The inspection took place on 8 May 2017 and was unannounced. The last comprehensive inspection took place in April 2015, when the provider was meeting the regulations.

Ashton Court is a care home for older people who require personal care. It can accommodate up to 24 people. The bedrooms are situated on three floors which can be accessed by a passenger lift or stairs. There is a small car park to the rear and an enclosed garden at the front of the building.

At the time of our 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.

Staff we spoke with were knowledgeable about how to safeguard people from abuse. They told us they attended training and they had learned about the different types of abuse and how to recognise and report it.

We looked at four recruitment files and found the provider had a safe and effective system in place for employing new staff.

We looked at systems in place to manage medicines and found that they were safe. Medicines were stored and administered correctly.

Care plans we looked at identified risks associated with people’s care. We saw plans were in place to instruct staff on how to minimise the risk.

We spoke with staff who said they received appropriate training which gave them the skills and confidence to carry out their responsibilities. Training included moving and handling, first aid, health and safety, fire prevention, safeguarding, and food hygiene.

Through our observations and from talking with staff and the registered manager we found the service to be meeting the requirements of the Mental Capacity Act 2005. Staff confirmed they had received training in this subject.

People were offered a choice of food at each meal and drinks and snacks were provided throughout the day in line with their preferences and dietary requirements. The mealtime experience was calm and relaxed.

We looked at peoples care plans and found that relevant healthcare professionals were involved in their care when required.

We observed staff supporting people and found they were respectful and caring in nature. Care plans we saw included information about people’s likes and dislikes.

We looked at care records belonging to three people and found they were informative and reflected the care and support being given.

The service employed an activity co-ordinator who was available in this role 20 hours a week. This person organised events and social stimulation for people, based on their individual preferences.

The provider had a complaints procedure and people felt able to raise concerns if they needed to. The registered manager kept a log of concerns received and addressed them effectively.

People told us the registered manager was supportive and they felt able to approach the manager and felt she listened to them and acted on what they told her.

We saw regular audits took place to check the quality of service provision. Action plans were devised to follow up any issues.

People were involved in the service and their views were sought. We saw evidence that people were involved in residents and relatives meetings and were able to comment about the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with managers and staff. We also looked at records in relation to infection prevention and control.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Improvements had been made since the last inspection of the service. This meant the service was mainly safe, clean and hygienic.

Is the service well-led?

The manager had taken appropriate steps to ensure compliance in the prevention and control of infection. Audits and cleaning schedules had been developed and corrective action had been undertaken where required.

At this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people using the service, three relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. One person we spoke with said, “Staff are always available to make sure we get the care we need, I would speak to the manager if I was worried about anything.”

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that people will be safeguarded as required.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. Some areas required attention to improve the prevention and control of infection.

Recruitment practice is safe and thorough. The manager had recently taken action to ensure staff that was deemed unsuitable to work with vulnerable adults had been referred to the relevant bodies. Policies and procedures are in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Relatives confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with said, “The staff are very good they bring me my meals to my room and ask if they can help me with anything.” Relative’s we spoke with told us they thought the care was good and staff made sure they (the relative) were kept informed about the care given to their relative.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. We saw that staff responded quickly to meet the needs of people. For example one person said they did not feel very well. The person was assisted back to their room and the doctor was called to visit the person within a few minutes.

People knew how to make a complaint if they were unhappy. One person we spoke with said, “If I have a problem the manager deals with it quickly.” Relatives also confirmed that they had raised concerns and the provider had listened and had taken appropriate action.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. For example dieticians and speech and language therapist had been involved when assessing people’s nutritional needs.

The service held meetings with relatives’ and residents’ to gain their views on the service. Comments from relatives confirmed they felt involved in making decisions to improve the service.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We completed this inspection because our inspection of 24 June 2013, found that the service was not compliant with regulation 23 of the Health and Social Care Act. The provider wrote to us and told us that they would be compliant by October 2013.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

At this inspection we spoke with six people who used the service, and five relatives. We found that people’s privacy, dignity and independence were respected. People told us they were happy living in the home. One person said, “I spend most of my time in my bedroom, I like my own routines and I know staff are available if I need help.”

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff had a good knowledge of the needs of people who used the service.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People experienced care, treatment and support that met their needs and protected their rights. Relatives said, “I visit regularly and my mum always seems to be happy, and the staff do the best they can.”

People were cared for by sufficient staff. However, improvements were required to ensure staff were supported and trained to deliver care and treatment safely and to an appropriate standard.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

We spoke with three people who used the service. They told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

We spoke with two relatives of people who used the service. They told us they were happy with the care provided. They said they were kept informed about any changes to their relatives care and treatment. Relatives knew how to raise concerns and they had confidence in the new provider and manager.

People we spoke with told us that staff were kind and always treated them with respect. One person said “I like living here I have good friends and we spend time together.” Another person told us they enjoyed activities like sing-a-longs with staff.

There were policies and procedures in place to keep people safe and protected. Staff had received training in the protection of vulnerable adults.

There were sufficient staff to meet the needs of people who used the service. The provider had taken steps to ensure management arrangements were in place; however the registered manager was unavailable during this inspection.

This inspection was carried out on 25 and 30 March 2015 and was unannounced on the first day. We last inspected the service in July 2014 and found they were meeting the Regulations we looked at.

Ashton Court is a large house which has been extended to accommodate and provide care for up to 24 older people. The bedrooms are situated on three floors and there is a lift for people to use to gain access to the different floors. There is a small car park at the rear and an enclosed garden at the front of the building.

The service has a registered manager who has been registered with the Care Quality Commission since March 2013. 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 Ashton Court. Everyone we spoke with told us they were confident that they could tell the staff whatever they needed to if they were worried about anything. There were procedures to follow if staff had any concerns about the safety of people they supported.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

People were able to access some activities. The activity coordinator worked three days each week, but sometimes covered care shifts instead of working as the coordinator. The registered manager was addressing this issue by employing more staff.

We found the home had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt that the staff knew them and their likes and dislikes. One person said, “Staff are great, they know what I need help with and support me in the right way.”

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it. We noted from the records that there had been four complaints received in the last 12 months which had been responded to appropriately.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and a representative of the provider. The reports included any actions required and these were checked each month to determine progress.