Ashley Gardens is registered with CQC to provide residential care for up to 47 older people. There are bedrooms which can be used as double occupancy if requested. At the time of the inspection there were 39 people living at the home and three double rooms were currently in use.

Ashley Gardens specialised in providing care for people who had memory loss or dementia. The home is a purpose built care home providing communal areas and private rooms for people. The home has a passenger lift and wide stairways to assist people to access areas of the building.

This was an unannounced inspection which took place on 14 and 15 July 2016.

Ashley Gardens had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 fully involved in all aspects of the day to day running of the home supported by the provider, deputy managers and senior care, administrative and support staff.

Equipment was in place to support people to stand if they were able to weight bear, and emergency equipment was in place to assist people from the floor in the event of a trip or fall. However we found one person whose support needs had recently changed and they were now unable to weight bear. This meant that staff would not be able to assist this person to get out of bed if they requested it or in the event of an emergency. We discussed this with the registered manager who immediately assessed that the home needed a full lifting hoist. This was ordered immediately and staff training arranged to ensure people remained safe. We have made a recommendation about this.

Staff received support, training and supervision to ensure that they were able to provide safe and effective care for people. This included training to support them in meeting the needs of people with dementia. Staff demonstrated a clear understanding around how to safeguard people from abuse and told us the actions they would take if they had any concerns. Policies and procedures were in place to support staff, they also received a staff handbook which contained all relevant policies and guidance to support them in their role.

Staffing levels were assessed and staffing numbers adapted to ensure there were enough staff to meet people’s needs. People were supported by kind and considerate staff who had an excellent understanding of dementia and memory loss. This meant that people received care in a way that supported their needs. Management and staff were open and engaging, examples of this were seen throughout the inspection. Visitors and relatives were welcomed into the home and relatives felt that the consistency of regular staff meant that they knew people really well.

Pre-admission assessments were completed. This information was used to formulate care plans and risk assessments. These were reviewed monthly or more frequently if changes occurred. Any changes were discussed with people or their next of kin if appropriate. Care plans and documentation was person centred, staff had access to relevant information about people, including their life and medical history, significant life events and likes and dislikes. This meant staff were supported by clear and relevant information to enable them to provide good care for people.

People were involved in day to day choices. When people were assessed as lacking capacity this was followed up with referrals to other professionals if required. For example Mental Capacity Assessments (MCA) were completed and Deprivation of Liberty Safeguards (DoLS) applications were submitted when it was identified that a person may be at risk.

Dignity and privacy were maintained, people were supported to dress in the way they chose and involv

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and what we learnt from the records we looked at. We spoke in detail with four people who lived in the home and two people who were visiting relatives. We talked with three care assistants, an activities coordinator and the office manager. Records we looked at included five care records, staff training records, management audits and the service’s quality assurance documentation.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People living in and visiting the home told us they considered Ashley Gardens provided a safe environment. A visitor said “Safety comes from staff availability and awareness.” Another visitor said staff showed a constant level of respect for the people they cared for. All staff undertook annual refresher training about safeguarding vulnerable people, provided by an external trainer. They had separate annual training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The home had experience of obtaining advice from DoLS advisers from the local authority, although no applications had needed to be submitted. Staff we spoke with demonstrated an understanding of working with people’s consent, and how to record in detail when care was delivered on the basis of ‘best interests’.

All care staff were trained in working with people with dementia type conditions. Care plans were clearly written. They directed staff how to minimise the risk of people becoming distressed and how to manage behavioural issues should they arise. There was a system in place to ensure staff were aware of people’s whereabouts and wellbeing throughout the day and night.

Is the service effective?

People received a thorough assessment of need before moving into the home. They and their families were involved by staff in developing care plans to meet identified needs. Planned care interventions were based on reducing risk and enhancing wellbeing and choice. Care plans were reviewed monthly. Reviews showed evidence of care objectives being met. However, we identified activity coordinators were not as involved in planning and reviewing individual activity needs as their expertise would allow them to be. However, activities provision was planned in such a way as to ensure a variety of activities was made available every day. A visitor said they saw their relative was supported to experience a daily routine, and stimulation from activities, despite worsening dementia.

Records showed people received medical attention in a timely way when needed. Visiting relatives we spoke with told us the staff were quick to observe and act on any indicators of ill health, including obtaining a GP visit promptly when necessary. A person living in the home told us “Staff are very attentive, they notice if you’re not so well and get the doctor if necessary, but they’re good at looking after you anyway.”

Care staff were well aware of the content of care plans. Shortened versions of the plans were kept with care assistants’ daily records and in people’s bedrooms. Staff always began work with receipt of a handover of information, including updates to care plans. Staff were supported in delivering care by an organised training programme, which included dementia awareness and meeting privacy and dignity needs. They were subject to frequent ‘spot check’ supervision, to ensure they were effective in putting their training and the provider’s policies into practice.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People’s preferences, interests and diverse needs had been recorded and care and support were provided in accordance with people’s wishes. People told us staff were very respectful of their privacy and dignity needs.

A visitor told us the home provided a caring, calm environment. They said “I see lots of one on one interactions and people are never ignored.” We observed that as care staff went about their work in the home, they acknowledged all people and engaged verbally with them. Daily records showed all people were regularly seen and therefore were not isolated or overlooked. When people were involved in group activities with an activities coordinator, a care assistant remained immediately available to meet care needs arising. This meant the activity was not disrupted by care issues and people were supported if they wished or needed to leave the group.

People told us they consistently enjoyed their meals and the way they were served. In the dining room, staff were attentive and gave people time to eat at their own pace. In a response to the service’s own survey of relatives who visited the home, one person had written “All staff seem to have unlimited patience and provide excellent care. The home provides a loving environment.” Care records showed people were supported to continue to receive foot, eye and dental care from practitioners of their choice or as arranged by the home.

Is the service responsive?

Care plans were reviewed every month, or more often in response to events or needs arising. We saw that issues raised by family members received immediate attention, people being invited to enter into discussion about best ways of addressing their concerns. The survey of views of relatives of people living in the home had been analysed and gave rise to an action plan, to ensure matters raised were investigated and shortfalls addressed.

Staff and management were readily available to people in the home, and to visitors. Staff responded readily to requests to move by people who were not independently mobile. Specialist health, mental health and social care resources were accessed when necessary. Care records showed specialist advice and care directions were incorporated into care plans and were followed by staff.

Is the service well-led?

The provider maintained oversight of and support to the home by regular visits. The registered manager and deputy managers carried out a series of regular audits that checked standards were maintained, for example in medicines practice and infection control. Action plans were developed and monitored for any area of shortfall.

Staff we spoke with said they were strongly supported by the management team. Records of staff meetings, supervision and information circulated to staff showed they were kept informed of all developments in the home and their views were valued. Material improvements to the home were carried out on a planned basis and to a high specification. This showed management took account of the wellbeing of those living and working there.

Staff told us they were clear about their respective roles and responsibilities. A care assistant told us, “You’re never alone with any situation, there’s always someone who will support you.” There was a strong sense of working as a team to help ensure people received a good quality service at all times.

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

When we inspected this service in September 2013 we found that people were not always protected against the spread or risk of infection as they were not cared for in a clean, hygienic environment.

Following our inspection we received an action plan from the provider that told us processes were in place that ensured compliance with this standard. This inspection was carried out to check that the home had complied with the compliance action made at our previous visit.

We found that the home had put in place new systems for monitoring cleanliness in the home. The new systems were working well and records demonstrated that the home was continually reviewing and improving upon the service it provided.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

Those who could speak with us told us that the care was good. One person said, “I can’t fault the staff they look after us well.” Another person said, “I have everything I need in my room and the food is excellent.”

We found that care plans clearly documented the needs of people and how they should be met. Staff ensured that consent was obtained prior to providing care and support. Where appropriate, specialist advice and support was obtained to meet people's individual needs.

The systems in place to ensure the cleanliness of the home were not always effective. The home had a thorough recruitment procedure in place to ensure that they employed suitable staff to work in the home. There were detailed systems to ensure that the quality of care provided was monitored and reviewed on a regular basis.

We used a number of different methods including SOFI to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We found that care plans clearly documented the needs of people and how they should be met. Care was based on the individual needs of people and where appropriate, specialist advice and support was obtained. People using the service and/or their representatives were involved in decisions about their care and treatment.

We examined the systems and processes in place for the safe management of medicines and found they were in order. We assessed that there were sufficient staff on duty to meet the assessed needs of the people living in the home.

We looked at the systems and processes the home had in place to respond to complaints and to protect people from abuse. These processes ensured complaints could be raised and that they were fully investigated. Staff knew what constituted abuse and what to do if it was suspected.

People said that they were treated well, that the staff were lovely and that there was plenty of choice in the food served.

There were mixed responses received in relation to the quality of food served. Comments included ‘I like the food, but not always hot enough’, ‘good choices and usually tasty’ and ‘pretty good’.

Residents said that staff were kind and that they were looked after. Visitors to the home said that they are now more involved in the home.

Residents spoken with stated that they were happy and that staff were caring. One service user said that they choose not to participate in activities within the home as they prefer to spend time in their own room and have plenty of hobbies and interests to keep them busy.

Two residents said that they thought that the home had deteriorated in the last six months since new staff began working in the home. They said that they had difficulty understanding staff and in turn felt that the new staff had difficulty understanding them. A number of the staff working in the home do not have English as their first language.

Two residents spoken with stated that there is very good choice in relation to meals. One resident said that despite the varied choice the standard of food has gone downhill in the past few months. Another resident said that ‘staff are caring’. They went on to say that if they call for assistance staff come when able, it just depends how busy they are. Sometimes you have to wait.

Following the inspection we received detailed information from Social Services regarding their findings following their visit to the home on 16,17 and 18 November 2010. Findings back up and increase risks highlighted in this report. In addition we received information that seven safeguarding referrals were raised during their inspection relating to individual residents. At the time of writing this report two residents had moved on to alternative accommodation.