This focused unannounced inspection took place on 27 March 2018. This inspection was carried out to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in October 2016 had been made. The team inspected the service against two of the five questions we ask about services: is the service well led and safe. This is because the service was not meeting some of the legal requirements in these areas.

No risks or concerns were identified in the remaining key questions through our on-going monitoring or during our previous inspection, so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

Ashley Grange Nursing 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, and both were looked at during this inspection.

Ashley Grange Nursing Home accommodates 55 people in one adapted building. The building comprises of an older property with a newer extension added. It is on the outskirts of the village of Downton and set in landscaped gardens. At the time of our inspection, there were 40 people living at the service and nine people staying at the service temporarily. One person was staying at the service on respite, which enabled their carer to have a break from their caring role. The service also had eight rooms that had been designated for ‘intermediate care’. This was for people who had been discharged from hospital but required support with rehabilitation for a short period of time before they could move back to their own home. People were also referred by their GP to use ‘intermediate care’ from their own homes when they became unwell. This helped to prevent unnecessary hospital admission. People could have the support they needed to regain their independence before moving back home.

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.

Medicines were managed safely. The service had made the required improvement to make sure topical creams and topical patches were being applied as prescribed. Staff had received training in medicines management and used an electronic system to support administration of medicines.

Staff were aware of their responsibilities in keeping people safe from harm. Appropriate checks were made before staff started work to make sure they were suitable to work in a care setting. There were sufficient numbers of staff working to meet people’s needs.

Risks had been assessed and measures put in place to keep people safe. There were also comprehensive risk assessments in place to make sure the environment was safe and regular checks were completed to maintain safe working systems.

The service was clean and free from odours, there were cleaning schedules in place to cover all areas of the service. Staff had access to personal protective equipment such as gloves and aprons and we observed they wore these when appropriate.

The service was well-led with an established and experienced senior management team. Quality monitoring was completed regularly in a range of areas. Feedback was sought from people, relatives and visiting professionals. The service was open about what feedback had been received and action they were taking to make improvements.

Community links were established with a local day service being welcomed one day a week. This enabled people to maintain relationships with old friends and keep in touch with life in the village.

Ashley Grange Nursing Home provides accommodation which includes nursing and personal care for up to 55 older people. At the time of our visit 44 people were using the service. The bedrooms are arranged over two floors. There are communal lounges with dining areas on the ground floor with a central kitchen and laundry.

During the last inspection in September 2015, we found breaches of some of the legal requirements in the areas we looked at. Improvements were seen during this inspection which demonstrated the service had responded to our feedback and had implemented improvements in line with their action plan.

The inspection took place on 10 and 11 October 2016 and was unannounced.

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, managing director and operations director were present on both days of the inspection.

The ordering and disposal of medicines was managed effectively. However, the storage of medicines requiring refrigerated storage was not well managed. This was addressed during the inspection and processes immediately put in place to correct this.

People told us they felt safe when receiving care. Staff were able to tell us how to recognise signs of potential abuse and what action to take if they had any concerns. People’s risk assessments had been completed and recorded in people’s care files. Where accidents and incidents had occurred, these were documented and followed up as required.

There were sufficient numbers of suitable staff to support people however, people, their relatives and staff told us agency staff were often deployed, especially at evenings and weekends. People and their relatives told us agency staff did not have the same understanding and knowledge of how to care for people as regular staff and at times they waited longer for assistance. People who used the service and their relatives were positive about the care they received from regular staff and told us they had sufficient knowledge to provide support and keep them safe.

Staff received regular training in relation to their role and the people they supported and told us this training supported them to do their job effectively. Staff received regular supervisions and an appraisal where they could discuss personal development plans. This meant staff received the appropriate support to enable them to provide care to people who used the service.

People were encouraged to make decisions and staff gained people’s consent prior to carrying out any tasks. The service had a clear understanding on the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

There was a choice of drinks, snacks and meals available and people told us they enjoyed the food.

Information on people who had been assessed as having poor fluid intake was communicated within the team and this information was also available in people’s nutritional risk assessments. Although concerns relating to people’s fluid intake were communicated to staff some of the documentation to monitor how much people were drinking was not consistently completed.

People had access to health services and a GP performed weekly visits to the home with additional visits according to any changing healthcare requirements. Health and social care professionals spoke positively about the service. They told us they were promptly informed when there were changes to a person’s health and worked well as a team to ensure people received care according to their current health needs.

People and their relatives spoke positively about the care and support they or their family member received. T

People looked well cared for and were settled in their environment. People had good support to meet their health care needs. Assessments were in place in terms of people’s risk of falling, malnutrition and pressure ulceration. People were offered choices and able to participate in a range of organised social activities.

Priority was given to people’s nutritional needs. There was an emphasis on meeting people’s dietary requirements and individual personal preferences. A high level of food was cooked “from scratch” using fresh ingredients. The chef regularly met with people to gain feedback about the meals.

All areas of the home including those areas less visible were clean. There were clear systems in place to manage the risk of infection. Staff received infection control training on an annual basis.

People were positive about the staff team. We observed good interactions between staff and people who used the service. Staff were friendly, caring and attentive in their manner. People were well supported yet there were lengthy delays in some people receiving their lunch time meal. Staff commented they were particularly busy at weekends and key times of the day.

People and their relatives were encouraged to raise concerns if they were not happy with the service they received. There was a clear, organised system for managing complaints. There were forums such as relative meetings to share views, make suggestions and gain support.

Ashley Grange Nursing Home provides accommodation which includes nursing and personal care for up to 55 older people. At the time of our visit 51 people were using the service. The bedrooms are arranged over two floors. There are communal lounges with dining areas on the ground floor with a central kitchen and laundry.

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.

We looked at eight care plans and found some guidance did not always identify how care and support should be provided. This meant that people were at risk of not receiving the care and support they needed.

We found the service was not meeting the requirements of the Mental Capacity Act (2005). Where people were deemed as lacking capacity assessments were not always completed and sometimes gave conflicting information. In response to this, the provider has contacted its software provider and arranged for an amendment to the software to enable it to record greater detail in these assessments”.

People were supported to eat a balanced diet. There were arrangements for people to access specialist diets where required. There were snacks and drinks available throughout the day during our inspection. However, monitoring charts were not being used in a proactive way and concerns about poor fluid intake were not being shared or communicated with the team.

People and their relatives spoke positively about the care and support they or their relative received. People and their relatives said they felt comfortable with raising concerns and had confidence that action would be taken where appropriate.

People were supported by staff that understood how to respect people’s privacy and dignity. Staff had the knowledge and skills to carry out their roles. Staff told us they had access to training that was appropriate to their role. They said if they required any additional training, they could ask and had confidence it would be provided.

Staff knew how to identify if people were at risk of abuse and what actions they needed to take should they suspect abuse was taking place. The registered manager dealt with and responded to all safeguarding concerns.

Medicines were managed safely. Nursing staff managed medicines and ensured people received their medicines as prescribed. We observed two medication rounds and found nurses to be knowledgeable about the people they were supporting.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours.

Health and social care professionals spoke positively about the care and support people received and praised the management team. They said they found the staff and management team approachable and told us they sought advice and guidance where appropriate regarding changes in people's care and support.

There were systems in place for monitoring the quality of the service to ensure people received a high standard of care and support. The service had a clear set of values which included treating people with dignity and respect and promoting independence.

There were plans in place to respond to emergencies such as fire. There was a business continuity plan in place to cover emergencies such as loss of utilities or flooding.

We found 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.