Ashville care home is a ‘care home’. 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. Ashville accommodates up to 29 people in one adapted building. Accommodation is provided on two floors with lift access between each floor. There are four communal areas on the ground floor which includes a large dining area.

This inspection took place on 7 November 2018 and was unannounced. At the last inspection in September 2017 we rated the service Requires Improvement. We found further work was required to the environment to make it pleasant and staffing levels needed increasing as there was no activities co-ordinator and people lacked interaction and stimulation.

At this inspection, whilst activities staff had now been recruited, we found the quality of the environment had deteriorated. We identified a number of risks associated with the environment and which had not been identified and rectified by the provider. Risks associated with the environment had been a long-standing concern in the service, for example at the April 2016 and February 2017 inspection. We also found the quality of care planning and nutritional care planning needed improvement and some risks to people’s health and safety were not assessed and mitigated. Action was needed to improve governance and quality assurance procedures to help drive sustained improvement of the service. Because concerns over risk management and governance were long standing and demonstrated a lack of action to sustain acceptable practice, we rated the service ‘Inadequate’ overall and in the Is the service Safe? And Is the Service Well Led? domains.

A registered manager was in place. 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, relatives and health professionals provided positive feedback about the service and said it met individual needs. Systems were in place to protect people from abuse and improper treatment. Some risks to people’s health and safety were assessed and risk assessments put in place to guide staff. However, we found some instances where safe plans of care were not followed. We found numerous risks associated with the environment, including poor or defective lighting, and bathroom taps which were not working.

Overall medicines were managed safely. A new electronic system was in place which reduced errors and helped ensure people received their medicines as prescribed.

There were enough staff deployed to ensure people received appropriate care and supervision. Staff were recruited safely to ensure they were of suitable character to work with vulnerable people. Staff received a range of appropriate training and told us they felt well supported.

Overall 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. However, practices relating to covert (hidden) medicines needed review. People were given choices on a daily basis and people were listened to.

Some improvements were needed to the management of nutrition to ensure people’s needs were consistently met. Care planning around nutrition and the monitoring of people’s food input was not sufficiently robust. There was a lack of information to show why decisions relating to the consistency of people’s food and drink had been made.

Staff were kind and caring and treated people well. People were treated equality and we saw no evidence of discriminatory practices.

The service liaised with a range of he

Ashville Care Home provides personal care for up to 29 older people, some of who are living with dementia. On the day of the inspection, there were 25 people living in the home. Accommodation is provided on two floors with lift access between each floor. There are four communal areas on the ground floor which includes a large dining area.

This inspection took place on 5 September 2017 and was unannounced. At the last inspection on 14 February 2017 we rated the service ‘requires improvement’ overall and rated the safe domain ‘inadequate’ due to concerns over medicines management, risk management, safeguarding and the premises. In total we identified four breaches of regulation and issued a warning notice for Regulation 17, Good Governance. At this inspection we found a number of improvements had been made and the service was no longer in breach of regulation. Improvements had been made to the safety of the service, supported by more robust systems in areas such as medicines management and governance. However further refurbishment and decoration work was required to bring the premises up to a good standard. We also found staffing levels were not always maintained at a level to ensure a person centred approach particularly in the absence of an activities co-ordinator. We would need evidence these issues were addressed and the other improvements made were sustained before we were assured the home provided a consistently good service.

A registered manager was in place. 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.

Medicines were safely managed. People received their medicines as prescribed and clear records were kept to demonstrate this.

People said they felt safe in the home. Risks to people’s safety had been assessed and plans of care put in place to keep people safe. Staff understood how to identify and act on any concerns. Incidents and accidents were recorded, investigated and analysed to help prevent a re-occurrence.

Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people. We noted staff did not always have time to spend quality time with people and interactions were very task based. The home was without an activities co-ordinator and we noted there was a lack of stimulation and activity available to people.

Since the last inspection a number of improvements had been made to the building to make it safer. Whilst we did not identify any safety concerns, further maintenance and improvement of the building was required to ensure the building was brought up to a good standard.

Staff received a range of training and felt well supported by the manager. Staff knew people well which helped ensure effective care was provided.

Overall, the service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

People were treated with kindness and compassion by staff. It was clear that good positive relationships had developed between people and staff. People were encouraged to maintain their independence around the home. People were listened to by staff and their opinions valued.

People’s needs were assessed and clear and person centred plans of care put in place. These were subject to regular review. People, relatives and staff told us they were satisfied with people’s needs were met by the service.

The registered manager was hands on and knew people well. They demonstrated a good knowledge of the topics we asked them about and were very involved in how the service operated. Staff praised the registered manager and said morale was good.

Syste

Ashville Care Home provides personal care for up to 29 older people, some of who are living with dementia. There were 25 people using the service when we visited. Accommodation is provided on two floors with lift access between each floor. There are four communal areas on the ground floor which includes a large dining area.

This inspection took place on 14 February 2016 and was unannounced. At the last inspection on 12 April 2016 we rated the service as ‘Requires Improvement’ and identified 3 breaches of regulations relating to ‘Safe care and treatment’, ‘Staffing’ and ‘Good Governance.’ At this inspection we found improvements had been made to staffing levels, however we identified four breaches of regulation.

Although we found some good areas of practice during the inspection, we rated the safe domain as ‘Inadequate.’ This was because a number of concerns were found relating to management of risk, the premises, ‘as required’ medicines and prescribed creams. Some of these concerns were similar or identical to issues raised at the previous inspection, meaning we did not feel assured that they would promptly resolved.

A registered manager was in place who had been in post for several years. 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 and relatives we spoke with provided good feedback about the home. They said staff were kind and treated people well. They said care and support met people’s individual needs.

Most people received their medicines as prescribed. However, ‘as required’ medicines and topical creams were not always managed in a safe or proper way.

Care records demonstrated a number of risks to people’s health and safety were assessed for example in relation to skin, nutrition and moving and handling. However, there was a lack of assessments in place relating to the safe management of bed rails. We identified a number of wardrobes in people’s bedrooms which were unstable and risked injury to people.

There was suitable space within the premises for people to spend time and some adaptions had been made to the premises to meet the needs of people living with dementia. However, we found a number of maintenance issues relating to the premises which required resolving to ensure people were cared for in a comfortable and well maintained environment.

People told us they felt safe in the home and comfortable in the company of staff. Safeguarding incidents were recorded and in some instances we saw records of action taken to keep people safe. However, referrals had not always taken place to the adult protection unit and care and support plans were not always updated following incidents.

During the inspection we found there were sufficient staff available to meet people’s individual needs and staffing levels had been increased since the previous inspection. However we had some concerns that staffing levels may not be sufficient during the overnight period. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards. DoLS applications had been made for a number of people living in the home. Staff respected people’s choices and gained consent before delivering care and support.

People had access to a range of suitably nutritious food. This included a choice of meals and snacks throughout the day. Action was taken where people were at nutritional risk.

Staff had access to a range of training relevant to their role. Staff said they felt well supported and had regular supervision and annual appraisal.

People and relatives said staff wer

This inspection took place on 12 April 2016 and was unannounced. At the last inspection on 7, 8 and 13 May 2014 we found the service was meeting the regulations we looked at.

Ashville Care Home provides personal care for up to 29 older people, some of who are living with dementia. There were 25 people using the service when we visited. Accommodation is provided on two floors with lift access between each floor. There are four communal areas on the ground floor which includes a large dining area.

The home has 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 2008 and associated Regulations about how the service is run.

Although no concerns were raised with us about staffing levels, we concluded there were not always enough staff to meet people’s needs as there were only three care staff on duty during the day and two at night for 25 people. There were ancillary staff, an activity co-ordinator, an administrator and managers on duty at times in addition to these numbers. However, there was no system in place to calculate safe staffing levels or evidence to show that people’s dependencies and the layout of the building had been considered when determining staff numbers.

Overall we found the systems in place for managing medicines were safe, although some of the records required improvement.

Staff had a good understanding of safeguarding and knew the procedures to follow if abuse had occurred or was alleged. We saw safeguarding incidents had been dealt with appropriately.

Risks to people were not always well managed. For example, we found where incidents such as falls had occurred there was a lack of information to show what action had been taken to prevent a re-occurrence. There was also a lack of environmental risk assessments. For example, free standing heaters which were hot to touch had not been risk assessed, although immediate action was taken when we brought this to the registered manager’s attention.

The building was generally clean and well maintained. However, there were some issues relating to beds not being properly made and stained bed linen which had not been identified until we raised them. However, the deputy manager told us daily checks of rooms were being introduced to address this issue.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). People were cared for by staff who received the induction, training and support they needed to fulfil their roles and meet people’s needs.

People enjoyed the food and were offered a choice with drinks and snacks available and provided at any time. People had access to healthcare services and had input from professionals such as community nurses, GPs and dieticians. Complaint were managed and dealt with appropriately.

People and relatives praised the staff for their kindness and caring attitude. People were comfortable and relaxed around staff and we saw people laughing with them. We saw people enjoyed walking freely around the different communal areas on the ground floor. People’s privacy and dignity was respected and maintained.

People and relatives expressed satisfaction with the care provided. Yet we found improvements were needed to ensure the care documentation was person-centred and reflected people’s needs and preferences.

People, relatives and staff spoke highly of the registered manager and had confidence in them. Some of the systems and processes which audited the quality of care provided needed improvement. For example, there was no staffing tool, medicine audits had not identified the issues we discovered and there were no systems in place to audit the care records. Improvements were also required in docum

We found that appropriate arrangements were in place in relation to medicines administration and recording helping to ensure that people’s individual medicines needs were met.

Some people living at the home were less able to express their views about medicines handling due to a variety of complex needs. We spoke with one person who told us staff administered the medicines at the same sort of times each day and confirmed that they had enough support with their prescribed creams.

We found that one person’s medicines records had not been promptly updated following their return to the home from hospital. Prompt action was taken when we drew this to the attention of the manager.

During our inspection on the 28 May 2012 we found the registered care provider was not fully compliant with the Essential Standards of Quality and Safety. The registered care provider wrote to us on the 28 June 2012 to tell us about the improvements they were making to enable them to become compliant. We carried out this inspection to see if they were now compliant with the standards.

During this inspection we used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spent time in the lounges observing how staff engaged with people living in the home and we engaged with the Registered Manager and three members of staff.

The Registered Manager showed us a quality assurance questionnaire which they had recently sent to family, friends and advocates. This showed they had received 15 responses, when asked how they would rate staffs understanding of peoples needs, nine had rated it as very good and six had stated it was excellent.

We found that improvements had been made to the care and welfare of people and to the environment. However we found the new system of recording peoples care and treatment needs was not yet embedded and peoples records were not always an accurate record of the care and treatment provided.

We visited Ashville Care Home on the 28 and 29 May 2012 because we had concerns raised with us about the environment and whether people were receiving the appropriate care and treatment. Also whether there was sufficient trained staff.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We visited the service and talked with one person using the service, four relatives, the Registered Manager and three members of staff. We observed how staff interacted with people living at Ashville Care Home

We talked with one person living in the home and four relatives all told us they were satisfied with the care and treatment people were receiving. Four relatives told us people had access to a general practitioner and other health professionals when they needed one and they were kept informed about any changes in their relative’s health.

Relatives also described how they had witnessed staff offering support when people became distressed.

One person told us they were satisfied with the meals provided. Two relatives explained how people were offered a choice of menu and they were offered regular drinks.

Two relatives told us the staff were “Respectful” and “Caring”. One other told us that "Staff were brilliant and if we want anything they are up and will get it straight away."

Two relatives also told us the Ashville Care Home was “Homely”.

No comments were obtained from people who use services at this follow up improvement review.

People told us that they felt safe and enjoyed living at the home and that they had choices of activities and families could visit them at any time. One person told us that they enjoyed living at the home.

The visitors we spoke to also confirmed that they can visit the home at any time and felt that their relatives were being well cared for. One visitor commented that general activities were provided daily, but they felt that their relative needed a more individualised programme of activity. Another visitors told us how impressed they were with the current care regime and how involved they felt with the care of their relative.

All people we spoke to commented positively that they could approach and talk to the manager if they had any concerns.

During our inspection we looked for the answers to 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 describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We saw risk assessments in place linked with peoples care plans. These identified potential risk areas and reduced or removed the risk. We saw sufficient staff to make sure people were safe and could be responded too in a reasonable time. We spoke with staff who informed us of safeguarding and how to report it.

Is the service effective?

We saw people had their needs assessed before entering the service and this was updated with any changes. We spoke with staff who told us the most recent changes for people. For example one staff told us one person recently obtained a pressure sore and now they need regular turns and an air cushion. We saw the care plans identified peoples likes, dislikes and preferences. We saw one person had end of life care plan in place.

Is the service caring?

We spent some time observing staff interacting with people who used the service. We found they treated people with respect by asking if people are ok, we saw one staff member ask someone, "Are you ok, would you like anything"? We saw when people were sitting down, staff would crouch to speak to them at eye level. Staff told us they had received training on dignity and respect. We saw a satisfaction survey had been carried out on an annual basis with people saying they were happy with how they were treated.

Is the service responsive ?

We spoke with family members who told us they get invited to reviews. We looked through peoples care files and saw evidence of people signing their own documents to show they had been involved. We observed people receiving correct care in line with their care plans. We spoke with staff who told us detailed information about the people using the service. This showed us staff were familiar with the care plans. When people had made suggestions in the annual survey, we saw these had been listened to and acted on.

Is the service and well-led?

The senior staff member told us they carry out regular audits on health and safety, medication and care plans. We spoke with the staff who told us they had confidence in the manager and would not hesitate to report anything to them. We saw evidence of regular supervisions and training plans in place to support the staff. We observed staff asking the senior for support and this being given.