About the service: Ashlands Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both were looked at during this inspection.

The care home accommodates up to 30 people aged 65 and over in one adapted building. At the time of our inspection 21 people lived there.

People’s experience of using this service:

¿The provider had improved their systems to monitor and review the quality of care people received. This was an improvement from our last inspection and the provider was no longer in breach of Regulation 17 HSCA (Regulated Activities) Regulations 2014 good governance.

¿However, some risks were present in the general environment and these had not always been identified and mitigated. We have made a recommendation about health and safety risk management.

¿We found other areas required improvement. These included checks made during the recruitment of staff, the maintenance plans for the premises and information sharing.

¿Other risks and risks associated with people’s healthcare conditions were identified and managed. Procedures were in place and followed by staff, to ensure medicines were managed safely and infection protection and control practices were effective.

¿Sufficient staff were available to meet people’s needs and staff understood what actions to take to protect people from harm and abuse. The registered manager looked to learn from incidents and make improvements when things went wrong.

¿People’s needs were assessed and monitored and people’s diverse needs were supported. Policies and procedures helped to ensure care was delivered in line with current standards.

¿Staff received support and training to help them work effectively in their roles. Staff made referrals to other professionals for their advice and guidance regarding people’s care when needed. People had access to other healthcare services as required.

¿People had choices of food and drink to help them maintain a balanced diet. Staff supported people with their meals and drinks when needed.

¿People liked their home and were happy with the on-going work to re-decorate the premises.

¿People felt well looked after and liked the staff who cared for them. People’s views were taken into account when their care was planned. Staff took steps to ensure people’s privacy and dignity was respected. People’s independence was promoted.

¿People were supported to have maximum 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.

¿People received personalised and responsive care and enjoyed how they spent their time at the service. No-one had a complaint to make however, people knew how to complain should they have need to. People’s communication needs were identified and met.

¿Quality of care was checked by the registered manager through spot checks and audits. The registered manager was keen to ensure care promoted positive outcomes for people. The registered manager was considered to be open and approachable and was keen to ensure the service continuously improved. People and staff felt listened to and had opportunities to be involved in the service; more information is in the full report.

Rating at last inspection:

At our last inspection, the service was rated as 'Requires Improvement.' (Published 12 July 2018). At this inspection we found the service had improved and was no longer in breach of the Act however, the service was still rated 'Requires Improvement.' This is the fourth inspection where the service has been rated 'Requires Improvement.'

Why we inspected:

This is a scheduled inspection based on the previous rating. The previous inspection found there was a breach of Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

Follow up:

We

This inspection took place on 16 May 2018 and was unannounced. Ashlands 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 30 people in one adapted building. At the time of our inspection there were 19 people living in the home.

At the time of our inspection there was not a registered manager in post. A new manager who will be referred to in the report as ‘manager’ had been appointed who was intending to register with 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.

The service had previously been rated as ‘requires improvement’. At this inspection the service remained 'requires improvement'. We found breaches in regulation. The service had failed to address the issues raised at previous inspections and ensure arrangements were in place to deliver safe care and improve quality. This is the third time the service has been rated Requires Improvement.

Guidance was not consistently in place to ensure people received their medicines when required. Medicines were administered safely, however we found a number of issues in relation to medicine management. Medicine records were not consistently completed.

Where people were unable to make decisions arrangements had not been consistently made to ensure decisions were made in people's best interests. Best interests decisions were not always specific to the decisions which were needed to be made.

A system was being developed to carry out suitable quality checks but appropriate checks had not been regularly carried out. The provider had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care. Sufficient background checks had not been completed before new staff had been appointed according to the provider’s policy.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. There were arrangements to prevent and control infections. Staff did not always follow best practice to avoid cross infection.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a limited range of activities. However people did not access local community facilities. The manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Arrangements were in place to support people at the end of their l

We carried out an unannounced inspection of the service on 16 November 2016.

We carried out a comprehensive inspection of this service on 21 April 2016 and two breaches of legal requirements were found. These included; insufficient systems in place to maintain cleanliness and hygiene at the service and quality assurance systems in place to monitor quality and safety had not been completed consistently. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashlands Care Home on our website at www.cqc.org.uk.

Ashlands Care Home provides accommodation and personal care for up to 30 older people including people living with dementia. At the time of our inspection there were 21 people living at the service.

During our last inspection there was no registered manager in place. However, a registered manager had been recently recruited and was in post during 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 felt safe. Staff were aware of the safeguarding adult procedures to protect people from avoidable harm and had received appropriate training. Risks to people’s health were known by staff but these were not always documented or reviewed regularly. Therefore risks were not always managed safely.

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly. However, medicines given as and when required did not have the appropriate guidance or protocols that staff needed to follow. The internal and external environment was monitored and improvements had been identified and planned for.

Safe recruitment practices meant as far as possible only people suitable to work for the service were employed. Staff received an induction, training and appropriate support. There were not always sufficient experienced, skilled and trained staff available to meet people’s needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for, but their weight was not regularly recorded where needed. People received a choice of meals. People’s healthcare needs had been assessed and were regularly monitored.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. Best interest decision were not always recorded.

Staff were kind, caring and respectful towards the people they supported. Staff were task centred in their support. The registered manager confirmed they were looking at changing records so that support is offered in a more person centred way. The provider asked relatives and visiting professionals to share their experience about the service provided. Communication between relatives and external professionals had improved since our last inspection.

People or relatives were not always involved as fully as possible in their care and support. There was a complaints policy and procedure available. Information was available to inform people of independent advocacy services. There were no restrictions on people visiting the service.

Some people were supported to participate in activities of their interest, but these were not always run consistently. An activities coordinator had been recently recruited who was looking at improving this are

This inspection took place on 21 April 2016 and was unannounced.

Ashlands Care Home provides accommodation and personal care for up to 30 older people including people living with dementia. At the time of our inspection there were 27 people living at the service.

A registered manager is required at Ashlands Care Home. 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 was not a registered manager in place. The provider had newly recruited a manager who was having recruitment checks completed. The provider told us that the manager was due to commence their role imminently and they would submit their registered manager application when in post. We will monitor this.

People told us that they had some concerns about the cleanliness of the service. We found that the systems in place to maintain cleanliness and hygiene were insufficient. The provider had failed to implement requirements made by the clinical commissioning group infection control audit that was completed in November 2015.

Staff were aware of the provider’s safeguarding policies and procedures and their role and responsibilities in keeping people safe. The provider was working with the local authority in investigating some current safeguarding concerns.

Risks to people had not always been assessed appropriately, and the control measures identified to reduce risks had not always been put in place. Risk plans lacked detailed information for staff. Accident and incidents were not always recorded appropriately, and there was a lack of analysis to consider patterns, trends and lessons learned to reduce further reoccurrence.

Concerns were identified with the deployment of staff, they lacked direction and organisation. Appropriate dependency assessments to determine staffing levels were not in place. The provider had not always completed recruitment checks before staff commenced employment.

People received their medicines as prescribed but staff did not have information about managing people’s medicine prescribed as and when required. People’s preferences of how they liked to take their medicines were not recorded.

Some shortfalls were identified with the staff induction, training and support opportunities available to staff.

Staff had limited understanding of the principles of The Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. Where people lacked mental capacity to make specific decisions about their care and treatment, some assessment’s and best interest decisions had been made but some people’s capacity required further assessments.

People received sufficient to eat and drink and choices were offered. Where food supplements had been prescribed, people had received these. People said they liked the food but found the portion size a concern. People did not always receive appropriate support from staff with their eating. External health professionals were involved in meeting people’s health care needs. People’s care records did not always show what action had been taken to support people’s health needs.

Staff communication and interaction with people was variable. People described staff as caring and kind. People did not have available information about independent advocacy services should they have required this support. Information about the complaints procedure was not displayed easily for people to see and was not in an appropriate format for people with communication needs.

Staff had limited information available about people’s individual needs, routines and preferences this impacted on their ability to provide effective and responsive care. New care records were being introduced. People received limited opportu

We carried out this inspection to check that the provider had made improvements since we last inspected the service. We spoke with four people who used the service, the provider, manager and cook. We also checked records of care planning, care delivery and quality assurance systems.

We found that people who used the service had their needs assessed and planned for from the start of their admission to the home and care was delivered in a way that was intended to ensure people's safety and welfare.

We found that people who used the service were supported to have adequate nutrition and hydration.

We found that people who used the service were supported by sufficient staff to meet their needs.

We found that there was effective management of risks to the health, welfare and safety of people who used the service. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with three people who used the service who told us they were supported safely. Comments included, “I have been here before, I like it here, the staff are really nice and they help you whenever you need it.” Another person told us, “It’s not like being at home but they (staff) do their best for you and they are kind.”

We found that care was not always planned in a way that was intended to ensure the safety and welfare of people who used the service. Nutrition and hydration monitoring needed to be improved. Staffing levels were not sufficient to meet the needs of people who used the service and improvements were needed to the way the provider was monitoriing the quality of the service.

We received information of concern that told us the planning and delivery of care did not ensure the health and welfare of the people who used the service. We looked at the individual aspects of the concerns that we received. We found that people using the service had their needs assessed and planned for and their individual choices recorded and respected.

We spoke with five people who all told us they felt safe and cared for at the home. One person told us, “I think it’s marvellous here, the staff are always kind and thoughtful. I have never needed to be in this sort of place before but I think they provide me with everything I need, I could not wish for anything better.”

We spoke with a relative who told us, “The new manager has made a difference. I am always kept informed of any changes and they involve me wherever necessary. The food is good and I have no concerns.”

We spoke with a visiting advanced nurse practitioner who provided an urgent response service through a single point of access for all primary care issues. She told us, “I have absolutely no concerns, the home is managed a million times better. The manager and senior staff refer people to me promptly and appropriately. They anticipate end of life care needs well.”

We carried out this responsive inspection because we had concerns that this service had not been visited since 2009. During our visit we spoke with a number of residents who told us they were happy with the care and support they received from staff. One resident told us: “I have been here for two years and I am very happy.”

Residents told us the quality of food was good. One resident told us: “The food is very nice, we get some lovely dinners.” Another told us: “I have to have different foods, and they always make sure I have them.”

Some of the residents we spoke with told us there was a range of activities they could get involved with. One resident: “They put a sing-along on for us, we also do exercises to music, the staff are good at getting us involved.”

We asked residents about their experience of receiving medication. One resident told us: “We always get our tablets when we are supposed to have them.”

All of the residents we spoke with told us that they were well cared for and protected by staff. One resident told us: “I feel safe and well looked after by staff, the staff are very caring.” Residents told us if they had any worries or concerns they would speak to the manager or owner of the service who they believed would deal with the matter quickly and effectively.

Residents told us that staff were committed to providing a good quality service. One resident we spoke with told us “The staff are very good they are very caring.” Another resident told us: “The staff seem to be trained and can do their job.”

The provider had a number of ways in which residents could give feedback about the services they received. One resident told us: “We can talk to any of the staff about what needs to improve.” Another resident said: “The owner is lovely and they always ask if everything is ok or if anything needs to improve.”