We carried out an unannounced inspection to this service on 29 January 2019 and found improvements were required but there were no breaches of the regulations of The Health and Social Care Act 2008. We last inspected this service on 21 and 23 June 2016 and rated it good. Since the last inspection there have been no concerns about the service from other authorities and it has the same registered manager in situ.

Ashville House 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 House is registered to provide accommodation with personal care to 51 older people. During our inspection visit there were 44 people using the service. The service is situated close to amenities in the town of Downham market and provides both ground and first floor accommodation. There is a chair lift and passenger lift.

There was a registered manager at the service. 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.

In summary we found some aspects of the service very positive and other aspects requiring improvements. We found risks from the environment were not always well managed or taken into full consideration when an incident occurred. There were records of incidents, accidents and falls but the information was not fully collated, showing the level of impact or lessons learnt. Record keeping was not as robust as it needed to be which meant we could not clearly evaluate if people always received the care they needed. For example, around their skin care, hydration and nutrition.

Allocated staffing levels were based around people’s dependency levels and for most staffing levels were appropriate. Some people told us however staff were sometimes rushed and call bells not always answered quickly at busier times of the day. Several people were frail and spent most of their time in their room. Their experiences were enhanced by staff spending time with them each day. Some people’s experiences were that staff were busy and sometimes rushed.

Through our observations we saw that additional staff were employed to ensure high standards of cleanliness in the service. There were also activity hours which were used well and clearly benefited people and boosted their well-being. We found people were living well and engaged with all aspects of the service.

Medicines were managed safely and people’s health care needs were monitored and the service was well supported by three different GP practices and other health care professionals. People received nutritional food and lived in comfortable surroundings.

Staff were adequately recruited, trained and supported. Staff worked well together and supported people appropriately. The service was mostly well led and the registered manager well respected.

Staff were trained to recognise abuse and knew what actions to take to promote people’s safety and well-being. Staff spoke with people regularly and gave them opportunities to feedback their experiences of the service.

The service run in the interest of people using it. The service had an established complaints procedure and listened to people’s experiences and could demonstrate how they acted on their feedback. Most people and relatives were complimentary about the service and its management. Staff were kind and respectful and upheld people’s dignity.

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. Staff understood actions to take s

The inspection took place on 21 and 23 June 2016 and was unannounced.

The home is registered to provide accommodation with person care for up to 51 people. During our visit there were 45 people living at the home. The home had double rooms; however they were used as single rooms.

There was a registered manager at the service, who was permanently based onsite. 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 told us that they felt safe living at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people to be at risk of harm. Staff knew what they had to do if they needed to report any suspicion of abuse.

There were sufficient staff on duty to keep people safe and to meet people’s needs. Safe staff recruitment procedures were in place, which ensured only those staff suitable to the role were in post.

The home followed procedures to identify risks and protect people from harm. Risk assessments were in place and regularly reviewed. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to relevant health care professionals. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were knowledgeable about MCA and DoLS and had received training. Where appropriate referrals and applications had been submitted to the relevant body. Staff sought consent from people regarding their care.

People health care needs were assessed, monitored and recorded, and referrals for assessment and treatment were made. Where people had appointments within healthcare services, staff supported them to attend these.

Staff were caring and they knew people well, they supported people in a dignified and respectful way. Staff acknowledged people's privacy. People felt that staff were understanding of their needs and provided relevant support. Staff had positive working relationships with people. People living at the home told us that staff listened to their wishes and carried out care tasks they asked for, that may be additional to their planned care tasks.

The registered manager told us that whilst people were very independent when they arrived at Ashville, it was important to the staff to make sure people knew they could stay as long as they wanted. This included end of life care, which was carried out with care and compassion.

Care was based on people’s individual needs and was person-centred. People and their relatives were fully involved in the assessment of their needs and in care planning around them.

Quality assurance systems were in place that reviewed the quality of the service that was provided. The views of people, relatives, health and social care professionals were gathered as part a quality assurance process.

During our visit of 16 May 2013 we reviewed six care plans out of a total of 51 that showed how people were fully included in discussions about how they had chosen to be assisted and what their goals for the future were. We looked at care plans that clearly explained how a person preferred staff to support them, showing people were fully consulted at every stage.

We observed positive interaction between staff and people using the service whilst respecting their values and human rights. During this visit people we saw were smiling, laughing and talking in a relaxed and confident way with staff. This showed us that people living in the home were confident and could discuss matters with staff.

Staff expressed a thorough knowledge and understanding of matters relating to safeguarding. They told us how they would deal with any suspected abuse and how they ensured people were protected and made to feel safe. People living in the home said they felt safe and happy at Ashville House. Everyone we spoke with confirmed this and two people explained that, ’Although this not our home, it is the second best thing and staff look after us very well.’

Visitors we spoke with on the day of our inspection said that the home was very good and staff were always available. One person told us that their relative, ‘Was always clean, well dressed and looked well cared for’.

All of the people that were spoken with said they enjoyed living at the home. This was because they were treated with respect and their support and care needs were met in a way that matched their expectations. One person told us, “I can’t fault it. I am very happy here”. Staff treated people in a respectful way.

People were supported to maintain their health and well being. This was because of the available range of social activities. People were also supported to access health care services. Staff supported people with their personal care needs in a safe and appropriate way.

People told us that they liked their room. One person said, "I think I have a nice room. It’s nice and large enough for me”. The home was a safe and well-maintained place.

Effective staff recruitment and training systems were in place to make sure that people who used the service received support and care from suitable, skilled and knowledgeable staff. People told us that they liked the staff. One person told us that they gave, “100%” (excellent) rating for the staff.

Quality assurance systems in place meant that people had opportunities to influence how their support and care was provided. They could also be assured that their support and care was reviewed and monitored as an ongoing quality assurance measure.