The inspection took place on 25 August 2016, and the visit was unannounced. We returned for a second day and this was an announced visit.

Ashton Lodge Residential Home provides care and accommodation to older people including people recovering from mental health issues and some who are living with dementia. Ashton Lodge is registered to provide care for up to 27 people. At the time of our inspection there were 26 people using the service.

A registered manager was 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 felt their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People told us staff were kind and caring and ensured they remained safe. Staff mostly understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives. Some improvements were needed to the way staff implemented this legislation

People’s care and support needs had been assessed and people were involved in the review of their care plans, or when appropriate, happy for their relatives to be involved. Care plans included changes to peoples care and treatment, and people attended routine health checks.

We observed staff offered people choices and respected their decisions. Staff had access to people’s care plans and received regular updates about changes to people’s care needs. Visiting health professionals were complimentary about the staff and the care offered to the people using the service. There were enough staff available to meet people’s care and support needs and staff worked as a team in order to do this.

Medicines were ordered and stored safely and staff were trained to administer the medicines to people as they were required. Staff sought medical advice and support from health care professionals.

People were provided with a choice of meals that met their dietary needs. Staff were provided with up to date information about people’s dietary needs, and sought people’s opinions to meet their individual meal choices. There were sufficient personalised activities provided on a regular basis. Staff had a good understanding of people’s care needs, and people were able to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

The building was well maintained and staff were aware of the reporting procedure for faults and repairs and were able to arrange emergency repairs when necessary.

The provider had a clear management structure within the home and staff knew who to contact out of hours. The provider undertook quality monitoring in the home supported by the registered manager and their deputy. The provider had developed opportunities for people, relatives and health and social care professionals to express their views about the service including an annual questionnaire. We received positive feedback from visiting professional and the contracting staff from the local authority with regard to the care and service offered to people.

Staff felt confident they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

We spoke with four people who used the service, one relative, two carers and the registered manager. We briefly observed people in the communal areas and observed people eating their meal at lunchtime.

People we spoke with told us they were satisfied with the care and support being provided and that their choices were respected. Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. We found that people were confident approaching staff and that carers were responsive to people’s needs.

We looked at the records of four people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.

However, we found that the home did not have suitable arrangements in place for acting in accordance with the best interests of the person when they were unable to consent to the care and treatment being provided.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

Our inspections of 28 May 2012 and 10 October 2012 found the provider was not compliant with a number of the essential standards of quality and safety that we inspected. We identified shortcomings with the standard of cleanliness and maintenance of the home and in the assessing and monitoring of the quality of service provided. We issued a formal warning saying the service must make improvements or face further action.

We briefly spoke to some people using the service and asked them about their experiences of the home. People were positive and told us they liked the decorating and refurbishment that had recently been carried out. We saw that people were involved in making plans for Christmas arrangements at the home. Our brief observations showed people were comfortable and confident with staff. At our inspection of 28 May 2012 we spoke to a number of people in more detail. Please see our previous report for further details.

At this inspection we found that the service had made significant improvements. There were now effective systems in place to reduce the risk and spread of infection. In addition, we saw that the service had commenced a planned and ongoing programme of maintenance. We found the service had made improvements to its quality monitoring system. There was evidence that the provider and manager were assessing and monitoring the quality of the service provided to ensure people were protected from the risk of inappropriate or unsafe care.

At our last inspection on 28 May 2012 we found that the provider was not compliant with a number of the essential standards of quality and safety that we inspected.

We briefly spoke to some people using the service during this inspection and asked them about their experiences of living at Ashton Lodge. They all were positive in their responses and said they were looking forward to the Halloween party. At our last inspection we spoke to a number of people in more detail. Please see our previous report for further details.

We found the service had made improvements to peoples’ records and care plans. Care plans we looked at gave clear guidance to staff about how care should be provided and records showed that people’s health was monitored.

The service had made improvements to some areas of the property and gardens but we found the standard of cleanliness and maintenance was still poor. We found

the home was still not clean or hygienic and there were risks to people using the service getting or passing on infections because of this.

We found the service had not made improvements to its quality monitoring system. There was limited evidence that the provider or manager were assessing and monitoring the quality of the service provided to ensure people were protected from the risk of inappropriate or unsafe care.

We are following up areas of non-compliance identified during this inspection and will report on any action taken when it is complete.

People told us in the main that they were well cared for and supported at Ashton Lodge. Most people said the staff were helpful and they could talk to them. People said:

“it’s a beautiful place, staff are nice”

“the food is gorgeous, we have two choices”

“I like it here and wouldn’t change it”

Comments from relatives in a recent survey included:

“there has never been any problems whenever I’ve visited”

“they are kept clean, well fed and warm and the carers are kind to them. You couldn’t ask for more”.

Two people told us that they were bored with watching the television and one person said they would like to do more activities outside of the home.