Ashtree House is registered to provide accommodation and personal care for up to 27 older people, including people living with dementia. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We carried out our inspection on 30 August 2017. The inspection was unannounced. There were 26 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.

At our last inspection in July 2015 we rated the home as Good. Following this inspection the rating remains as Good.

Action was required to improve the provision of activities and other forms of stimulation and occupation. In all other areas however, the provider was meeting people’s needs effectively.

There was a calm, relaxed atmosphere and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality that met their individual needs and preferences. The décor and facilities in the home reflected the needs of people living with dementia.

There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way. There was a varied training programme in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for three people living in the home and was waiting for a further 11 applications to be assessed by the local authority. Staff had an understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager was well-known to everyone connected with the home and had the loyalty and respect of her team. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

Our inspection team was made up of one inspector. We considered our evidence to help us 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, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

The service was safe, visibly clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured that staff were trained and supported to do their roles.

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. 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.

People told us they could express their views at meetings, on a one to one basis and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People commented, "Staff are lovely, so patient." and "I love living here."

People, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

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 told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

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.

The service had a quality assurance system. Records showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

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 that were in place. This helped to ensure that people received a good quality service at all times.

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We looked at eight care plans for people who used the service. These were personalised and provided detailed and up to date guidance about how people’s needs should be met.

We were present whilst lunch was taken. We saw appetising food was served. One person told us, “The food is good, we can always ask for things we really like.”

We looked around the home and observed a good overall standard of cleanliness. We observed the interior decoration of the building was good and we were shown many areas that had been totally refurbished, including many people’s rooms. Some carpets had become worn; the manager told us these would be addressed in the coming year.

We observed a member of staff administering medications in one unit of the home. We reviewed the medications administration records (MARs) and found them to be accurate.

We spoke with a unit manager who explained how the staff rotas were set up and how cover for holidays and sickness was arranged from within the team itself.

We found the building had been maintained effectively. We checked the home’s maintenance records and found the electrical safety certificate was valid and oil fired boiler installations had been checked each year. We saw all radiators were covered in order to protect people from harm.

We did not speak to people who used the service on this occasion as we were checking records and speaking to staff.

As part of our inspection we spoke with some people who used the service and relatives. We also used the Short Observational Framework for Inspection (SOFI) to determine whether staff were looking after people, especially those with communication difficulties and dementia.

People told us they liked living in the home and confirmed they were supported to make choices and decisions about the care they received. One person told us, "They take care of me well here." A relative told us, "I am more than satisfied with the care xx receives."

People who used the service knew staff kept records on them. All but one person had seen their records. They told us they could talk to any staff, any time and they would be listened to.

They also told us they felt safe. One person said, "I feel safer here than in my own home."

People said the staff knew a lot about them and they could easily answer their questions. One person said, "Staff know the answers to most of my questions and if they don't they quickly find out." They told us they were sent a questionnaire earlier in the year. One person said,"I had nothing but praise for them then and still do."

One person we spoke with told us “I’m well looked after here. I do have everything I want and if I ask for something I know the manager will do her best to get it for me.”

Another person told us “I chose to stay here after a couple of week’s respite. It was a good decision and I’ve been happy ever since.”

A relative we spoke with told us “This was the best place for my relative. I looked at some others but there was no doubt in my mind that this was the right choice.”

Ashtree House is registered to provide accommodation and personal care for up to 27 older people, including people living with dementia. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We carried out our inspection on 30 August 2017. The inspection was unannounced. There were 26 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.

At our last inspection in July 2015 we rated the home as Good. Following this inspection the rating remains as Good.

Action was required to improve the provision of activities and other forms of stimulation and occupation. In all other areas however, the provider was meeting people’s needs effectively.

There was a calm, relaxed atmosphere and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality that met their individual needs and preferences. The décor and facilities in the home reflected the needs of people living with dementia.

There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way. There was a varied training programme in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for three people living in the home and was waiting for a further 11 applications to be assessed by the local authority. Staff had an understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager was well-known to everyone connected with the home and had the loyalty and respect of her team. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.