Ayrshire House is a residential care home for people living with a learning disability. They are registered to provide care for up to 15 people. At the time of our inspection there were 12 people living at the home.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and managed safely.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. Where people had specialist dietary needs appropriate arrangements were put in place to support them to manage these.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision.

People were encouraged to enjoy a range of leisure and social activities. People accessed local resources for leisure and took an active part in the local community. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives and people who lived at the service were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

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 support this practice.

Further information is in the detailed findings below

This inspection took place on 28 January 2015 and was unannounced.

Ayrshire house specialises in the care of people who have a learning disability. It provides accommodation for up to 15 people who require personal and nursing care. On the day of our inspection there were 13 people living at the home on a permanent basis and one person who was there for a short break.

At the time of our inspection 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. The provider had systems and processes in place to safeguard people and staff knew how to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).If the location is a care home Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as an occupational therapist and GP.

Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs. People had access to leisure activities and excursions to local facilities.

People had their privacy and dignity considered. Staff were aware of people’s need for privacy and dignity.

People were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

We saw that people were involved in making decisions about their care and how their day was managed.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. People were encouraged to raise issues both formally and informally.

Audits were carried out on a regular basis and action put in place to address any concerns and issues. However it was not always clear from the audits when actions had been completed.

The registered manager was not present on the day of our inspection but we spoke with the provider who was present at the service, a member of staff and two people who used the service. We checked service records, policies and procedures and did a tour of the building.

People who used the service confirmed the menu had been reviewed since we last visited in May 2013. We saw the menu provided a choice of well-balanced, nutritious meals that met people’s needs. Comments received from people who used the service included, “We have a new menu, we always get a choice of what to eat and can have an alternative if we don’t like the choice.” And, “If you are hungry and want a snack, you can ask the staff.”

People were protected against the risk of health care related infections. We saw the prevention and control of infections policy and procedure had been updated. We also saw the cleaning schedules had been amended.

The provider told us two part time staff had been appointed since we last visited in May 2013. We saw the dependency needs of people had been assessed and the rota showed required staffing levels.

We found the manager had introduced monthly audits to enable regular monitoring of the service. We also saw people who used the service and other people, such as professionals had been asked for their views about the quality of the service provided.

During the visit we spoke with eight people who used the service and a visiting health care professional and asked them for their views. We also spoke with two care workers, the owner and the registered manager. We looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a tour of the building.

People who used the service talked positively about the care and support they received. One person told us, “I like living at Ayrshire House very much.” And, “I talk to my key worker if I’m sad, or (name), she’s the top boss.”

Another person said, “We have meetings with the staff and we talk about day trips.” And, “It’s lovely to live here, I like the activities, we do arts and crafts, play football and go out.”

We had some concerns about how people’s weight was monitored and their nutritional needs met. Menus were not pre planned and people had limited choice of puddings and snacks.

We saw some infection control policies and procedures were not in place, which put people at the risk of infection

There were not always sufficient staffing levels available to meet people’s assessed needs and that kept people safe.

The service lacked systems that assessed and monitored the quality of the service provided. People had not been asked about their views in relation to the standard of care provided.

During this inspection we checked to see if the provider had complied with actions we took following our last inspection in November 2012. We reviewed all the information we had received from the provider including an action plan they sent us in November 2012 detailing how they would become compliant.

We did not speak with people who used the service at this inspection. We spoke with the registered manager, two members of staff and looked at three people's care plan records.

We found the provider had developed and was using new care plan documentation. The support plans we looked at showed people’s needs were assessed in a way that reflected their individual strengths, abilities and interests. This meant that staff had information and direction about how to meet people’s individual needs.

We spoke with three people who used the service and two relatives of people who used the service.

One person told us, “I’ve lived here a long time, I have lots of friends.”

Another person said, “I like all the staff, they listen to me and help me.”

We asked if the staff showed dignity and respect, one person told us, “We get a choice of when we go to bed and get up, the staff knock on our bedroom doors to see if we are awake.” Another person said, “The food is lovely, you have a choice of something different if you don’t like what there is.”

We spoke with two relatives of people who used the service, comments included, “We are always welcomed, it’s top class and we have no concerns.” And “Communication is good, we are kept in the picture of what’s happening. We get invited to attend review meetings.”

We saw some people had gone out either to their voluntary work placement or into the community independently. We saw other people assisting with domestic jobs around the house, for example supporting staff with the preparation of lunch. We saw a person sweeping up outside and other people doing different activities in the games room.

There were 15 people accommodated at the service, at the time of our visit.

We spoke with three people who used the service, as well as the manager and the provider.

People who used the service told us that they receive care in a way that was respectful of their privacy and dignity.

People who used the service told us that they were treated by staff in a kind and caring manner. We were told that care staff were respectful and open to changes in people's care needs.

People told us that there are lots of activities to go to and that they are free to attend the ones that they like.

People who used the service that we spoke with, told us that they felt safe living there.

People that we spoke with told us that there always seemed to be enough staff on duty. They told us that staff are approachable and willing to help.

People who used the service told us that they can speak with staff and the manager at any time and that they feel included in decisions made about the care received and the way in which the service is run.