We inspected Ashridge Court on the 20 and 21 November 2018.This was an unannounced inspection.

Ashridge Court 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.

Ashridge Court Care Centre is a care home with nursing located in Bexhill On Sea. It is registered to support a maximum of 69 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home has four separate wings offering residential care based on people’s particular needs and requirements, including one which is a specifically designed dementia unit that can accommodate up to 14 people. On the day of our inspection, there were 63 people living at the service.

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.

We previously carried out an unannounced comprehensive inspection of this service in September 2017. Ashridge Court was awarded an overall rating of ‘Requires improvement’ as improvements were needed in the safe and well led questions. At that inspection improvements were needed to ensure that care delivery was supported by risk assessments that ensured that people’s health needs were monitored and acted on when needed. This inspection found that the necessary improvements had been made and the overall rating had improved to ‘Good’ with all questions being awarded ‘Good’.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and Dementia. There was a good level of information and guidance for staff to follow for those people who lived with complex needs. For example, oxygen therapy, moving and handling and percutaneous endoscopic gastrostomy (PEG) which is a way of introducing food, fluids and medicines directly into the stomach by passing a thin tube through the skin and into the stomach, for those unable to eat were clear and accompanied by photographs of how equipment for each should be used. There were safe systems for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and people said staff were available to support them when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. For example, the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. There was a consistent use of agency staff and the registered manager ensured that the agency staff used had the necessary skills to work at Ashridge Court. People said they felt comfortable and at ease with staff and relatives felt people were safe.

People were supported with their nutrition and hydration needs. Clear guidance was available for staff to follow when people had specific dieta

We inspected Ashridge Court on the 21 and 22 September 2017.This was an unannounced inspection.

Ashridge Court Care Centre is a care home with nursing located in Bexhill On Sea. It is registered to support a maximum of 69 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home has four separate wings offering residential care based on people’s particular needs and requirements, including one which is a specifically designed dementia unit that can accommodate up to 16 people. On the day of our inspection, there were 63 people living at the service.

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.

At our inspection on 16 December 2014 we found that the service was safe, effective, caring, responsive and well led. Our overall rating of the service was Good.

At this inspection improvements were needed to ensure that care delivery was supported by risk assessments that ensured that people’s health needs were monitored and acted on when needed. This was because actions had not been taken to address high blood sugars, low blood pressures and some wound documentation was not accurate and did not follow good practice guidelines.

We recommend that the service seeks advice and support from a reputable source to ensure that staff are confident in the management of wound care, diabetes and hypotension.

Equipment such as pressure relieving mattresses were not set correctly as per the manufacturer’s guidance. In addition, the quality monitoring systems had not identified these shortfalls. We found staff knowledge and understanding in areas such as the Mental Capacity Act 2015 (MCA) and behaviours that challenge required improvement. The provider had not ensured that staff completing MCA assessments had a clear understanding of how to capture and record people’s capacity in line with legislation. MCA assessments did not evidence how staff had arrived at decisions related to people’s capacity via best interest meetings and discussions. The documentation and guidance to manage behaviours that challenge for some people was about responses to behaviours shown, rather than proactive strategies to reduce the likelihood of negative behaviours that place staff and people at risk.

Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration. Some minor improvements were needed for ‘as required’ documentation in that they lacked monitoring of the effectiveness of the medicines.

People told us they felt safe in the home. Staff were knowledgeable about safeguarding policies and how to recognise different types of abuse. Routine health and safety checks were undertaken covering areas associated with fire safety, health and safety and servicing. The service had contingency plans in the event of an emergency evacuation. Staff and records indicated that fire training and testing was undertaking regularly. All staff were trained in first aid and resuscitation techniques.

People were satisfied with staffing levels. There were enough staff on duty to support people at busy times of the day such as meal times, and to support people with one to one time. The service had used regular agency nurses and care staff whilst recruiting to the vacancies at Ashridge Court. Staffing levels were regularly reviewed to ensure appropriate numbers of staff were available when people’s dependency changed. The provider had safe systems for the recruitment of staff.

Medicines were given out in a safe way. Medicines were kept securely and there were full records of medicines administration. Some minor improv

The inspection took place on 16 December 2014. Ashridge Court Care Centre was last inspected on 17 September 2013 and no concerns were identified.

Ashridge Court Care Centre is a care home with nursing located in Bexhill On Sea. It is registered to support a maximum of 69 people. The service provides personal care and support to people with nursing needs, some of whom were living with dementia. The home has four separate wings offering residential care based on people’s particular needs and requirements, including one which is a specifically designed dementia unit that can accommodate up to 16 people. On the day of our inspection, there were 60 people living at the service.

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 were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work with vulnerable adults. One person told us, “I feel completely safe and happy”. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the service to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were encouraged and supported to eat and drink well. One person said, “I eat my meals in my room and the meal is excellent. It is nourishing and we have plenty of choice”. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People could choose how to spend their day and they took part in activities in the home and the community. People told us they enjoyed the activities, such as pet visits, quizzes, visits from singing groups and trips to the local town.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. Staff had received regular supervision meetings with their manager, and formal personal development plans, such as annual appraisals, were in place.

People felt well looked after and supported and we observed friendly and genuine relationships had developed between people and staff. A visitor said, “I can tell that my husband’s well cared for, because his face lights up when he’s approached by the nurses, carers, cleaners and laundry staff. You can’t fake that kind of thing”. The registered manager told us, “We make people feel like they have ownership. It’s up to them what they do. It’s not you’re here in this home so do X, Y and Z. We’re here to support you”. Care plans described people’s needs and preferences and they were encouraged to be as independent as possible.

People were encouraged to stay in touch with their families and receive visitors. One visiting relative told us, “I come in each day and the staff care about me as well. He is in safe hands”. Relatives were asked for their views about the service and the care delivered to their family members. Completed surveys showed families were happy overall and felt staff were friendly, welcoming and approachable. Residents’ and relatives meetings were held and people said they felt listened to and any concerns or issues they raised were addressed. One person said, “If I had a problem I would raise it with my key worker and they would sort it out with the management. I’ve been here three years and have never had a complaint”.

Care plans gave detailed information on how people wished to be supported and were reviewed and updated regularly.

People were involved in the development of the service and were encouraged to express their views. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service.

Ashridge Court Care Centre is registered to provide accommodation for 69 residents. This includes dementia care provided in a specialist dementia care wing for up to 16 people. At the time of our inspection there were fifty two people living at Ashridge Court Care Centre.

We used a number of different methods to help us understand the experiences of people using the service. Not everyone who lived in the home was able to tell us about their experiences. Those who could told us “I have a wonderful life here.” And “staff are wonderful.” Visitors we spoke with told us they were very happy with the standard of care. One person told us “I am kept informed of all that’s going on, staff listen and things get done, they look after people so well.”

During our inspection we found that people had been involved in decisions about their care, and chose how they spent their time.

Care plans documented the needs of people living in the home. Risk assessments had been completed when required. Peoples care needs were reviewed regularly, this meant that staffing levels could be assessed to ensure that there were sufficient staff to meet the needs of people living in the home.

Staff received regular supervision, and were encouraged to attend further training. All staff we spoke with told us that training was offered regularly, we were told “there is lots of training every month we can do something, the training is really good.”

We used a number of different methods to help us understand the experiences of people using the service. Some people using the service had complex needs, which meant they were not able to tell us their experiences. Those who could, told us they were very happy with the standard of care provided. We were told “I have been here some time, staff here are so kind, that is why it is so good here, and that is why I stay.” And “This room was chosen for me by my family, it is a lovely room, I have such a wonderful view, I am very happy here.”

During our inspection we found that care and treatment was being provided to meet people’s needs. People using the service and/or their representatives were involved in decisions about their care and treatment.