About the service:

Ashfields Care Home is a ‘care home’ providing personal care accommodation for up to 39 people. Accommodation was provided in the main building and five self-contained apartments.

People’s experience of using this service:

People continued to be protected from abuse and avoidable harm. Safe recruitment procedures were followed and there were sufficient staff to meet people’s needs. People received their medicines safely and when required. Staff were provided with a ready supply of personal protective equipment (gloves and aprons) and with relevant guidance of how to control and prevent the spread of infection. We saw that some staff did not follow the correct guidance and brought this to the registered manager’s attention. They took action to remind staff of requirements.

The service continued to be effective. People’s needs were fully assessed, and individualised care plans developed to ensure that effective care was delivered. Staff were well trained and knowledgeable about the people they supported. When people were unable to make decisions about their care, the service followed the principles of the Mental Capacity Act 2005. People were supported to maintain their health and well-being with access to a wide range of health and social care services.

People were served good quality nutritious food although we received contrasting feedback about a lack of choice to meet people’s preferences. The registered manager confirmed that they would discuss this at the next service user meeting and a recently distributed questionnaire also invited people to express their views about food served.

People were cared for by a staff group who were kind and caring. If needed, people had access to advocacy services to ensure their rights were protected.

There was a consistent and established staff team who knew people’s needs, likes and dislikes well. Each person had a personalised care plan detailing the support they required which was regularly reviewed. Activities were organised by the care staff. Some people said that they would like more to do and we discussed this with the registered manager. They confirmed that, along with the feedback regarding meals, they would discuss this at the next service user meeting.

People and staff described the registered manager as approachable, supportive and willing to listen to any concerns. There was a process to assess and monitor the quality of the service. The registered manager was aware of their responsibilities for reporting and had notified the CQC about events that had occurred within the service. Due to an administrative oversight, there had been a delay in informing us about a recent event, this was addressed, and we have received all notifications as required.

Rating at last inspection:

At the last inspection the service was rated Good. (12 October 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection was unannounced and took place on 25 April 2016.

Ashfields is a 39 bedded three-storey care home for older people. It is located in Macclesfield and is close to local shops and the town centre. Included in the number of bedrooms are five single storey flats located within the grounds of the home. The flats are linked to the main building via a roofed walkway and equipped with a call system. The flats have en-suite facilities including a small kitchenette and are designed for people who are more independent.

The service was last inspected in March 2013 where the service was found to be compliant in all the areas we looked at.

The home has a registered manager. 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. At the time of our inspection there were 38 people living in the home.

We found that people were provided with care that was safe, person centred, sensitive and compassionate. The home was managed and staffed by a consistent team of care assistants who were well supported.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke to confirmed that they were aware of the need to report any safeguarding concerns.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

We found that there were sufficient staff deployed to meet the needs of the people living in the home.

The provider had their own induction training programme which was designed to ensure that any new staff members had the skills they needed to do their jobs effectively and competently. This resulted in staff having the skills and knowledge to carry out their jobs well and provide safe and effective care.

We asked staff members about training and they all confirmed that they received regular training throughout the year and that this was up to date and provided them with knowledge and skills to do their jobs effectively.

People had care plans which were personalised to their needs and wishes. Each care plan contained detailed information to assist support workers to provide care in a manner that respected the relevant person’s individual needs, promoting their personal preferences’.

People living in the home told us that the standard of care they received was good. Comments included, “The staff are excellent” and “They treat me well”. Relatives spoken with praised the staff team for the quality of care provided. They told us that they were confident that their relatives were safe and well cared for. One person told us, “I’m happy that they are looking after my mum”.

The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This meant that staff were able to help and support people who had difficulty in making decisions and ensured that plans were put in place in the person’s best interests. We saw that applications had been made appropriately.

There was a flexible menu in place which provided a good variety of food to people using the service. People living there told us that the food was good and they had a wide variety of food choices as well as where they could eat their meal.

Staff members we spoke with were positive about how the home was being managed and felt that the manager was supportive, organised and approachable.

There was an internal qu

During our inspection we spoke to three people who lived in the home and they all told us that they were very happy with the care that they received. They all spoke very highly of the manager and the staff team. One person told us; “The staff are all very nice and the food is beautiful.” Another person told us; “They are lovely girls who work here. They work hard and look after us well.”

We looked at four care plans and found them to be well organised and maintained. We found evidence that people who lived in the home and their families were consulted in the planning and reviewing of their care.

We looked at the cleanliness of the home and found that it was clean and well maintained. We looked at the procedures and practices in place to protect the health and safety of the people who lived in the home and found that these were in place and were regularly reviewed and updated.

We spoke to three members of staff who told us that they felt well supported in their roles and that they received regular supervision and lots of training. One told us; “We have a supportive and understanding management team and they are flexible in their approach.” We looked at the training and supervision records for the staff and saw that they were well supported and had access to regular training.

We looked at the complaints procedure in the home and found that there had been no complaints made in the last year and that people were encouraged to make comments about their care.

When we visited Ashfield’s we spoke with six of the people who lived there and two of their visiting relatives and friends. All without exception made positive comments about the standard of care and accommodation. Several people described the home, the staff and the standard of care provided as excellent. They told us that they felt safe and well cared for.

We asked the people who lived at the home about their experiences of how the service involved them and kept them informed. They told us that they were treated with respect and were involved in making decisions about their care and support. One person said; “I am very happy with my care plans I have read them and signed them and I am very happy with the way they have been written”.

A person who spoke with us at some length told us that had been very unwell when they moved in. They told us how staff had involved them in making decisions, developing their care plans and how this had helped them develop their confidence. Another person said; “They ask us about the things that are important us, what we want doing and the way we want it done, it makes us feel we still have a brain”.

A visitor told us they were full of admiration for the manager and staff for their commitment and dedication to caring for the people who lived at the home. Another visitor, who described the standard of care as excellent said: “The staff have been lovely, they have accommodated my (relatives) personal care needs and helped them develop their confidence”.

We asked people about staffing levels and they told us that there were always enough staff on duty. One person said; “We don’t have to wait and they are very good”.

Visiting relatives told us that they were impressed by the staff. They told us that there had never been a problem with number of staff on duty and they always had a positive and welcoming attitude. One visitor said told us; “The staff are well trained and have the right attitude and skill set, we have been very happy with them”.

We spoke with eight of the people who lived at Ashfields, eight visiting relatives/friends, a district nurse and a GP during our visit. Without exception they all spoke positively about the home and the people who were working there.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “The staff are lovely”, “The staff are very good.

A visiting family member whose relative had only just moved into Ashfields said; “I looked at 14 other homes but chose Ashfields because it is so homely and friendly”. This person also spoke positively about how well the home was being managed. Another family member we spoke to said; “Absolutely brilliant, I looked at other homes but thought that this was the best. I come at various times and am always made to feel welcome”. Other comments from relatives and visitors included; “It’s lovely, warm and very homely”, “I am always made to feel welcome and the staff are friendly”, “My relative is being well looked after and is happy here”, “I have no complaints at all but would ask the manager if I had a problem”.

We spoke to a visiting district nurse who told us that there was good communication with the home and they kept her and her colleagues informed of any issues that arose. She also said, “The carers seem to care”.

A visiting GP also spoke positively about the home, he said; “There are no problems with Ashfields”.

Before we visited the home we spoke with Cheshire East contracts monitoring officers. They told us that they did not have any concerns about the home.