This inspection took place on 9 February 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Ashwood Park is a ‘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 Park accommodates 65 people in one adapted building across five separate units. One of the units specialises in providing care to people living with dementia. On the day of our inspection there were 62 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in December 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Ashwood Park.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

This inspection took place on 10 December 2015 and was unannounced. This meant the staff and the registered provider did not know we would be visiting. The home had a registered manager in place. A registered manager is a person who has registered with CQC 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.

On 23, 24 March and 2 April 2015 we completed an inspection at Ashwood Park and informed the registered provider they were in breach of a number of regulations including staffing, medicines and premises and required improvements to make the service safe, effective, responsive and well- led. Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

Ashwood Park is located in Easington Colliery, County Durham. The home is set in its own grounds, in a quiet residential area. The home is registered with CQC to provide accommodation with personal care and nursing, including intermediate and respite care, for up to 65 older people and people with a dementia type illness. The home is made up of five units and on the day of our inspection there were 58 people using the service. The home comprised of 65 bedrooms, all of which were en-suite. Facilities included several lounges and dining rooms, a therapy room and a hair salon.

People who used the service and their relatives were complimentary about the standard of care at Ashwood Park. We saw staff supported and helped to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people using the service.

Training records were up to date and staff had regular supervision meetings and appraisals, which meant that staff were properly supported to provide care to people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and most areas of the home were suitably designed for people with dementia type conditions.

The service was working within the principles of the Mental Capacity Act 2005 and any conditions on authorisations to deprive a person of their liberty were being met. We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. Care records contained evidence of consent.

People were protected against the risks associated with the unsafe use and management of medicines.

People had access to food and drink throughout the day and we saw staff supported people to eat at meal times when required.

People who used the service had access to a range of activities in the home.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. Care plans were reflective of people’s needs and were reviewed regularly.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered and people who used the service had access to healthcare services and received ongoing healthcare support.

The registered provider had a complaints policy and procedure in place and complaints were fully investigated.

The registered provider had a quality assurance system in place and gathered information about the quality of their service from a variety of sources.

People who used the service were given appropriate information and support regarding their care or treatment.

We spoke with people who used the services at Ashwood Park and their relatives who were visiting them. One person said "They treat (my relative) with respect” and another person said “It’s marvellous here. The people (staff) are so kind.”

People told us they were happy with the care and support they received. One person told us "This is the best place I’ve been in” and another person said “I wouldn’t like to go anywhere else but here now.”

People said they felt safe at Ashwood Park and with the care staff employed by the service. One person told us “They (the staff) come around and talk and ask how you are doing.” All of the staff we spoke with during the inspection were familiar with safeguarding procedures.

We spoke with seven people who lived in the home about medicines and none of them raised any concerns about the way their medicines were handled. Comments from people included; ‘’I am looked after well’’, ‘’wouldn’t be anywhere else’’ and ‘’they help me with my medicines, no problems there’’. We found it difficult to get the views of a number of people due to their health and complex mental condition.

Overall, we found that medicines were handled safely.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

On the day of our inspection visit Ashwood Park had 35 people living there. People lived in one of three units, the Willows nursing wing, ground floor residential wing or the upper floor, where care was provided for elderly people who were mentally infirm.

We spoke with five people who used the service within the home. We saw they were able to express their views freely. All the people we spoke with said they were happy at Ashwood Park. People told us “The staff are very caring” and “The lovely meals are done on the premises.” Other comments included “The décor could be updated but it is being updated now” and “I’m not afraid to complain if there was a complaint; not that there is any complaints.”

We also spoke with two relatives of people who lived at the home. Both were very satisfied with the care their relative received. They were complimentary of the care staff and felt fully engaged with the recently appointed manager.

We visited the parts of the home where people required the highest levels of support because of their dementia type illness. Here most of the people found it difficult to express their views about the quality of their care, however people did make statements about their care which included;

“I’m going for a walk now;”

“I like the singing;” (accompanied by singing with staff),

“Its lunch, I hope we’ll enjoy it.”

This inspection took place on 23, 24 March 2015 and 2 April 2015 and was unannounced. This meant the provider did not know we were inspecting the home at that time.

We last inspected Ashwood Park on 2 July 2013 and found it met our regulatory requirements.

Ashwood Park is registered with the Care Quality Commission to provide care for up to 65 elderly people. The home provides a mixture of residential care both with and without nursing, and provides care to people with dementia type conditions. At the time of our inspection there were 60 people living in the home. The provider had recently altered the ground floor accommodation to separate people with dementia care needs from those with nursing care needs.

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. During our inspection we found the previous registered manager had left the service and a new manager had been appointed. On the first day of our inspection the new manager had been in post six days. They expressed their intention to apply to become the registered manager.

We found staffing levels at the home needed to be reviewed in the light of our findings during the inspection. Relatives and staff told us the levels were too low to meet people’s needs in the home.

We found there were gaps and errors in the records for people’s medicines.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services.

We found the home in parts required further cleaning to reduce the risk of the spread of infection.

Since our last visit the home had been reconfigured and people who had dementia type illnesses were now restricted in their ability to walk continuously around the unit. As a consequence we observed staff supporting people to turn around at the dividing doors which had been put in place.

The provider worked within the Mental Capacity Act 2005. We saw that all people living in Ashwood Park had undergone a consent to support’ and Mental Capacity Act assessments to identify their capacity to consent to their care. We also saw Deprivation of Liberty Safeguards were in place. This meant applications had been submitted to the local authority to deprive people of their liberty and keep them safe.

We observed staff speak to people in kind and reassuring ways. However we saw over a lunchtime period those who could not verbally communicate were not engaged by staff in any interaction.

People told us they felt their dignity and privacy were respected by staff.

We saw a notice board on which was displayed information about the activities for that week. During our inspection we found none of the activities on the board had taken place. We found further work was required to provide a stimulating environment for people who used the service.

We found the provider had audits in place to measure and monitor the quality of the service However we found not all of the audits addressed the deficits we found in the service.

We saw the provider had in place a complaints policy and the manager had investigated complaints and provided a response to the complainant.

When we spoke to the manager about the deficits we found during our inspection we observed them talking with staff, questioning practice and exploring solutions to the problems. We found the manager was willing to start to address service improvements.

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.