This inspection took place on 7 and 8 February and was unannounced.

Ashley House 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 House does not provide nursing care.

Ashley House is registered to provide personal care and accommodation to up to 25 older people. Accommodation is provided in a converted residential dwelling over two floors. At the time of our inspection, 17 people were using the service.

At our last inspection in February 2016, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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.

People told us they felt safe living in the home. A relative told us, “No worries here, when I go home I don’t have to worry I know [the person] is safe.”

Medicines were managed safely, securely stored, correctly recorded, and only administered by staff that were trained and assessed as competent to give medicines.

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse.

There was sufficient staff to safely meet the needs of people living in the home. People told us they thought there was plenty of staff. One person said, “At night if I ring the bell they come to me straight away.”

People received effective care from staff who understood their needs. Staff were able to tell us about people’s specific likes and dislikes. People told us they thought staff were well trained and understood them well.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food and menus were regularly discussed and recorded at resident meetings.

All staff attended induction training before they started to work in the home. All staff spoken with said they had plenty of opportunities for training.

People could enjoy a full programme of activities and staff had built up links with the local community to ensure people could stay in touch with organisations such as their place of worship the local school and toddler group. The home was also a member of the Langport Dementia Alliance Group and were planning further initiatives for the year which included a, “Monday meander" (a walk around the local area), a dementia café and singing for the mind.

People said they received care and support from caring and kind staff. Comments included, “The staff are all very caring, They listen to you it’s like a home from home.” And, “They are all very nice and care comes with a smile.”

People received care that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives.

People told us they could talk with staff and the registered manager if they wished to raise a concern. One relative said, “The manager is always available, her door is always open and if I want to raise any concerns she listens.”

People were supported at the end of their life to have a comfortable pain free death. Care plans showed people’s advance decisions were taken into consideration and a

This inspection was unannounced and took place on 29 December 2015.

Ashley House (Langport) is registered to provide care and accommodation for up to 25 people. The home specialises in the care of older people.

The last inspection of the home was carried out in November 2013. No concerns were identified with the care being provided to people at that inspection.

There is 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.

People living at Ashley House (Langport) told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “I told my daughter what I wanted and expected and she visited several places and said this home was ideal. I can’t argue with that, however I did have the choice if I was not happy to find somewhere else, so as I am still here I must be happy.” Another person said, “I am very happy here. It is the place I chose and I can choose what I do daily.”

Everybody told us they felt safe living in the home, one person said, “I have always felt safe right from day one.” Whilst another person said they felt very safe when being cared for by the staff. Everybody was relaxed with staff and there was a friendly, cheerful atmosphere in the home.

Before the inspection we received concerns that staffing levels at night were low in the home which may have an impact on the safety of people. The registered manager confirmed there was one waking and one sleeping member of staff at night. They explained they monitored people’s care needs and if an extra staff member was needed more regularly, they were able to have two waking staff at night. They also confirmed a senior member of staff was available on call at all times.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during the day. One person said, “They all seem to care for you as an individual and take the time to sit down and have a chat.” Another person said, “[The registered manager] is so nice she came and sat on my bed and we talked about how I felt and if there was anything she could do to help.” A staff member said they felt they had plenty of time to do their tasks and chat with people through the day. The manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities.

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, for example they were receiving training in dementia awareness and end of life care to help support the increasing number of people referred to the home with more complex needs. They understood people’s needs and were able to explain to us how they would care for each person on a daily basis. One staff member said, “We are a small home so we know people very well. We also have handovers when we discuss specific changes and needs. Then the care plans are very informative.”

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included the person’s written consent to care. Staff had comprehensive information and guidance in care plans to deliver consistent care the way people preferred.

The registered manager had a clear philosophy for the home. The statement of purpose said their aim was t

When we visited 20 people were using the service. We spoke with 17 people, a visitor and three members of staff. We also spent time observing how staff interacted with the people who lived at the home. Staff interactions were kind and respectful and staff offered people assistance in a discreet and dignified manner.

Without exception, everyone we spoke with was very positive about the care and support they received. Comments included “I’ve lived here for eight years and I honestly can’t think of anything they could do better”, “I feel so very lucky to be here. It’s perfect in every way” and “the staff will do anything for you." One person told us “It’s just like being part of a family. Every single member of staff, it doesn’t matter whether it is first thing in the morning or in the middle of the night, greets you with a smile and a kind word.”

People felt safe and staff spoken with were aware of issues of abuse and knew how to report any worries or concerns. They said they felt confident that any reports would be fully investigated to ensure that people were protected.

The home’s health and safety procedures minimised risks to the people who lived at the home. We saw that people had been provided with equipment in line with their assessed needs.

People using the service were provided with opportunities to express a view on the quality of the service they received. Quality assurance procedures helped to reduce risks to people who lived at the home.

When we visited 22 people were using the service. We spoke with 18 people, two visitors and three members of staff. We also spent time observing how staff interacted with the people who lived at the home. The people we spoke with were able to tell staff how they wished to be cared for. Comments included “the staff here know how much help I need and they always check that I am happy with everything” and “I am very satisfied and the staff never try to make you doing anything. They explain things really well.”

The people we spoke with were positive about the care and support they received. Comments included “I am very satisfied with everything and I can’t fault the staff” and “I haven’t been here long but it feels like a very happy and homely place. All the staff are so very kind.” The visitors we spoke with told us “we can’t fault anything. The care is excellent and the staff are angels.”

The home ensured that people received their prescribed medicines in a safe way.

Staff recruitment procedures minimised any risks to the people who used the service.

The people we spoke with told us that they would feel confident in discussing any concerns if they had any. They said “I don’t have any worries at all but if I did I would certainly tell the staff or manager” and “I am very happy with everything. If I wasn’t, I know that they would sort things out.”

People who lived at the home told us that they were able to make choices about all aspects of their daily lives. Comments included “I can go where I like when I like”, “I decide when I go to bed and when I get up” and “you are never made to do anything, you can just please yourself which is lovely”.

During our visit we observed people moving freely around the home. We spoke with two people who had chosen to spend the majority of their day in their bedrooms. They said “I prefer my own company and the staff respect that”, “they check on me regularly and if I ring my bell, they are here straight away”. One person said “It’s the same at night, you can ring your bell at 2 o’clock in the morning and they are there and they always ask if you would like a cup of tea”.

People told us that they had been consulted about their preferences for food and drink. Comments included “It’s amazing really, all the staff know what I like and what I really don’t like”, “If you leave something on your plate, the staff come and ask you if there was a problem or whether you didn’t like it”. Information about each person’s dietary preferences had been displayed in the kitchen.

People told us that they felt well informed about what was going on in the home. They said “we have regular meetings and the manager is marvellous, she keeps us up to date everyday really” and “we know what is going on everyday”. A visitor told us that they were always kept up to date about their relative’s care and well being.

Some people spoken with were aware that they had a care plan and they said that they were always asked about the care they needed and their preferences. One person said “the staff know me well and they know how much help I need”. Another person told us “I am always treated with respect by the staff and I never feel rushed”.

People appeared very comfortable in the presence of staff and it was evident that staff knew people well. Staff interactions were noted to be kind and respectful. The atmosphere in the home was relaxed and inclusive and people were offered assistance with personal care in a dignified and discreet manner. We observed that staff knocked on people’s bedroom doors before entering. One person said “the staff always knock on your door before coming in and they all treat you with the upmost respect”.

People who lived at the home were very positive about the care they received. Comments included “I would recommend this home to anyone, you really cannot fault anything”, “you get everything you need just when you need it, I am so very happy here”. One person said “It is like a five star hotel really, you want for nothing and the staff are so very kind and helpful”. A visitor told us that they were “very happy” with the care their relative received. They said “you can’t fault anything, they are just marvellous”.

People told us that they could see a doctor or health care professional when they needed to. They said “the doctor comes in every week”, “If you are not feeling very well the staff will telephone the doctor straight away”. They also said “the chiropodist visits the home regularly and we are very well looked after here”. One person said “the manager has taken me to hospital appointments. She is just wonderful you know”.

People were positive about the meals offered at the home. Comments included “you are never hungry here, the food is very good”, “they know about all the things you really don’t like and all the things you love”. We observed lunch being served and the meal looked appetising and plentiful. People had chosen where they had wanted to eat their lunch and were offered food and drink in line with their preferences. People were offered a choice of drinks including alcoholic beverages. One person said “they know I always like a sherry with my lunch”. We observed the lunch time experience to be relaxed, unhurried and sociable”.

People told us that they were provided with opportunities for social stimulation. Comments included “there is always something going on if you want to join in”, “they have regular entertainment where they lay on food and drink. Your relatives or friends can come and the staff bring their families. It is lovely”.

Everyone asked said that they felt there were enough staff on duty to meet their needs. One person said “the staff are very good and they come if you ring your bell”. Another said “the staff are always there when you need them, day or night”.

People commented on the kindness of the manager and the staff team. Comments included “You couldn’t ask for a better manager than Sue, she is so kind and helpful and really cares about you”, “all of the staff are so kind and friendly”, “you just can’t fault the staff, and they are so lovely and so very patient”.

We observed that staff responded promptly to any requests for assistance. There was a relaxed atmosphere in the home and staff had time to chat with people as well as undertake tasks.

Staff appeared confident and well motivated. Staff turnover was low which meant that people living in the home received a consistent level of support as staff members were aware of their changing needs.