About the service: Ashley House Care Home is a residential nursing home. Ashley House provides accommodation, personal care and nursing care for up to 44 people with physical disabilities or age-related frailty. At the time of the inspection there were 39 people living at the service.

People’s experience of using this service:

• People’s risks had been identified and appropriate safety measures were in place. People were supported by a consistent team of staff who were kind and caring. Staff had good relationships with people and knew them well. People told us they liked living at the service and were happy with the staff who supported them.

• People received their medicines as prescribed and medicines were managed safely. People could see healthcare professionals when needed and supported to live healthy lives.

• Staff knowledge in relation to people’s conditions, their needs, and how to support them was thorough.

• Care plans were person centred and included people’s personal preferences. This meant people were able to receive a service which was tailored to their individual needs.

• People were able to attend many various activities. People were supported to access their local community to follow their interests. People’s independence was promoted by positive risk-taking approaches. This meant people could maintain life skills and enjoy a community presence.

• There was an open culture where staff and people could raise concerns or issues. People told us they felt safe at the service and felt happy to speak up.

• People, relatives and staff told us the service was well-led. The registered manager was a visible presence and knew people and their relatives well. People’s feedback was encouraged and used to shape the service.

The service met the characteristics of Good overall; more information is available in the full report below.

Rating at last inspection: At the last inspection the service was rated Good (This report was published on May 2016).

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Good rating. Previous CQC ratings and the time since the last inspection were also taken into consideration.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection of Ashley House Care Home commenced on 1 August 2017 and was unannounced.

We undertook this focused inspection of Ashley House Care Home on 1 August 2017. This inspection was prompted in part by the provider’s notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns about safe care and treatment. This inspection examined those risks and reported on the findings in the safe and well led domains. This incident is subject to a separate police investigation and as a result this inspection did not examine the circumstances of the incident.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ashley House Care Home’ on our website at ‘www.cqc.org.uk’. The last inspection report was carried out 18 and 19 May 2016. At that inspection the service was rated as “good” and was meeting all of the relevant regulations. There was some area for improvement identified regarding the deployment of staff within the service. Our findings at this inspection have not changed the current rating of ‘requires improvement’ for the key question Safe, the current rating of ‘good’ for the key question Well-led or the overall rating of ‘good’ for this service because we did not look at all the areas for the key question Safe and Well-led. We will review all areas of the key questions of Safe and Well-led in full at our next comprehensive inspection.

Ashley House Care Home provides residential and nursing care for up to 47 older people. 25 people were using the service at the time of our inspection. Some of the people living at the home were living with dementia or other long term health conditions.

The home has 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 and associated Regulations about how the service is run.

People felt safe living at Ashley House Care Home. Care and nursing staff had clear guidance to assist people with the risks associated with their care, such as moving and handling and the risks of falls. People’s risks had clearly been assessed and clear detailed guidance was available to nursing and care staff.

Management systems were in place to ensure people were kept safe from preventable harm. The registered manager and senior staff ensured action was taken where shortfalls had identified. The service learnt lessons from incidents within the service to prevent future harm.

This unannounced inspection took place on 18 and 19 May 2016.

Ashley House provides nursing, residential and respite care for up to 44 people. At the time of our inspection 37 people were living there. There was 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. There were no breaches of legal requirements at the last inspection in July 2014.

People told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. Sometimes people had to wait for staff to answer their call bell. Recent changes in deployment of staff were aimed to help improve the experience for people. People were supported by staff that were well trained and had access to training to develop their knowledge.

People were provided with personalised care and were supported to make their own choices and decisions where possible. Staff knew what they valued and how they liked to be supported. Peoples care was regularly reviewed and any specific care needs were recorded and evaluated to record progress. People were usually treated with kindness and compassion and people told us staff were very good when they supported them with their care. Healthcare professionals supported people and there was good care and support for people and their relatives when nearing the end of their life.

People told us the food was good and there was a choice of meals. When people required assistance with their food staff supported them and gave them time to enjoy their meal. Hot drinks were always available in the foyer for people to relax with their visitors. This area was due to be refurbished to enhance the experience for people.

People had activities to choose from which included quiz games, exercise classes, pat the dog, arts and crafts, musical afternoons and ball games. Care staff had helped to provide activities for people when there was no activity organiser but there had been less individual engagement with them. Volunteers visited the home and spent time talking to people. Improvements to activities were planned when the new activity organiser started soon.

The registered manager and provider monitored the quality of the service with regular checks and when necessary action was taken. People and their relative’s views and concerns were taken seriously. They contributed in meetings and regular reviews of the service and improvements were made. Staff felt well supported by the registered manager and deputy manager who were available to speak to people their relatives and staff. Staff meetings were held and staff were able to contribute to the running of the home.

A single inspector carried out this inspection. The focus of the inspection was to answer 5 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 staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People told us that they felt safe living at the home. People’s privacy and dignity were respected by staff.

The service followed the local authority safeguarding procedure and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to improve.

The home had suitable policies and procedures and training in place in relation to safeguarding, the Mental Capacity Act 2005 and accompanying Deprivation of Liberty Safeguards (DoLS). DoLS protect the human rights of adults who live in a care home or hospital and lack capacity to consent to arrangements proposed for their care or treatment. Such arrangements may amount to deprivation of liberty for some people. DoLS are not used for people detained or liable to be detained under the Mental Health Act 1983 (as amended by the Mental Health Act 2007). No authorisations had needed to be in place at the time of our visit. Relevant staff had been trained to understand when an application should be made and in how to submit one. This means that people would be safeguarded as required.

Is the service effective?

An advocate, an independent person who helped to represent the needs and wishes of a potentially vulnerable person, told us that “staff seem very good”. People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

The service worked in collaboration with other professionals and services to ensure that people received effective care.

Is the service caring?

People were supported by kind and attentive staff. A relative told us “The care that’s given here is excellent.” We saw that care staff explained and encouraged when they supported people. People who used the service, their relatives and representatives involved with the service completed an annual satisfaction survey. Issues or concerns raised were addressed by the provider.

People’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided according to people’s wishes.

Is the service responsive?

People participated in a range of activities in and outside the service on a regular basis. Most people required support while others accessed the community independently. The home had access to adapted transport, which helped to keep people involved with their local community.

People knew how to raise concerns or make a complaint if they were unhappy. A relative told us “If there’s anything troubling you, say it.” People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service had a quality assurance system. Records we reviewed showed that identified issues were addressed. As a result the quality of the service improved.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of their roles.

When we inspected Ashley House in July 2013 we had concerns about the standards of some record keeping and we asked them to make improvements. When we visited again on 11 September 2013, we found that although improvements had been made, there were still areas were records were not consistently completed. The inspector had concerns about records that lacked sufficient detail and a lack of attention to records of care in respect of lifestyle and social interaction.

The provider sent us their action plan and told us about the further improvements they would make. This return visit was to make sure that those improvements had been made. We spoke with the registered manager and the deputy manager and looked at the care records for six people who lived in Ashley House.

We found a good standard of care planning. Care plans had consistently been reviewed on a monthly basis. There was a programme of audit in place and a percentage of care files were checked each month and any remedial actions were recorded and had to be signed off. Coaching sessions had been held with care staff in respect of making meaningful entries in daily care records. Work had also taken place with care staff on their role in meeting people’s social care and emotional needs.

We previously visited this home in July 2013. At that time we had concerns about the standard of record keeping. Records in respect of consent were incomplete, and some staff had a limited understanding of their responsibilities under the Mental Capacity Act 2005.

The provider sent us an action plan to show how they were going to make improvements and we made a return visit to check that these improvements had been made. We spoke with the registered manager and deputy manager, and with two staff. We looked at the records for five people who lived at Ashley House.

We saw that care plan reviews had taken place with people who used the service. Where people lacked capacity to make decisions, this was explicit in their records because Mental Capacity assessments had been carried out. There was evidence that decisions made on their behalf were taken in their best interests and in consultation with significant others.

We found that care plans were well written and appropriately detailed to guide staff when supporting people. Risk assessments were mostly up to date. However records of care and support still lacked sufficient detail to provide assurance that people's needs were consistently met. We were particularly concerned about the lack of attention given to care plans and records of care in respect of lifestyle and social interaction.

People told us they enjoyed living at Ashley House and they were well cared for. Staff were friendly and attentive and people appeared relaxed and content in their company. People told us they had plenty to eat and drink and enjoyed a good choice of healthy and nutritious meals.

People's needs had been assessed and care planned to meet those needs. Staff were knowledgeable about the people in their care and how to support them; however care plans did not always support this. We had concerns about the standard of record keeping. Records in respect of consent were incomplete and some staff had a limited understanding of their responsibilities under the Mental Capacity Act 2005.

People told us they felt safe and they felt able to report any concerns. They were confident that any concerns would be properly investigated. The home had received few complaints but those complaints that had been received had been investigated and responded to appropriately.

Staff felt well supported by the manager, deputy manager and their colleagues. They received regular supervision and training, although training records indicated that some mandatory refresher training was overdue. Some staff indicated the need for training in subjects related to the care of older people, such as caring for people with dementia, Parkinsons, diabetes and palliative care.

On the day of our visit we spoke with four people who lived at the home, three relatives and four staff. Feedback was on the whole very positive. People said that the staff were kind, and cared for them well. However some concerns were expressed that call bells were not always answered promptly. These were concerns that the home was aware of and was taking steps to investigate and improve.

We observed staff interacting positively with people and treating them with respect. People appeared clean, well groomed and appropriately dressed. Care plans were comprehensive and up to date and appropriate safeguards had been put in place to safeguard people from identified risks. We had some concerns about record keeping which was not always sufficiently detailed to show that people’s needs were consistently being met. Improvements in this area would help the provider to respond to relatives’ concerns that there are sometimes insufficient staff to attend to people’s needs in a timely fashion and concerns that some staff pay insufficient attention to detail.

We found the home to be clean and well maintained, with the exception of a sluice room which we have asked the provider to take prompt action to improve.

We were assured that the home had appropriate recruitment and vetting procedures to ensure that people were not cared for by unsuitable staff.

There were effective systems in place to monitor quality.

People who were able to talk to us said they were well looked after and they felt at home.

One person said they thought we would be hard pushed to find anywhere better.

One person told us that she knew both managers of the service and would not have a problem in talking to either of them about anything that was worrying her.