This inspection took place on 21 June and the 6 July 2017. The first day was unannounced.

We carried out an unannounced comprehensive inspection of this service on 08 and 09 December 2016 and breaches of legal requirements were found. The provider was in breach of Regulations 09, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took action against the provider in relation to Regulation 12 and 17.

Regulation 12 was reviewed at the inspection in March 2017 (this report is available on our website) and we reviewed Regulation 09 and 17 at this inspection. We found the service was now meeting the requirements of these Regulations.

Ashfields Care Home is a nursing home which provides support and nursing care to up to 46 older people, some of whom live with a dementia related condition. Two beds in the service are designated enhanced beds for people who are nearing the end of their life. On the days of our inspection visits there were 42 using the service.

There was a registered manager 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.

People had good end of life care and the service worked well with other related health care professionals including Mc Millan nursing service. The provider had robust systems in place to review and update the service in a timely manner and in accordance with people’s needs and wishes.

People’s medicines were managed safely. There were procedures in place to ensure medicines were safely stored, administered and disposed of.

The provider had systems in place to keep people safe and staff were aware of their duty of care to people.

The provider had a system of ensuring new staff participated in an induction which included a period of shadowing an experienced staff member. New inexperienced staff completed The Care Certificate as part of their induction. All staff were offered the opportunity to achieve appropriate qualifications such as NVQ and specialised training.

Staff felt supported by other staff members. There were enough staff available to support and respond to people’s needs in a timely manner. The provider had effective and safe recruitment procedures in place and employed new staff once appropriate checks had been completed.

People’s care plans and records were updated and provided staff with the information needed to meet people’s needs. People and their relatives were happy with the care and support provided and everyone felt their individual needs were being met.

Staff and the provider were able to explain to us how they protected people’s rights. Training was provided in relation to The Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS) and safeguarding. Appropriate referrals for authorisation to the DoLS team had taken place.

Staff supported people to maintain good health and have access to the appropriate health professional. Specialist end of life health care professionals attended the service on a daily basis. People’s nutritional needs were met; special dietary needs were catered for.

Staff knew people well and were aware of the importance of treating them with dignity and respect. Staff were kind, caring and compassionate; people’s self-esteem was promoted and staff supported and encouraged them to remain as independent as possible.

We carried out an unannounced comprehensive inspection of this service on 8 and 9 December 2016 and breaches of legal requirements were found. The provider was in breach of regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took action against the provider in relation to regulation 12 and 17.

We undertook this focused inspection to check that they had made improvements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to confirm they now met that legal requirement. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashfields Care Home on our website at www.cqc.org.uk.

We inspected the service on 22 February and 06 March 2017. The second visit was specifically to look at end of life care. Both inspection visits were unannounced. Ashfields Care Home is a nursing home which provides support and nursing care to up to 46 older people, some of whom live with a dementia related condition. Two beds in the service are designated enhanced beds for people who are nearing the end of their life. On the days of our inspection visits there 41 and 40 people respectively, were using the service.

The service had a registered manager in place 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.

Improvements had been made in all aspects of the care we looked at. People were supported to maintain their nutrition and hydration. People receiving end of life care could be assured this would be managed effectively and without unnecessary discomfort and pain.

Some improvements had been made in relation to aspects of the assessment and planning of people’s care and support. People were supported by a caring and compassionate team of staff who responded to their needs in a timely way and were able to facilitate activities.

During the inspection we found the service met the breach of Regulation 12 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014.

We inspected the service on 8 and 9 December 2016. The first day was unannounced and the second day was announced. Ashfields Care Home is a nursing home which provides support and nursing care to up to 46 older people, some of whom live with a dementia related condition. Two beds in the service are designated enhanced beds for people who are nearing the end of their life. On the day of our inspection 46 people were using the service.

The service had a registered manager in place 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 were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were not being assessed and planned for to protect them from harm.

People did not receive the support they needed from staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who did not have all the skills needed to meet people’s individual needs. People were supported to make certain decisions and staff knew how to act if people did not have the capacity to make decisions.

People may not receive the support they require to maintain their nutrition although staff were monitoring and responding to people’s health care requirements.

People who were receiving end of life care were not assured this would be managed effectively and without unnecessary discomfort and pain. People did not consistently receive care in a kind and compassionate way or have their needs responded to in a timely manner.

People were not provided with the care and support they required in a well-planned and organised manner. People were provided with opportunities to participate in social activities and felt that any concerns or complaints would be listened to and acted upon.

Although the new registered manager had made some improvements people were not using a service that was consistently managed and well run on a day to day basis. Systems to monitor the quality of the service were being implemented, but these had not been in place for sufficient time to identify where improvements to the service could be made.

During the inspection we found breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is