About the service:

Ashley Court is a residential care home for up to 15 adults with a physical disability. It provides care to people who require accommodation and personal care. Accommodation is provided on the ground floor of a building with privately rented flats above. The provider had just registered with the Care Quality Commission (CQC) to provide personal care for up to five people in the adjoining flats.

People’s experience of using this service:

People using the service benefitted from responsive care that was outstanding. People told us of how staff supported them to live full lives and spoke with enthusiasm about the activities they were involved in, on an on-going basis. Care was exceptionally individualised and tailored to the needs and wishes of the people using the service. Services were delivered in a way that was flexible, provided choice and ensured continuity of care. People were truly placed at the centre of the service and were consulted and involved at every level.

People felt safe living at the service and staff were aware of action needed to protect people from avoidable harm and abuse. Staff reported accidents and incidents and responded appropriately to changes in risks. Processes were in place for the safe management of people’s medicines and people told us they received their medicines regularly. Staffing levels were planned to meet the needs of people using the service and reviewed regularly.

Staff were supported to deliver effective care and received training to ensure they had the skills and knowledge they required. They received regular supervision and appraisal. Staff ensured people had access to healthcare services by making appropriate and timely referrals and following their recommendations and advice. Staff involved people in decisions about their care and obtained the necessary consent for the care and support provided.

People continued to receive care from staff who were kind and compassionate in their approach. People’s relationships with staff were very positive. People felt supported and it was apparent from our discussions with staff and observations throughout the inspection, that staff cared about them and their well-being. People were involved when their care plans were reviewed and were actively involved in decision making in relation to their care and support.

The service continued to be well led and benefitted from clear and consistent leadership. People were at the centre of quality assurance processes and we found a culture of continuous learning and improvement. Action plans were in place to address findings from audits and were continually reviewed and updated.

Rating at last inspection: Good (report published 21 July 2016)

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

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

This inspection took place on 22 June 2016 and was unannounced.

Ashley court specialises in the care of people who have a physical disability. It provides accommodation for up to 15 people who require personal and nursing care. On the day of our inspection there were 15 people living at the home.

At the time of our inspection 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 2008 and associated Regulations about how the service is run.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe. Risk assessments were in place. Medicines were administered and stored safely. Accidents and incidents were monitored and recorded.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals such as a dietician and GP. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs. People had access to leisure activities and excursions to local facilities.

People had their privacy and dignity considered. Staff were aware of people’s need for privacy and dignity.

People were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff available to care for people appropriately. A safe recruitment process was in place. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff and people who lived at the home felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. The provider recorded and monitored complaints.

Audits were carried out on a regular basis and action put in place to address any concerns and issues. People were involved in the improvement of the home.

When we visited this service on 29 April 2014 we found that the service was not compliant. This was because the provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We found this had a minor impact on people who used the service.

During this inspection we found that improvements had been made and the provider was now compliant.

We spoke with the manager and deputy manager.

We were told that people were involved in discussions about the safety of the service at staff and resident meetings.

We saw there were systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others

We found fire safety and work place risk assessments had been carried out and areas for improvement identified and actioned.

This inspection was carried out by one inspector. We met with ten people who used the service and observed their experiences of care to support our inspection. We spoke with the deputy manager, four care staff and two relatives and carers.

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People told us that they were happy living at the home and were supported to remain independent as safely as possible. They also told us that their needs were met.

Individual and general risk assessments were in place, but we found that there were areas for improvement. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to identifying, assessing and managing risks relating to the health, welfare and safety of service users and others who may be at risk from carrying on of the regulated activity.

At the time of the inspection, there were no Deprivation of Liberty Safeguards procedures in place. Staff had received training, so that they knew how to safeguard people at risk of abuse.

One relative told us that they thought their relative was safe living at the home and four people we asked confirmed that they felt safe living at the home too.

The provider had emergency procedures in place to keep people safe from harm, these included hospital admission procedures and personal evacuation plans.

There were regular inspections and audits completed to make sure the building and procedures were adequate and provided a safe environment for people to live in, although we found that action plans did not always show that they had been completed. We have asked the provider to tell us how they are going meet the requirements of the law to ensure that actions from these inspections are complete.

Is the service effective?

All of the people we spoke with and their relatives or carers, told us they were happy with the care being delivered and their needs were met. It was clear from our observations and from speaking with staff that they (staff) had a good understanding of the people’s care and support needs and that they knew them well. This meant people received an effective service. Staff had received adequate training to meet the needs of the people who lived at the home.

When we spoke to one relative, they told us the service was good and said, “You cannot get much better.” This showed evidence of an effective service.

One person who used the service told us they had seen improvements in another person’s mobility since they moved into the home. This showed staff provided effective levels of support.

We saw the registered manager had provided specific training for staff to ensure particular health conditions were better supported. Staff told us that they had good training opportunities to further develop and improve their skills.

Is the service caring?

We asked nine people if they had any concerns about the care provided by the home and they all told us that they were happy with the care provided and that the staff were caring.

Observations during the visit showed staff being compassionate and caring to the people they were supporting. We saw good interactions taking place and staff responding in a thoughtful and kind manner. One staff member told us about a sponsored event they were going to complete this year to raise money for the service.

Is the service responsive?

Information was collected by the service with regard to the person’s ability and level of independence. Regular reviews were carried out with the person who used the service and their representative to make sure the person’s care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Information collected by the service also gave staff an insight into the interests, likes and dislikes and areas of importance to the people in their care. This meant information gathered helped staff to provide social activities that people may have wished to be involved with.

People’s individual needs were taken into account and they or their representatives were involved in all decisions regarding their care.

Regular meetings took place with staff to discuss the running of the service and to ensure that the service was responsive in meeting the changing needs of people who used the service.

Is the service well-led?

Staff were knowledgeable about the support needs of people and the services ethos of maintaining safe independence and involvement of the person whatever their level of need.

People who used the service had regular contact from senior staff to check their wellbeing and monitor the quality of service provided by care givers. This was done through meetings arranged with the people who used the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law with regard to actions from meetings with people that show no completed outcomes.

People we spoke with confirmed that they had the opportunity to comment on the service and they felt they were listened to. People we spoke with also knew who to contact if they had a problem and were able to tell us where the complaints policy was.

One relative told us that they were kept regularly updated by the staff team if any changes occurred. They told us, “They (staff) ring me to keep me in the picture.”

During our visit we spoke with three people who lived at the home, four members of staff and the registered manager. We also looked at records and observed care. Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively. People told us the staff were caring and looked after them well. They told us “People help you” and “I get the care that I need here.”

People told us the food was good and we saw people were given a choice of meals at each mealtime.

When we spoke with staff they told us they had received training to enable them to provide safe and appropriate care to people. They said they felt supported in their roles and able to provide effective care to people.

We saw the home was clean and there were effective processes in place to protect people against the risk of infection.

We looked at records of incidences/accidents and found the provider reported them to us appropriately.

As part of our inspection we spoke with people who used the service. We spoke with one person at length and also with staff and looked at records.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We saw people were treated with dignity and respect. Care and treatment was planned and delivered in a way that ensured people's safety and welfare.

People told us they liked living at the home. One relative said, "Ashley Court is fantastic and xxxxx does not want to move away from Ashley Court.”

People told us they could usually get help when they needed it. One person told us it depended on how busy they were but some people had more needs than others.

We asked people about the staff and they said, “Staff team fantastic” and "The manager is good and listens."

The quality assurance systems in place enabled people to express their views about the services and care they received. People were encouraged to comment on how the home was run at meetings and on a day to day basis.

People told us they liked living at the home and they were well cared for.

We visited this service as we were concerned we had not been since the location registered under the Health and Social Care Act. We wanted to check that people were receiving good quality, safe care and that the service was compliant.

We spoke with two people who live at the service and they both told us they liked living at the service. They told us they could see their care plans at any time. They both told us they were happy that their needs were being met well.

Both of the people we spoke with told us they liked to maintain their independence. One person told us they did their own washing, ironing and made their own drinks and snacks. Both of the people we spoke with told us they had motorised mobility aids and could go out into the community whenever they chose.

The people we spoke with confirmed that they were asked for their opinions on the service and about how this could improve. People said they felt the home was well run and managed and they said the manager was approachable.