We carried out an unannounced focussed inspection of Ashwood Care Centre on 3 January 2019. Our inspection was prompted due to receiving concerns relating to staffing levels, staff competencies, and a decline in care quality. We also had concerns regarding the information received from the service in response to a safeguarding incident.

To address the concerns, we inspected the key questions of Safe and Well-Led. At the inspection we did not find evidence to indicate a full inspection of all five key questions was required, so these were not inspected. Our previous inspection in April 2018, found the service to be rated as Good in all key questions, and Good overall. At this inspection, we have found that the evidence supported the continued rating of Good, for Safe and Well-Led.

One recommendation has been made regarding medicines management on the ground floor of the home. This was because this was the only floor of the home where there were shortfalls in the medicines record keeping. The registered manager provided assurances that the identified shortfalls would be addressed and explained what action would be taken.

Ashwood Care Centre is a purpose-built care home. People in care homes receive accommodation and nursing or personal care as a single package, under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this focussed inspection.

Ashwood Care Centre provides accommodation and personal care for up to 82 people. At the time of our visit, there were 74 people using the service. The home is split over three floors, with each floor having two units. The units were known as ‘households’.

There was a registered manager 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.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Further information is in the detailed findings below.

The inspection took place 24 and 25 April 2018 and was unannounced.

Ashwood Care Centre is a purpose built care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ashwood Care Centre provides accommodation and personal care for up to 82 people. At the time of our visit, 76 people were using the service.

The home was last inspected on 24 April 2017 and was previously rated as Requires Improvement. Action had been taken to address the breaches in regulation identified at the previous inspection. At this inspection we found the service to be rated as Good in all domains and Good overall.

There was a registered manager 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.

There was an activities team and eleven volunteers working with the service to ensure social inclusion. We saw a broad range of activities were in place, including clubs based on hobbies and interests such as photography. Staff also had time in their day to ensure that people received quality social interactions either in groups, or on a one to one basis.

Medicines were managed safely. Staff were knowledgeable and received training around the management and administration of medicines. There were good relations with local healthcare services and the service utilised the contacts for advice. For example, phoning the district nurses to discuss changes in people’s needs and to ensure they received timely advice to address these concerns.

People told us they felt safe. We saw that there were pro-active measures in place to monitor people’s safety, such as observation charts and analysis of falls data to identify and address risks. There were risk assessments in place where needs had been identified, for example when a person was at risk of falling.

People were supported to attend healthcare appointments. The service also had visiting healthcare professionals that they could make referrals to, for eyesight, hearing and dental checks.

Care plans were written using person centred details, care staff referred to these for guidance and updated them regularly in the event of a person’s needs or preferences changing. Records were well documented and there was clear involvement with health professionals in a timely manner when assessed and required.

People spoke positively about the care they received, they praised the care staff for being kind and caring. Each interaction we observed was positive, with care staff taking time to ensure people were listened to and supported at their own pace.

Choices were offered visually, or using ‘flash cards’ for people who benefitted from visual aids to support them in the decision making process.

At meal times people had a visual menu. People were also offered visual choices of the plated meals. If a person did not want an option from the menu, they could choose an alternative of their preference. There was a range of snacks and drinks available and offered throughout the day.

Care staff understood their responsibilities with identifying abuse and reporting safeguarding concerns.

Complaints were responded to thoroughly and efficiently by the registered manager. We saw that complaints were investigated and the registered manager was quick to liaise with people and their relatives following any concerns they raised.

The home was clean and free from odours throughout. Maintenance checks were completed on the building and equipment, with any areas for repair addressed promptly.

There were thorough quality monitoring processes in place. The registered

Ashwood Care Centre is a purpose built home that provides accommodation and personal care for up to 82 people. At the time of our visit, 76 people were using the service. The inspection took place on 25 and 26 April 2017. This was an unannounced inspection. The home was last inspected on 23 March 2016 and received a rating of Requires Improvement.

The home was rated as Requires Improvement at this inspection but action had been taken to improve and three of the previous breaches of Regulation had now been met. The home had remained in breach of Regulation 11 Need for consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a registered manager in post when we inspected 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. The registered manager was accessible and approachable throughout our inspection. Staff, relatives and people who used the service told us the registered manager was available if they needed to speak with her and had confidence in her abilities to manage the service.

Although staff responded well in supporting people with behaviours that challenged, the appropriate guidance and risk assessments were not always in place to manage this. For example one person’s emotional wellbeing care plan stated they would “Pick up objects and threaten staff and residents with them, was verbally aggressive and would hit or punch.” There was no risk assessment in place that covered these particular behaviour expressions in order for staff to assess and review that the person was being supported in the most appropriate way.

Mental capacity assessments were not always consistently recorded and followed. Where people had someone to make decisions and consent on their behalf, this had not been correctly documented in care records. The service had not completed the required actions needed to meet the breach identified at the previous inspection and remained in breach.

We observed at this inspection that the home was not displaying the ratings from the last inspection. A report was available in the reception area but this was not in clear view and was behind some other brochures. The registered manager took swift action to ensure this was reinstated during the inspection.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home, however some of the issues we had identified during our inspection had not been picked up, including risk assessments and management around behaviour management and mental capacity assessments.

Medicine management had improved since our last inspection and the service were no longer in breach of safe practice in this area.

People told us they felt safe. Staff had received safeguarding training, and were aware of their responsibilities in reporting concerns, and the concerns of those they supported.

People received care and support from staff who had got to know them well. Staff were able to tell us about people’s likes, dislikes and preferences. Staff told us it was important to find out about people and aid conversations and building important relationships with people. People said they were cared for by friendly staff who kind, helpful and supportive. Comments included “The staff are fantastic here, they really care.”

People felt confident to raise any concerns they had and felt they would be responded to in a timely manner. Copies of the complaints procedure was clearly displayed and contained information on how to complain and where to go if you felt the complaint was not resolved.

People and their relatives spoke positively about the leadership of the home commenting “I do speak to her, she is a crac

Ashwood Care Centre is a purpose built home that provides accommodation which includes nursing and personal care for up to 82 people. At the time of our visit, 77 people were using the service. The inspection took place on 23 and 29 March 2016. This was an unannounced inspection. The home was a newly registered service and this was the first inspection to take place.

There was a registered manager in post when we inspected 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. The registered manager was accessible and approachable throughout our inspection. Staff, relatives and people who used the service told us the registered manager was available if they needed to speak with her and had confidence in her abilities to manage the service.

Medicines were not always managed appropriately in the home. This included the recording of medicines and the management of people who needed their medicines covertly.

People and their relatives spoke positively about the care and support they received. They said that if they had any concerns they could speak to either staff or the management team. They said they felt their concerns would be listened to and where required appropriate action taken.

Staff had not been receiving regular supervisions and for new employees there were no recordings of their induction support and progress. This will be addressed with the introduction of the new care certificate induction the home is implementing.

People were given choices at mealtimes and alternatives were provided if required. For people who had been assessed as losing weight or with reduced fluid intake action had not been taken or appropriate referrals made.

Where necessary the registered manager had made the appropriate referrals to the supervisory body when people were being deprived of their liberty. However consent was not always sought in line with current legislation and guidance.

The manager was approachable and available for people to see. People, their relatives and staff felt confident that the home was well managed.

Communication and participation in the development of the home was encouraged and feedback was considered and where appropriate acted upon.

Systems were in place which assessed and monitored the quality of the service but some findings indicated that action was not always taken in response to these audits.

We found 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 the report.