate and safe care.

People told us they liked living at the home. They said the staff were kind and helpful and were always willing to 'go the extra mile.' One person said ' I have really settled very well here it is faultless.'

People who use the service told us that the staff were very caring and always polite. They also told us that they were bored due to a lack of activities to do. People said they felt safe and would tell a member of staff or the manager if they had any concerns.

Staff told us that because there had been a shortage of staff they had not been able to attend training session and they had not had supervision. They said they did not feel supported by the manager.