We inspected the service on 6 and 7 September 2017. Ashton Court is registered to provide care and support for up to 39 people, including people living with a disability and/or a dementia related illness. The service is set out over two floors and there is a lift to enable people to access the second floor. On the day of our inspection 24 people were using the service.

At our last inspection in April 2015, the service was rated ‘Good’ overall with some improvements required with effective relating to people’s hydration and nutritional needs. At this inspection we found that the service remained ‘Good’ and the required improvements for effective had been made.

People continued to receive a safe service. Staff were aware of their role and responsibility in protecting people from avoidable harm. They had attended appropriate safeguarding training and had policies and procedures available to them. Some issues were identified with the environment and risks associated to people’s needs had not all been risk assessed. The registered manager took immediate action during our inspection to address these issues.

People were supported by appropriate staffing levels to meet their dependency needs. The staffing levels were regularly reviewed and were flexible to respond to people’s changing needs. The provider had safe staff recruitment procedures and these were followed. The storage and management of medicines were found to be safe.

People received an effective service. Improvements had been made to how people’s hydration and nutritional needs were assessed and planned for. Staff had the required information to meet these needs.

Staff received an appropriate induction, ongoing training, support and opportunities to review their work. Staff understood the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards that protected people’s human rights. People were supported to maintain good health and staff worked well with external healthcare professionals.

People continued to receive good care. People were treated with kindness, dignity and respect by the staff. People’s care records included detailed and personalised information which enabled staff to support people in line with their personal preferences. People had access to independent advocacy information should they have required this support.

People continued to receive a responsive service. Assessments were completed and support plans developed. This information supported staff to provide a responsive service based on people’s needs, routines and interests. People had access to the provider’s complaint policy and procedure. Where concerns had been raised they had been responded to appropriately.

The service continued to be well-led. The provider had arrangements in place for monitoring and assessing the quality and safety of the service. These included seeking and acting upon the views for people who used the service and others.

We inspected the service on 2 April 2015. The inspection was unannounced. Ashton Court is registered to provide care and support for up to 39 people including people living with a disability and/or a dementia related illness. The service is set out over two floors and there is a lift to enable people to access the second floor. On the day of our inspection 28 people were using the service.

The service did not have a registered manager in place at the time of our inspection. 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.

When we last inspected the service on 13 May 2014 we found there were improvements needed in relation to the way medicines were stored and administered to people. The provider sent us an action plan telling us they would make these improvements by September 2014. We found at this inspection that this had been completed and the provider had made improvements in line with their action plan.

People felt safe in the service and the manager shared information with the local authority when needed. Staff knew how to respond to incidents if the manager was not in the service. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people received their medicines as prescribed. People were cared for by adequate numbers of staff to ensure they received care and support when they needed it.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were supported to make decisions about their care. Where people lacked capacity to make certain decisions, they were protected under the Mental Capacity Act 2005.

People were not always supported to maintain their nutrition and staff did not always have the information they needed to monitor deterioration in people’s health.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people.

People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in improvements being made to the service.

During our inspection on 15 July 2014 we gathered information to help us answer whether the service provided care which is safe.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Medicines were not always handled or stored appropriately. This demonstrated that the procedures they used were not always safe and did not follow best practice.

Because some of the people who lived at the home have limited communications, we were unable to ask them about their experiences.

We spoke with two people who use the service about the support with medicines that people received from the staff. One person said “Don’t ask me what it’s for? They ask me every day, they ask me do I want a painkiller. They are very good like that". The other person said “I’m very happy living here and looked after”. Another person’s relative said “Generally speaking they have been very good and very helpful”.

The name of the registered manager on this report is incorrect. This is because we have not yet received the required application to de-register the manager. The service has a new manager who told us they plan to register with us.

We spoke with six people using the service and the relative of another person, who could not communicate with us. Five people we spoke with were very happy with the care they received at Ashton Court. They told us they felt that staff understood their needs and met them appropriately. People’s comments included, “I’m very happy here. It couldn’t be better for me” and “I have no complaints at all. It’s a good place to be.”

We observed staff having respectful and friendly interactions with the people in the communal areas. The people in these areas appeared relaxed and comfortable with the staff. Staff were chatting to people who were able to communicate and they provided respectful care to people with communication difficulties.

We looked at the records being maintained by staff in relation to three people. We saw they were recording their food and fluid charts appropriately. We did not have concerns about the quality of recording during this visit.

People’s privacy, dignity and independence were respected. We observed people being treated with respect by staff and staff were mindful of people’s privacy and dignity. We spoke with three people using the service and they told us staff were respectful and valued their privacy. One person said,” they are very respectful to us. I would soon speak up if they were rude to me.”

We spent time in a communal area of the home where people were sitting. We saw there was a relaxed atmosphere with people chatting to each other or talking to staff.

We saw positive interactions between staff and people using the service and people appeared comfortable talking with staff. Two people ate their meal in this room with one of them saying, “This is where I prefer to eat.” Staff checked on the two people during the meal and we saw they supported them to be independent but also offered help when it was needed.

We found some care plans did not contain the required information to make sure people were cared for safely. Some care plans did not contain evidence that the person had been supported to have a say in how their care was delivered.

We received positive feedback on the cleanliness of the service from people using the service and their relatives. One person told us, “It is always very clean here” and another said, “I can honestly say I find the place is always spotless.”

We observed care being delivered and found staff were available when people needed assistance. All of our observations of staff were positive and we received positive comments about their conduct. We spoke with one person using the service about staff and they told us, “They are very good, always polite and friendly.”

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw regular meetings had been held for people using the service with their relatives also invited to attend. Records showed people were encouraged to make decisions about the service such as meals, activities and the environment. During one meeting some people had requested a small alcoholic drink be given with their mid-day meal and we saw during our observations of lunch that people had an alcoholic drink offered to them. This means people were included in making decisions about the service.

We visited this home because we had concerns that they had not been inspected for two years.

We asked people who used the service if they were happy with the care and treatment they received at Ashton Court. Comments received included,

“I was made very welcome when I came here, the staff support me the way I want them to.” “I feel safe here and the staff are lovely.” “Staff know when I am unwell, they call the doctor and my family.”