This inspection took place on 9 March 2018 and was unannounced.

Ashley House - Guildford is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There are six double bedrooms with en-suite showers and toilets and 15 single occupancy rooms with en-suite toilets. People also have access to communal shower rooms and toilets. A passenger and stair lift are available for access to parts of the accommodation. The service has well-maintained gardens.

At the time of the inspection, 17 people were using the service.

A registered manager was 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.

At the last inspection of 9 and 10 November 2015, the service was rated Good.

At this inspection, we found the service remained Good.

People continued to receive care that protected them from abuse. The registered manager assessed and reviewed risks to people’s safety and well-being. Staff minimised the risk of harm and avoidable incidents. People’s medicines were administered and managed safely.

People received care from a sufficient number of staff who underwent safe recruitment practices. Staff followed good hygiene methods to prevent and control the risk of infection.

People’s needs were assessed, planned and delivered in line with evidence-based practice. Care delivery met the requirements of the Mental Capacity Act 2005 (MCA). People consented to care and treatment. Staff were supported, supervised and trained to deliver care effectively.

People received food that met their preferences and dietary needs. Staff supported people to maintain good health and access healthcare services. The premises were suitably adapted to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were treated with kindness and compassion. Staff knew people well and provided emotional support when needed. People were involved in making decisions about their care and staff respected their choices. People had access to advocacy services when required. People had their privacy, dignity and confidentiality respected.

People’s needs underwent regular reviews to identify any changes to their care and support requirements. Staff followed guidance to provide care that responded to people’s needs. People had opportunities to engage in activities and to maintain their independence. People knew how to make a complaint and were confident any issues raised would be resolved.

People’s care delivery was at the heart of the service. People and staff were happy about the management of the home. Staff understood and championed the provider’s vision to deliver person centred care. The registered manager was approachable and available to support staff in their roles. The quality of care underwent regular checks to drive improvement. Other agencies were involved to share best practice guidance and to improve care delivery.

People told us they considered the staff provided excellent care and support. They said the home was well organised but was also homely. People told us the staff were attentive and caring and the manager and the provider were available to them most days.

We observed staff interacting with people and found they were respectful, courteous and friendly. During our visit we saw staff knocking on people’s doors and waiting to be invited in. People said staff took care of their possessions and they ensured their dignity was maintained during personal care and support.

We saw the provider’s complaints file. There were no complaints recorded during the previous twelve months. We also saw the provider’s compliments and thank you cards folder. There were many letters and cards expressing gratitude for care provided from people’s relatives. Most of these referred to the kindness and compassion of staff. Other comments related to the high standard of care and comfort provided.

We observed the registered manager and provider on a number of occasions during the day interacting with the people living at the home. These observations showed us they knew the people well and had a good understanding of their needs. People appeared confident and comfortable in their company and they responded positively to them.

Relatives spoken with were very positive about the quality of care at the home, for example " it such a lovely place, my auntie is safe and well cared for", "staff always keep me informed about my auntie's care needs and if anything changes", " and " the staff are lovely, always polite and courteous", " I am so relieved my dad is in such safe hands and in such a lovely homely and family environment.

People and their relatives told us Ashley House was a safe place to live. Health care professionals told us the staff at the home were very good at noticing changes in people's needs. They also said, where necessary, people were referred to other professionals in a timely manner. They told us people at Ashley House were well cared for.

We were told that the provider worked at the home most days including weekends. Staff told us they spent a good deal of time chatting with people, and occasionally eating their meals with them. One person spoken with told us the "owners were as much part of the Ashley House family as they were".

Ashley House is registered to provide residential care for up to 29 older people. There were 23 bedrooms, with the provision that some rooms could be double occupancy if requested. There were 21 people living at the home at the time of the inspection.

People required a range of help and support in relation to living with dementia and personal care needs.

The home is a converted Victorian building with large communal rooms. The home has a passenger lift and wide staircases with handrails to assist people to access all areas of the building.

This was an unannounced inspection which took place on 9 and 10 November 2015.

Ashley House 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 manager was in day to day charge of the home, supported by the registered provider. People and staff spoke highly of the manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff told us that the manager had a good overview of the home and knew everyone well.

We received only positive feedback from people, staff, relatives and visiting professionals. Everyone told us that the manager was passionate about ensuring people received the best care possible. This was supported by clear up to date care documentation which was personalised and regularly reviewed.

Staff felt that training provided was effective and ensured they were able to provide the best care for people. Staff were encouraged to attend further training, with a number having achieved National Vocational Qualifications (NVQ) or similar.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and checks were carried out to ensure high standards were maintained. People were supported to self-medicate if deemed safe for them to do so and this was regularly reviewed.

There were robust systems in place to assess the quality of the service. Maintenance for example water, electric and gas had taken place and all equipment and services to the building had been checked and maintained regularly. Fire evacuation plans and personal evacuation procedure information was in place in event of an emergency evacuation.

There a programme of supervision and appraisals for staff. Staffing levels were reviewed regularly. Staff received training which they felt was effective and supported them in providing safe care for people. Robust recruitment checks were completed before staff began work.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all health care needs and had been reviewed regularly to ensure information was up to date and relevant. People’s mental health and capacity were assessed and reviewed with pertinent information in care files to inform staff of people’s individual needs.

People were encouraged to remain as independent as possible and supported to participate in daily activities. Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected. Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave positive feedback about the food and visitors told us they had eaten with their relative and found the food to be of a very high standard.

Referrals were made appropriately to outside agencies when required. For example GP visits, community nurses and speech and language therapists (SALT). And notifications had been completed to inform CQC and other outside organisations when events occurred.