This inspection took place on 27 March and 4 April 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Ashton Grange Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ashton Grange Residential Home accommodates 39 older people in one purpose built building. On the day of our inspection there were 37 people using the service. Some of the people were living with dementia.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 last inspected the service in March 2016 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

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.

Care records contained evidence of people being supported during visits to and from external health care specialists. People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs.

People who used the service and family members were complimentary about the standard of care at Ashton Grange Residential Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation and the service had good links with the local community. People had individual activity plans in place, which ensured activities were person-centred.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The registered manager continually strived to develop their knowledge and skills, and shared this learning with staff to ensure continuous improvement across the staff team. Staff said they felt supported by the registered manager.

The provider had an effective quality assurance process in place. People who used the service, family members and staff were regularly consulted about the qual

The inspection took place on 12 January 2016 and was unannounced. Two half day inspections took place on 15 and 20 January 2016 and were announced.

Ashton Grange is a two storey home that provides personal care and support for up to 39 people, some of who are living with dementia. At the time of our inspection there were 39 people using 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.

Staff had a good understanding of safeguarding and were confident in their role in safeguarding people.

Risk assessments were in place for people when required and there were clear links to associated care plans. There were also general risk assessments regarding the premises and environment.

Medicines where managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staff were recruited in a safe and consistent manner with all appropriate checks carried out. New care staffing levels had recently been increased, and plans were in place to introduce a more robust system to analyse staffing requirements in line with people’s needs. From staffing rotas we saw that staffing levels were consistent and alternative arrangements were available to cover shortages of staff.

All staff training was up to date including all mandatory subjects as well as other additional training. There was a system in place to flag up when refresher training was due and staff felt encouraged to develop their skills further.

The registered manager and staff we spoke to had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place for those who required them.

Staff received regular supervision and told us they felt supported in their roles. Appraisals were completed annually and were up to date for all staff members.

We observed people and staff during mealtimes. People were enjoying their meals, some independently and others with support from staff. There were choices available for people and support provided by staff was caring, compassionate and at an appropriate pace for each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs. People were empowered to embrace favourite past times and to live the life they wanted to.

The provider had a robust quality assurance and audit schedule in place which was carried out in practice. This ensured the quality of the service provided was assessed and monitored from every aspect and appropriate action was taken to improve and develop the service where possible.

The home had a major focus on activities and ensured there was a vast range available for people in the service. Activities ranged from a church service every month, walking football, singers, animal therapy, baking, cards, arts and crafts to outings in the community to a local pub, café, football stadium, museums and garden centres. Staff had a very good understanding of activities each individual enjoyed doing. People who used the service discussed activities at residents’ meetings and with the activities co-ordinator individually.

Some people using the service had complex needs which meant they were unable to tell us their views; because of this we used a number of different methods to help us understand their experiences.

We observed care and found that staff could respond to people’s individual needs and cared for people in a kind and respectful way.

We spoke with three people who said they were happy in the home and felt their needs were being met. One person said “It is nice, I like it (here) and I am settled”.

We spoke with three relatives who spoke highly of the service their relatives received. One said how “Lovely and helpful the staff were”. They also said they felt involved in the planning and reviewing of the care their relative received and that their opinions were taken into account to influence changes in the care being given. Another person told us their relative was “Well looked after, the staff know their needs”.

We saw that people were asked for their consent to care and treatment. The provider followed the correct procedures regarding the risk of infection.

Staff were provided with support and the training needed to carry out their roles and the provider had an effective system in place to monitor the quality of service provided.

People we spoke with were positive about the care they received at Ashton Grange Residential Home. Comments we received included "The staff are lovely" and "They treat me with respect".

We observed staff engaged in appropriate conversations with residents within the service. Relatives told us "The staff know them really well and they're always polite".