Ashleigh 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 regulated both the premises and the care provided, and both were looked at during this inspection.

Ashleigh Nursing Home accommodates 21 people in one adapted building. At the time of our inspection there were 17 people using 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.

This is the third time the service has been rated Requires Improvement.

We found two 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.

We looked around Ashleigh Nursing Home with the registered manager and found improvements were needed. We found many furnishings, including carpets and armchairs in communal rooms and bedrooms to be stained or torn. Paintwork in many bedrooms and corridors was damaged. We found a toilet that had a broken seat and pull cords in bathrooms and toilets to be heavily stained. Bed linen, including duvets and sheets had worn thin. A majority of the shortfalls we found had not been identified by the provider in their audit of the environment.

The registered person and registered manager did not have robust and reliable systems and processes in place to assure themselves as to the quality of the service being provided. This lack of oversight about the quality of the service and the services governance, meant shortfalls and areas for development and improvement had not always been identified. Plans for development in some areas had been identified, however there were no written plans about how and when these would be implemented, who would be responsible for their introduction and the process of how they would be monitored.

There were limited formalised opportunities for the management team, nurses and staff to share information about the quality of the service, share ideas for improvement and address shortfalls and concerns as staff meetings had not taken place.

People using the service and their family members spoke positively about the care they received, which included positive comments about the atmosphere of Ashleigh Nursing Home and the friendliness and approachability of staff.

People’s safety was promoted by staff that had the appropriate training to monitor and support people to be safe. Potential risks were identified and action to reduce these was taken. There were sufficient staff to keep people safe and staff were aware of their responsibilities in monitoring people’s safety and well-being. People received their medicine and were supported by staff with the appropriate knowledge and skills in the management of medicine.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice. People were supported by staff that had the necessary training and skills to provide care and support. Staff worked collaboratively with people using the service and health and social care professionals to monitor people’s health to maintain and promote people’s well-being. People's dietary requirements along with their likes and dislikes with regards to food and drink were recorded. People expressed satisfaction with the meals.

People spoke positively about the caring attitude and approach of staff. Staff promoted people's dignity and all interactions between staff, those using the service and family members were positive to ensure the best outcomes for people.

People were encouraged to make decisio

We carried out an unannounced comprehensive inspection of this service on 29 December 2016. A breach of legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirement in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashleigh Nursing Home on our website at www.cqc.org.uk

Ashleigh Nursing Home is registered to provide nursing and residential care up to 21 older people, with some of the people living with dementia. At the time of our inspection there were 17 people using the service. The service is located within a residential area and provides accommodation over three floors.

This inspection took place on the 17 July 2017 and was unannounced.

Ashleigh Nursing Home had 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.

We found improvements had been made to ensure people’s rights were upheld and that the provider, registered manager and staff acted in accordance with the Mental Capacity Act 2005 (MCA). We found conditions which authorised the restriction of people’s rights were being met. We found assessments as to people’s capacity to make informed decisions about their care; treatment and support were undertaken reflective of the principles of the MCA.

This inspection took place on 29 December 2016 and was unannounced.

Ashleigh Nursing Home is registered to provide nursing and residential care up to 21 older people, with some of the people living with dementia. At the time of our inspection there were 17 people using the service. The service is located within a residential area and provides accommodation over two floors.

The previous comprehensive inspection of 15 December 2014 found the service to be compliant with the regulations. Areas of improvement were identified.

Ashleigh Nursing Home had 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.

We found improvements were needed to ensure people’s rights were upheld and that the provider, registered manager and staff acted in accordance with the Mental Capacity Act 2005 (MCA). We found conditions which authorised the restriction of people’s rights were not being met. We also found a lack of awareness as to the appropriate and correct completion of mental capacity assessments. The registered manager said improvements would be made in this area.

People’s safety and well-being was promoted through the management of risk. This was achieved through the sharing of information with all those involved in the person’s care, which included health care professionals. Where necessary equipment was used to enable people to move around the home safely.

People’s safety was further supported through a robust recruitment process for staff and by their being sufficient staff to provide the support people required. Staff undertook training and they were regularly supervised, which included having their competency assessed to ensure they delivered safe and effective care and support to people.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what support people required, so that people’s independence was recognised and not undermined by staff. We observed staff supporting people to make decisions about their day to day lives and provided encouragement in the promotion of their independence.

People’s health and welfare was promoted through a range of assessments and the development of care plans which were regularly reviewed. People, with the support of staff where required, accessed the services of a range of health care professionals who monitored and promoted their health. People’s nutritional needs were assessed and met and regularly reviewed. People’s medicines were managed safely and effectively.

Staff had time to spend with people engaging them in conversation. When providing personal care and support staff promoted people’s privacy and dignity. Staff were seen to respond to people’s changing needs, which included supporting people sensitivity and kindness when they became upset or distressed. All interactions by staff were recorded onto hand held electronic devices. This meant all staff had access to up to date information as to the health and welfare of each person throughout the day so they could respond to people’s needs.

The provider had systems in place to monitor the quality of care being provided, which included seeking the views of people using the service and their family members. The provider was working with external organisations to bring about further improvements to the service being provided. They had purchased a computer software package to assist in the assessing and recording of people’s needs to support the delivery of high quality care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for Ashleigh Nursing Home is requires improvement as a breach in the regu

This inspection took place on 15 December 2014 and was unannounced.

Ashleigh Nursing Home is registered to provide nursing and residential care for up to 21 older people, some of whom are living with dementia. At the time of our inspection there were 21 people using the service. The service is a converted Victorian building with accommodation on two floors and a passenger lift for access.

The service had 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.

Staff were able to tell us what action they would take should they believe somebody was being abused and were aware of the provider’s policies and procedures, which included whistleblowing.

People we spoke with who used the service were satisfied with the care and support they received as was a visitor who was visiting their relative. We saw staff supporting people and offering reassurance when they became anxious. Staff told us and our observations showed that there were sufficient staff on duty to meet people’s needs.

People were supported by staff who had been checked as to their suitability to work with them. They had undergone an induction and had received training relevant to the needs of people in their care to ensure people received the appropriate care.

Staff we spoke with had a good understanding of people’s needs and knew the support and care they required. People’s assessments and plans of care had been regularly reviewed and provided clear guidance for staff as to the needs of people and their role in delivering the appropriate care and support. People’s medication was managed safely.

Staff had an awareness of legislation which promoted the rights of people and worked in accordance with legislation. This meant people were supported by staff to make day to day decisions as to their care and support. People in some instances had made advanced decisions as to their wishes should their health deteriorate.

We observed staff sitting with people and conversing with them about issues which were important to them. One member of staff sat talking with someone about a book they were reading. Photographs of recent events and activities in the service were on display, which included photographs of people holding a range of animals which had been brought into the service by an external organisation.

People’s health and welfare was promoted and they were referred to relevant health care professionals in order to meet their health needs. People at risk of poor nutrition and hydration had assessments and plans of care in place for the promotion of their health and well-being.

The provider, registered manager and staff had a clear view as to the service they wished to provide which focused on a homely and caring environment for people. Staff were complimentary about the support they received from the management team. However, we found that there were limited arrangements for the management team and staff to review their practices as staff meetings did not take place regularly. This could impact on the service and the support and care people received.

Monitoring systems were in place to check the quality and safety of the service provided. However where shortfalls were identified, we found that there was not a clear audit trail to evidence whether improvements had been made.

Systems for seeking the views of people who used the service and their relatives were in place. However, people’s views were not collated and used to develop the service nor were they shared with people and other stakeholders, such as relatives of people using the service and health and social care professionals. This meant that people could not be confident that their views had been listened to or acted upon.

We looked at the records and care plans of three people who used the service. We found people’s care was regularly assessed and reviewed. We spoke with a registered nurse who told us where practicable they discussed with the person their views about their care and treatment which were taken into account when reviewing people’s care plans. We found people’s rights to make decisions about their care and treatment were upheld.

People were supported by staff who were employed in sufficient numbers of meet their needs and who had undertaken training relevant to the needs of people. Staff we spoke with had a good understanding as to the rights of people who used the service and the care and support individual people required.

People had meals prepared using fresh ingredients. We spoke with the chef who was aware of the specialist dietary requirements of people. People’s individual dietary requirements were met. We observed the dining experience for people during the lunchtime meal and found improvements were needed. We discussed these with the provider and registered manager who met with staff to discuss our concerns on the day of our inspection.

The provider had a quality assurance system which monitored the effectiveness of the service people received, which included the maintenance of the environment in which people lived. Systems were in place to ensure audits were carried out by the provider and registered manager. The provider had sought the views of relatives of people who used the service by the sending out of questionnaires.

We spoke with a relative of someone who uses the services of Ashleigh Nursing Home. We asked them for their views about the care provided. “There’s only one word to describe it excellent.” The relative told us they were kept informed of changes to the person’s health care needs and they had had the opportunity to talk about future plans and care.

We observed staff supporting people and engaging them in activities and conversation. Staff were observed to have a good understanding of people’s needs and spoke with them in a respectful way and acted upon their wishes and requests.

We found care plans and other records were being completed consistent with the health and welfare needs of people using the service.

The Care Quality Commissions previous inspection report carried out in June 2012 provides further information about other outcomes inspected and the views of people using the service and their relatives.

We spoke with one person who used the service and visitors who were visiting relatives. We were told by them that they were happy with the service provided and felt that staff provided the care people needed. People’s comments included: - “I visit often, I think the care is very good, he gets all the care he needs, if I had any concerns I would speak with the manager, but I really can’t find any fault here.” Someone who used the service told us “the staff here are very good, you only have to ask for something and they’ll get it.”

People's experiences of living at the home were positive. Our inspection found concerns with regards to records.

A relative of someone using the service told us that they were happy with the care and support provided by the service and its staff. They told us: - “They’re very good here I can’t fault them, the staff are very good.”

We inspected the service in January 2012, and spoke with people who were visiting relatives all of which expressed satisfaction with the care and support provided by the service.

Relatives of people using the service told us that they were happy with the care and support provided by the service and its staff. They told us - “…..can be very difficult but the staff are brilliant, can’t be faulted.” “Any problems they let me know straight away.” “Manager will contact family straight away if there are concerns.” “The care is brilliant, very happy with how they look after her. I think it’s the care that’s keeping her going.”

People using the service did not in all instances have their dignity promoted. People’s care plans were not always implemented which means that people were not receiving the care and support they needed.

We found that the environment was not well maintained, which had the potential to impact on the health, safety and welfare of people. We found that equipment was not well maintained or cleaned which had the potential to put people at risk from cross infection.