This inspection of Ashlynn Grange took place on 17 and 24 May 2018 and was unannounced.

Ashlynn Grange provides, accommodation, nursing and personal care for up to 156 adults; some of whom have dementia. It is also registered to provide the regulated activity; treatment, disease, disorder and injury. At the time of this inspection there were 78 people living in four areas of the service (called communities), each of which have separate adapted facilities. The communities of Yeoman and Woolsack were housed together in one unit and the communities of Harvester and Hayward were housed in two separate units.

At the last inspection in 10 and 16 August 2017, the service was rated 'Requires Improvement'. At this inspection, we found the service had made the necessary improvements under the questions is the service caring, and responsive; and was now rated as 'Good'. Improvements were still needed for the question of, is the service safe?

Ashlynn Grange 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 was no registered manager in post at the time of this inspection. During this inspection the general manager had applied with the CQC to become the registered manager and were awaiting their fit and proper person interview. 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 were supported by staff who were knowledgeable about safeguarding and its reporting processes. Risk assessments were in place as guidance for staff to support and monitor people’s assessed risks. Technology was used to assist the majority of people to receive safe, care and support.

People’s confidential records were not always held securely. This put people’s personal information at risk.

Systems were in place to promote and maintain good infection prevention and control. Staff had been recruited safely prior to working at the service. A sufficient number of staff were deployed in a way which met people's needs in a timely manner in two out of the four communities (units). We have made recommendations about the provider making sure that the right skills mix of staff are available on shift to support people safely.

Actions were taken to learn any lessons when things did not always go as planned. However, records documenting the incident and any actions taken were not always in situ.

Medicines were administered as prescribed and they were managed safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received an effective service that met their assessed needs by staff who had been trained to have the skills they required. People were supported with their eating and drinking to promote their well-being. We have recommended that the provider looks at current guidance to make sure that people with short term memory loss are supported with both visual and verbal prompts to enable them to make food and drink choices.

Staff supported people to access healthcare services when this was required. The manager and staff team worked with other organisations to help ensure that people's care was coordinated and person centred.

People received a caring service as their needs were met in a kind, and considerate way. People’s privacy was promoted and maintained by staff and the majority of people’s dignity was supported by staff assisting them. People were involved in their care and staff promoted people’s independence as far as practicable. Staff knew the people they cared for well.

Activit

Ashlynn Grange provides accommodation, nursing, and personal care for up to 156 adults, some of whom may be living with dementia. It also registered to provide the regulated activity: treatment, disease, disorder and injury. At the time of our inspection there were 81 people living at the service. People lived in four areas of the service; Yeoman, Woolsack, Hayward and Harvester unit.

There was a registered manager in post at the time of the inspection. 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.

This was the first inspection carried out at this service under this provider since it was registered with the CQC in November 2016.

Staff assisted people in a way that supported their safety and people were looked after by staff in a kind and caring manner. Staff encouraged people to make their own choices. However, people’s privacy and dignity was not always promoted and maintained by staff.

Staff were knowledgeable of how to report incidents of harm and poor care. Accidents and incidents were identified and recorded. Actions were taken to, as far as possible; reduce the risk of recurrence where incidents had occurred. Staff were trained to provide effective and safe care. However, staff did not always move people in a safe way that would reduce the risk of injury and in accordance with their training.

People were supported to take their medicines as prescribed and medicines were managed by staff whose competency had been assessed. However, accurate records of people’s medicine administration were not always kept by staff members. Where there had been any errors in the administration of people’s medicines, these had been identified and were being dealt with appropriately. The provider’s quality governance manager had been tasked with undertaking a thorough audit of medicines management as a result of concerns identified by their own quality monitoring systems. This showed us that the safety of people’s medicines’ administration was effectively audited.

People and their relatives / advocates were involved in the setting up and agreement of their/their family members care plans. People’s care arrangements took account of people’s wishes including their likes and dislikes and any assistance they required.

Risks to people who lived at the service such as poor skin integrity or dehydration were identified and plans were put into place by staff to minimise and monitor these risks. During the inspection additional information about people’s specific health conditions and the management of these, including any equipment required, were added into people’s care records.

People were looked after by enough, suitably qualified staff to support them safely with their individual needs. Staff enjoyed their work and were supported and managed to look after people. Staff understood their roles and responsibilities and were supported to maintain their skills by way of supervision. Pre-employment checks were completed on new staff members before they were deemed to be suitable to look after people living at the service.

The service was flexible and responsive to people’s needs. People maintained contact with their relatives and friends and they were encouraged to visit the service and were made welcome by staff.

Activities took place at the service; however, some people felt that the number of activities taking place could be increased to improve social interactions.

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 supported to eat and drink sufficient amounts of food and fluids. Cho