Ashgate House Care Home is located on the edge of Chesterfield in Derbyshire and provides care and support, including nursing care, for up to 45 people. All the people living in the home are living with dementia. The home is split into two units. The older part of the building provides care for people with complex needs resulting from their dementia. On the day of our inspection visit 44 people were living in the home and one person was in hospital.

A registered manager was in post. 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.

The service was last inspected on 12 and 16 September 2016, when we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not taken appropriate steps to ensure sufficient staff were available to meet people’s needs and ensure their safety. We found the service did not promote person centred care towards people and their care needs. We also people’s medicines were not safely managed and risks to people’s health and safety were not identified and reduced and the provider had not taken appropriate steps relating to auditing and ensuring the requirements of the Mental Capacity Act 2005 had been met.

We asked the provider to send us an action plan to demonstrate how they intended to make improvements to meet the regulations. The provider sent us an action plan about the actions they intended to take to make improvements. At this inspection, we found improvements had been made.

The provider’s arrangements for medicines administration, recording and storage were safe. People were supported to have their medicines when they needed. People were supported to maintain good health and were supported to access appropriate health and social care professionals when this was required. Guidance from healthcare professionals was followed to help ensure people’s needs were met.

Staff understood the need to include people with decision making; staff considered people’s capacity and followed the key principles of the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed and people were supported to have choice and control over their lives where this was possible. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff had been provided with training so they were able to meet people’s needs and provide them with safe and effective care. New staff participated in a period of training and shadowing a more experienced member of staff as part of their induction.

People had sufficient to eat and drink, though not all people were supported effectively to have adequate nutrition during meal times. Special diets were catered for. People’s individual needs were assessed and care plans were developed and reviewed. People’s dignity and privacy was respected and staff showed kindness and compassion to the people they supported.

There was a complaints procedure and people and relatives knew who to complaint to if they felt it was necessary. Staff felt supported by the management team and supervision was provided to staff. Audits were carried out to help ensure people received safe and effective care.

Ashgate House provides care and support, including nursing care, for adults with a variety of needs. At the time of our visit we were told that all the people in the home were living with dementia. The home is registered to support 45 people. At the time of our visit 42 people were living there.

There was a registered manager in post. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

As all the people living in the home were living with dementia the information and evidence in this report is mostly drawn from relatives, observations and discussions with staff.

Relatives told us they were satisfied with the care and support provided and felt the needs of their family members were being met. People were treated with kindness and respect and relatives told us they felt their family members were safe living in the home. Plans were in place for health care if this was required. However, risks to people’s safety were not monitored consistently. Also people’s needs were assessed and plans put in place to meet those needs but these were not always followed through.

We saw people were supported by a staff team that, mostly, understood their individual needs. We saw that staff were friendly and kind and supported people to maintain their dignity. However, on several occasions we saw people try to attract the attention of staff and they did not receive a response.

People were not supported to follow their own interests or wishes and there was no specialist equipment in place for people living with dementia to enable them to engage in meaningful activities.

People’s nutritional and dietary requirements were met and a nutritionally balanced diet was provided.

Staff recruitment procedures were in place and there were appropriate checks carried out before staff started work. Staff received an induction and felt they had received the appropriate training to provide the support to people that was required.

Staff were aware of how to protect people from the risk of avoidable harm and were aware of safeguarding procedures, however, these procedures were not always followed through. There were insufficient staff on duty in all locations, at all times, to ensure people were kept safe.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 were not met in all instances.

Medicines were not always managed safely.

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.

Ashgate House Care Home provides care and support, and nursing care, for adults with a variety of needs. At the time of our visit we were told that all the people in the home were living with dementia.

At the last inspection Ashgate House Care Home was in breach of two regulations. These were in relation to consent to care and treatment and management of medicines.

At this inspection we found that improvements had been made and the home was no longer in breach of these regulations.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

People and their relatives were satisfied with the care and support provided and all felt their needs were being met. People were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this. As the majority of the people living in the home were living with dementia they were unable to comment about whether they were involved in the planning and delivery of their care. However, relatives informed that this happened as far as was possible and, also, their views were sought.

We saw that people were well supported by a staff team that, mostly, understood their individual needs. We saw that staff were friendly and kind and supported people to maintain their dignity. Staff we spoke with had a good understanding of people’s needs and felt valued.

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received a thorough induction and felt they had received appropriate training. Nursing staff had support for their continuing professional development.

Staff were aware of how to protect people from the risk of avoidable harm and were aware of safeguarding procedures. This ensured that any allegations of abuse were reported and referred to the appropriate authority.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 had been met and improvements had been made in this area since the last inspection. People’s needs were assessed and plans put in place to meet those needs. Risks to people’s health and wellbeing were identified and addressed. People were supported to access health care professionals when this was required. People’s nutritional and dietary requirements were met and a nutritionally balanced diet was provided.

Almost all of the people living at Ashgate House were living with dementia and as such were not able to have meaningful conversations with us about their experiences or feelings. We have therefore made our judgements based on our Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our visit we observed staff speaking with and asking people for their consent or views before supporting them around the home. We found however that the provider had not acted in accordance with legal requirements where people did not have the capacity to consent.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

There were appropriate arrangements in place in relation to the obtaining and disposal of medicines. However we found that people’s medicine administration records were not being completed accurately or clearly and that appropriate protocols were not in place for medicines prescribed ‘as required’.

People were being supported by suitably qualified, skilled and experience staff. The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

There were 32 people using the service at the time of our inspection visit. Ashgate House Care Home provides a specialist service for people with dementia and as such it was not possible for us to have meaningful discussions with people about their experiences or views of the service.

As it was not possible to speak with people using the service, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with the relatives of three people living at Ashgate House. Everyone we spoke with was happy with the care their relative received. One person said “If (my relative) can’t be at here, I’m happy they’re there”. People told us that when they had had concerns about their relative’s care, they had been dealt with appropriately and quickly.

We observed staff taking people’s welfare and safety into account during day to day activities, including at mealtimes and when moving around the home. Relatives we spoke with spoke highly of staff in the home and told us “the staff are very helpful, if I ask for anything its usually done straight away” and “they are very friendly and kind, including to me when I visit”.

In addition to the methodology identified at the beginning of this report and to further assist us in determining peoples' experiences of the care and support they received, we undertook focused and general observations of staff interactions with two people. These covered a period of one hour in the main lounge area during the morning of our visit, using our Short Observational Framework for Inspection (SOFI). Most of what we saw people experiencing is recorded from our observations.

We observed largely positive interactions with people which contributed to their well being and acknowledged people as individuals.

Staff took time to have conversations with people and were observed being attentive. For example, one staff member noticed the chair a person was on needed a cushion and quickly put this in place for them.

We did observe some staff walking through the lounge asking generally how people were as they went by. There were occasions where people responded and tried to engage staff in conversations, some of these attempts were responded to positively but some staff carried on walking by.

We spoke to one person who told us that they did not like the main meal of the day being served at tea-time but that they did like the main meal foods that were served.