Ashton Lodge Nursing Home provides accommodation, nursing and personal care for up to 100 older people, who may also be living with dementia. 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. The accommodation is set over two floors with communal lounge and dining areas. On the day of our inspection 93 people were living at the service.

The service had a registered manager. 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. The registered manager assisted us with our inspection on the day.

Risks to people’s safety were not always identified and staff were not always provided with sufficient information in order to help keep people free from risk. Staff did not always follow good infection control procedures and there was a lack of deployed staff to meet people’s needs at particular times of the day.

People were cared for by staff who showed kindness, care and attention. People were supported to remain independent and maintain relationships that were important to them. People were supported to access healthcare professionals when needed and were helped to remain healthy. People’s needs were assessed before they moved into the home to help ensure staff could meet their needs. People had access to a range of activities within the home.

Where people lacked capacity to make decisions we found that staff had followed the legal requirements in relation to consent. Staff were aware of their responsibilities in relation to safeguarding. However, following our inspection we were notified of a serious safeguarding concern involving one person sustaining injuries. There was person-centred information in people’s care plans to help ensure people received responsive care. Where people were on end of life care staff involved appropriate agencies.

People had been given information on how to make a complaint and people and relatives told us they were confident any concerns they raised would be addressed by the registered manager. We were given positive feedback about the registered manager and the impact they had already had on the home and staff. People and relatives were encouraged to be involved in the running of the service and the registered manager was keen to include everyone in changes for the better.

The registered manager had a clear vision for the service and there was a strong management structure in place. Quality assurance monitoring processes were in place and where actions were identified these were logged and monitored for progress. Staff felt supported by the registered manager and the registered manager worked with external agencies to help ensure people received appropriate care. This included following national guidance.

People received the medicines they required as well as sufficient food and drink. People were cared for by staff who had appropriate training and had been recruited through robust recruitment processes.

As a result of our findings we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made one recommendation to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

Ashton Lodge is a two-storey purpose built nursing home which provides respite and long term residential and nursing care for up to 100 people who may be physically or mentally ill or living with dementia. At the time of our inspection 92 people were living at the home.

This was an unannounced inspection that took place on 28 November 2016.

The home had a registered manager. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

We last inspected this home in August 2015 where we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of staffing, management of medicines and failing to follow legal requirements in relation to restrictions. They also related to a lack of dignity and respect shown to people, people not always receiving care in response to their needs and a lack of robust quality assurance processes. We asked the provider to submit to us an action plan outlining how they planned to meet these regulations. We reviewed the action plan during this inspection against what we observed, to see whether or not the provider had taken appropriate action.

Staff understood the principals of the Mental Capacity Act 2005 (MCA). The registered manager was aware of when people may be restricted and it was appropriate to submit applications to the supervisory body in relation to this.

There were sufficient staff in the home to help ensure people received the care and support they required. However, we have made a recommendation to the provider to consider reviewing staff deployment during peak times, such as lunch time. Robust recruitment processes were in place to ensure that those staff who were providing the care were suitable to be working at the home.

There was a kind, caring and relaxed atmosphere in the home where people and staff interacted together well. People and relatives were very happy with the care provided and relatives were made to feel welcome when they visited. Staff supported people to take part in activities and staff were attentive to people and knew them well. However, we have made a recommendation to the provider to continue working on developing appropriate activities for people who may be living with dementia.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff followed the guidance of healthcare professionals where appropriate.

Staff followed correct procedures in administering medicines and medicines were stored safely. Care was provided to people by staff who were trained and received relevant support from their manager. Staff told us they felt supported by the registered manager and enjoyed working in the home. There was a positive culture within the home.

Staff understood their role in safeguarding people. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. In the event of an emergency there was a contingency plan in place to help ensure people’s care would continue uninterrupted. Accidents and incidents were monitored and action taken to prevent reoccurrence.

Care plans contained information to guide staff on how someone wished to be cared for. Staff had a good understanding of people’s needs and backgrounds as detailed in their care plans.

Quality assurance checks were carried out to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. People and relatives were given the opportunity to provid

This was an unannounced inspection that took place on 18 August 2015.

Ashton Lodge Nursing Home is owned by Ashton Lodge Limited and is registered to provide accommodation with nursing care for up to 100 people. At the time of our visit, there were 93 older people living at the home. The majority of the people who live at the home are living with dementia, some have complex needs and the service also provides end of life care. The accommodation is provided over two floors that were accessible by stairs and a lift.

At the time of the inspection there was not a registered manager in post. 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.’ The manager who was previously the home’s dementia manager had been promoted to the home’s manager two weeks prior to the inspection. The manager informed us they had begun the application process to become the registered manager.

We found there were not always enough staff effectively deployed to meet people’s needs. People and staff we spoke with told us they did not feel there were enough staff on duty to meet people’s needs. This had an impact on the care and support people received.

People were at risk as their medicines were not administered or managed safely. We found some concerns around the storage of medicines that required refrigeration and the recording of medicines. Although risk assessments were in place we noted inconsistencies in the recording of information on risk assessments which could put people at risk of harm.

Staff had understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.

We noted that there were inconsistencies in the way people’s care and support needs were met.

People were not always treated with dignity. However people’s privacy was respected and promoted. We did see examples of caring practice from staff. People’s preferences, likes and dislikes had not always been taken into consideration and support was not always provided in accordance with people’s wishes.

Staff did not always respond to people’s needs in the right way and information for people around their care was not always detailed with the correct information. Staff did not always have access to appropriate equipment to respond to people’s needs. There were not sufficient activities to always meet people’s needs. However some people did enjoy the activities and events that were on offer.

People’s care and support needs could be affected due to records not being fully completed or kept up to date. The effectiveness of medicines were not appropriately monitored. There were not robust or effective systems in place to regularly assess and monitor the quality of the service provided.

People told us that they felt safe at Ashton Lodge. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from abuse.

Although the provider had systems to ensure appropriate standards of cleanliness were maintained, we still found some issues. We raised concerns about the carpets and chairs and some bedding in the home. We made a recommendation that the provider reviews their arrangements and implements current guidelines in regards to infection control.

The manager ensured staff had the skills and experience which were necessary to carry out their role. We found the staff team were knowledgeable about people’s care needs. People told us they felt supported and staff knew what they were doing.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. We found that some people had to wait quite a while for their lunch. We made a recommendation that the provider review their meal scheduling to ensure that people did not wait too long for their meals.

People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of people’s health. The service worked effectively with health care professionals and referred people for treatment when necessary.

People’s relatives and friends were able to visit at any time.

People told us if they had any issues they would speak to the nurse or the manager. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard.

The provider had sought, encouraged and supported people’s involvement in the improvement of the service. Action taken had been recorded to make people aware of the concerns raised and how these were being addressed.

People told us the staff were friendly, supportive and management were visible and approachable.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There were 84 people at the home when we visited.

We spoke with eight staff, five people and three relatives. We also carried out observations throughout our visit.

People and their relatives told us that they were treated with respect by the staff and we saw that in most instances this was the case. However, staff did not always explain to people before they started to carry out care.

People told us that they were well cared for. One person said “Its first class, I love it here.” Another person said “I would recommend it to anyone.” However, we saw that people did not alway receive the care that had been agreed.

We saw that people who had dementia were supported in an appropriate environment for their care and welfare needs. This included clear signage for bathrooms and stimulating objects such as, coloured scarves and cushions.

People felt safe at Ashton Lodge and told us that staff were "Very nice and "Kind." Staff were aware of how to look out for abuse but some were less aware of the duty to report any potential safeguarding situation to the Local Authority.

Relatives and some staff told us that there were shortages of staff at times. During our inspection we saw that people who needed extra support had not always received this due to staffing shortages.

Staff received appropriate training but supervision and appraisals were not up to date. We also found that some care plan records, inlcuding risk assessments had not been updated or completed.

In our discussion with people living at Ashton Lodge and their families we were provided with a range of complementary comments about the service and the staff. People felt well cared for and were happy with the level of support and assistance provided by staff.

We were told by most people that they were not aware of care plans or risk assessments written about them but told us the staff knew everything about them as they were looked after so well.

All people told us the staff were kind, thoughtful and professional.

It was not possible to speak to people who use the service on the first floor due to their mental frailty. We did spend time during this inspection in the communal areas observing people who use the service.

It was not possible to speak to people who use the service due to their mental frailty. We did spend time during this site visit in the communal lounge observing people who use the service.

During our inspection in July 2013 we found shortfalls with the service in relation to staffing levels, staff training and supervision and records. We carried out this inspection to check whether the provider had taken action to address these shortfalls. The follow up inspection was carried out by two inspectors over two days. We spoke with the acting manager, dementia manager, operations manager, nine members of staff, two people who used the service and three relatives.

During our observations we found that people were respected. A shortfall from the previous inspection related to staff numbers on the floor where people with dementia lived. During this inspection we saw that there were enough staff on the dementia unit to meet people’s needs. We found that staff now received regular supervision sessions with their line manager. We saw that all care plans and risk assessments had now been reviewed and updated.