We undertook an unannounced inspection of Ashgrove House Nursing Home on 26 April 2018 and an announced visit on 27 April 2018

Ashgrove House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 35 persons who require personal care. On the day of our inspection 34 people were living at the service.

At the last inspection, the service was rated Outstanding in the Caring, Responsive and Well led domains and Outstanding overall. At this inspection we found the service had continued to meet the characteristics of outstanding in Caring, Responsive and Well-led domains, they had also improved in the Effective domain from good to outstanding. The overall rating continues to be Outstanding.

People were at the heart of Ashgrove House Nursing Home. We saw examples of staff wanting to make a positive difference to people’s quality of life. This reflected the values that staff held and the culture of the service ‘being more than a job’.

Without exception people said and gave examples of where staff had gone ‘the extra mile’ to make their lives special. They told us they felt well cared for and were offered emotional support when needed. Relatives were enthusiastic about the support they received. They said they felt encouraged to continue to play an important part in their relatives lives and told us the service provided a holistic approach to care, which included them even after their loved ones had left the service. People’s dignity was always respected and people were able to build meaningful, caring relationships with staff.

The service was led by a registered manager who promoted a service that put people at the forefront of all the service did. 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 registered manager was very passionate about working with people and their aim was to ensure the service met people’s physical and emotional needs. There was a culture of positive teamwork and empowering staff in line with the provider’s values. There was a very high level of confidence in the leadership and management of the service expressed by people, relatives and staff.

The registered manager was supported by an owner and organisation that was committed to providing high quality, innovative care. There continued to be a culture of putting people first which was evident all the way through the service from the provider to the care staff.

The owner and registered manager worked proactively with other organisations to develop training and support which provided enhanced support for the people living at Ashgrove House Nursing Home.

The team worked closely with other agencies and promoted an open and transparent culture that promoted a strong emphasis on continually striving to improve the service. There were effective systems in place to monitor the quality of the service provided and appropriate action was taken promptly when required.

The atmosphere at Ashgrove House Nursing Home was one of caring, happiness and positivity. This enabled staff to embed a strong culture that valued people, relatives and staff and promoted a caring ethos.

People received exceptional care and support from staff who were skilled and knowledgeable and supported them on an individual basis. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access h

We found that the people who lived at Ashgrove House and their advocates were happy with the care they received and that, as far as possible, they were consulted and involved in how they wished to lead their lives.

We saw that people's health and welfare needs were being met and the support they received was appropriate to their needs. Experienced staff were available in enough numbers to be able to provide the care and support that people required.

We found that people were being well treated and there were systems in place to protect them from possible abuse.

The quality of the service was being monitored and systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

We spoke with three people who lived in the home. They told us that the staff were polite and respectful. They said that the staff gave them the help and support that they needed. One person told us that the staff were very good. They said that the activities organiser always asked them their views about activities. Another person told us that the staff always asked them what help and support they needed.

A relative told us that the staff were very good and caring and were always polite and respectful. They said that the staff "go the extra mile." They told us that they visited at different times of the day and people always seemed to be very happy and comfortable in the home. They were very pleased with the care and support for their relatives.

We saw staff speaking to people with respect and responding sensitively to their needs. We found that there was a clear system of care planning so that people's needs would be met. The plans were person centred so that people could continue to live the life they chose.

People were protected from abuse because staff had the right training and knowledge about prevention of abuse. People told us that they felt safe in the home. Staff had the right training, qualifications and support to meet people's needs. The provider had comprehensive systems to assess and monitor the quality of the service and to manage risks to people.

A person who had multiple medical conditions reported on how well they felt staff were supporting them, listening to what they wanted, but also encouraging them in being independent.

We observed that a care worker noticed quickly when the arm of a person who had had a stroke came off a support pillow. They replaced the person’s arm on the support pillow gently, explaining to the person what they were doing and why.

A person, after finishing their meal: “it WAS nice”

A person told us “I had some reservations about coming in but within a few weeks, it felt like home”

We observed a registered nurse explaining to a person why their medicines had changed, as the person was not sure why their tablets were different from what they remembered.

“Got a call bell – occasionally I fall and they come running”

“I speak me mind and they take notice”

We observed that there was a family atmosphere in the sitting room. A member of staff was putting up Christmas decorations, they knocked some items off a shelf as they did so. Residents in the vicinity who noticed this laughed, chatting and teasing he member of staff.

We carried out this inspection over three days on the 19, 21 and 26 January 2016. The first day of the inspection was unannounced. During our last inspection to the service in October 2013, we found the provider had satisfied the legal requirements in all of the areas we looked at.

Ashgrove House is registered to provide accommodation for up to 34 people who require nursing and personal care. On the day of the inspection, there were 33 people living at the home. The provider was in the process of increasing the number of people to 35. They had submitted an application to us, which was in the process of being assessed.

A registered manager was employed by 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. The registered manager was available throughout the inspection.

People and their relatives were extremely satisfied with the service they received. There were many positive comments about staff and the management team, as well as the overall care provided.

There was a strong person centred ethos, which was embedded throughout the home. This was to always treat people with dignity, as you would want to be treated and to remember the “Ashgrove smile”. The ethos of the home was intended to make people feel valued, supported and included, with an aim to enhance overall wellbeing. There were a high number of staff on duty at all times, to support people effectively. The staffing levels enabled people to receive focused, uninterrupted care in a relaxed and unhurried manner.

Staff consistently showed a caring, attentive and respectful manner. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. Interactions promoted wellbeing and showed staff knew people well. People were supported to undertake meaningful activity, which reflected their interests. There was involvement with the community by attending events and local groups, visiting the home. People were able to undertake household chores such as making their bed or laying the tables for meals.

There was an ‘all inclusive’ cost to living at the home. The cost included services such as chiropody, physiotherapy, aromatherapy, hairdressing and transport, with an escort to all medical appointments. People were able to use the therapies to assist with relaxation and the management of health care conditions. People were supported to achieve aspirations such as increased independence.

People’s medicines were managed in a safe and ordered manner. People received good support to meet their health care needs. This included a GP who often visited daily and ‘at a drop of a hat’. There were many compliments about the care given to people at the end of their life. People’s dying wishes were discussed at an early stage to ensure everything was in place when required. People had comprehensive, well written care plans to inform staff of their needs, preferences and any support required. Any wounds or specific health care issues were well managed with clear treatment plans in place.

People were offered a range of food and drink based on their preferences. There was no actual allocated food budget with staff saying people could usually have what they wanted. People had a varied selection of foods and drinks. There were accessible cabinets, filled with cakes and desserts so people and their relatives could help themselves to what they wanted, throughout the day.

There was a strong emphasis on personalised care and the further development. A comprehensive range of audits were used to monitor all aspects of the service. A “secret shopper” was used to experience the home, to get to the heart of how the service felt. The registered manager met with people and their relatives on a regular basis to ensure they were happy with the service received. Feedback from meetings and surveys, formed part of the home’s service development plan.

Staff received regular training in relation to their role and the people they supported. The training was generally undertaken by specialist trainers or health care professionals.  Systems were in place to enable staff to develop and progress. All staff had an allocated area of expertise or interest, in which they received ongoing training. They cascaded their knowledge to the rest of the team through in house training sessions. Staff told us they felt valued, very well supported and were fully committed to the home and its ethos.