This was an unannounced inspection carried out on 14 and 24 June 2017, both dates were unannounced.

Stoneygate Ashlands provides accommodation and personal care for up to 37 people. The service specialises in caring for older people including people living with dementia or those who require end of life care. The accommodation comprises individual en-suite rooms, and there were 36 people living in the service at the time of our inspection visit.

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.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Most of the relatives we spoke with were also complimentary about the staff and the care offered to their relatives. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. People’s care and support needs had been assessed and people were involved in the development of their plan of care. Staff had a good understanding of people’s care needs; access to people’s care plans and received regular updates about people’s care needs.

People were provided with a choice of meals that met their cultural and dietary needs. The catering staff were provided with up to date information about people’s dietary needs, and sought the opinions of people to tailor their individual meal choices. Medicines were ordered, stored and administered safely and staff were trained to provide the medicines people required.

Care plans included the changes to peoples care and treatment, and people attended routine health checks. Staff sought medical advice and support from health care professionals. There were sufficient staff available to meet people’s personal care needs and we saw staff worked in a co-ordinated manner.

There were sufficient activities provided over five days of the week, with additional volunteers helping in the ‘gardening club’. The provider had engaged with a group from learning for the forth age (L4A) to identify and provide appropriate activities and pastimes. People were able to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the service. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

Staff told us they had access to information about people’s care and support needs and what was important to people.

Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

The provider had a clear management structure within the service, which meant that the staff were aware who to contact out of hours. The registered manager undertook quality monitoring in the service, which was overseen by a director of the company.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives. We received positive feedback from visiting professionals with regard to the care offered to people and professionalism of staff. Staff were aware of the reporting procedure for faults and repairs and had access to emergency maintenance information to ensure emergency repairs were arranged promptl

This was an unannounced inspection carried out on 6 April 2016.

Stoneygate Ashlands provides accommodation and personal care for up to 37 people. The home specialises in caring for older people including people living with dementia or those who require end of life care. The accommodation comprises individual en-suite rooms, and there were 37 people living in the service at the time of our inspection visit.

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.

The administration of medicines was not consistent. Checks undertaken to ensure medicines were administered safely, were not robust which meant a number of shortfalls not being identified or addressed. Medicines were safely stored, however we noted aspects around the administration and recording of medicines which needed to be improved.

Care planning and risk assessments recognised people’s individual needs, and care plans provided detailed information about people’s individual preferences. People were encouraged to take part in meetings to review their care plans. Records and observations provided evidence that people were treated in a dignified way which encouraged them to feel valued. Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home had sufficient suitably recruited and trained staff to care for people safely. The environment of the home was safe for people and safety checks were regularly carried out. Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They understood that people should be consulted about their care and the principles of the MCA and DoLS. People were protected around their mental capacity.

People’s nutrition and hydration needs were met, most people enjoyed the meals, however some were given choices that they previously indicated they did not like. Risks to people’s nutrition were assessed and specialist advice was followed. People were treated with kindness and compassion and we saw staff had a good rapport with people, treating them with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well. People were encouraged to engage in activities though some felt there was not enough to do and were bored. Some people would benefit from one-to-one support which was not being offered at the time we inspected. Staff were responsive to people’s needs and understood people’s individual requirements so that they could support them in the way they preferred.

People told us they were aware how to make complaints and who they could complain to. The results of complaint investigations were clearly recorded.

The registered manager did not have an effective quality assurance system in place. Records were not reviewed thoroughly or issues picked up by the current auditing system. The registered manager had an understanding of their role and they consulted with people who lived at the service, people who mattered to them, staff and health care professionals, in order to identify required improvements. Staff were supported and trained for their role.

We found a breach 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.

We asked people if they felt that their privacy and dignity was respected, we were told it was. We saw that support plans detailed how staff should maintain people's dignity and staff spoken with told us they had recently had privacy and dignity training.

We asked people if they felt their care needs were being met as they wanted them to be. Some people told they were most of the time but sometimes call bells were not always answered as promptly as they would like as staff were very busy. We spoke with the manager who told us their staffing levels were designed to meet the needs of people using the service and they were reviewed regularly to ensure that there were enough staff. We did not find evidence to suggest people were not having their needs met such as increase in falls or pressure care.

We looked at how the home protected people from abuse. People told us that staff were kind and they felt safe, visitors said they felt they were leaving their relatives in a safe environment. We saw that staff received safeguarding training. We saw that they responded to allegations of abuse promptly.

We asked people if they felt staff were well trained and they said that staff know what they are doing. Although we were told by visitors that they felt that not all staff had the same knowledge based on their experience. We saw records that showed staff receive ongoing training and supervision.

We spoke with seven of the 31 people using the service at the time of our inspection. We found that people’s nutrition and hydration needs were being met, although we have told the provider about some improvements that were still needed. Three of the people we spoke with were dissatisfied with the main meals provided by the provider’s central kitchen service.

Most of the people we spoke with thought there were enough staff to meet their needs, although one person commented: “The staff – they have no time to talk.” During our inspection, we saw that care workers took time to talk with people whilst they delivered care.

The provider was introducing new systems to monitor the quality of the service. People using the service were encouraged to contribute their views by attending meetings or completing satisfaction surveys. Two of the people we spoke with were not aware of this, but we saw that people had been offered support to give their views. One of the people we spoke with commented: "The care has been to the uppermost and very best. It is lovely here.” A relative of a person using the service also contacted us following our inspection and told us: "The staff treat my wife with dignity in a friendly atmosphere, which is now only being enhanced by the recent arrival within the past year of the current manager, who is determined to maintain and improve the appropriate standards of care my wife and the other residents require."

We spoke with two people using the service and three visitors, including a health professional. People told us they were treated with dignity and we saw they were involved in decisions about their care. People were satisfied with the care they received. We saw the provider had assessed people’s needs and put plans in place to ensure appropriate care was delivered. We noticed that some care plans lacked detail about how care should be delivered by staff. Care records were up to date and accurate and they were stored securely.

We did not ask people about how they were protected from abuse, but we saw the provider had systems for identifying and reporting abuse. Staff were aware of reporting systems. We found the provider had not ensured that all incidents were reported to the appropriate bodies.

People told us they liked the food and there was plenty available. However, visitors told us people were not given food that was suitable for their nutritional needs. We found that staff had not been given adequate information or training about protecting people from malnutrition and dehydration.

Visitors told us there were not enough staff to meet people’s needs. People who needed additional support or who had changing or complex needs did not receive the support they needed, because there were not enough staff.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) and a practising professional.

We spoke with six of the 35 people using the service on the day of our visit. People told us that generally they were treated with dignity. Two people told us about occasions when care workers had been unkind or disrespectful. We saw that people had to wait for assistance to use the toilet and that people who chose to eat their meals in the bedrooms waited up to 40 minutes for their meals.

We spoke with four people about food. Their views about food at the service varied. One told us, “We’re always being fed and watered.” Another said the food was really good. Three people told us they often waited a long time to be served their food.

We spoke with three people using the service about safeguarding. They all told us they felt safe at the service. They said they would report any concerns about their safety to the manager. One person told us, “ When I fell out of bed, they were wonderful.” Although people told us they felt safe, we found that safeguarding concerns were not always reported properly.

We spoke to two people using the service about staff. One thought the service was understaffed on the day of our inspection due to holidays. We found that staffing levels were reflective of the usual patterns for the service. The other person we spoke with said, "The problems we have are always caused or compounded by insufficient staff. It's outrageous how few they try to manage with." We saw that people had to wait for assistance because there were not enough staff.

We spoke with one person using the service about their records. They thought they knew what was in their plans of care. They said care workers gave them information about their records, but the information changed depending who they asked and when. This meant people using the service could not be sure their records were accurate as they were given contradictory information about them. We found that records were not updated with current information and records were not accurate so people were at risk of receiving inappropriate care.

People told us they liked living at Stoneygate Ashlands. One told us, “It’s very free and easy here. That’s why I like it.” They praised the staff team. One said, “The carers are good. You can have a laugh with them.” Another commented, “The staff are wonderful, from the kitchen assistant to the manager.” People said the home was well run. One said, “The manager runs this place like a home, not an institution

One person told us that since going to Stoneygate Ashlands they had been on day trips, visited Skegness, and played cards and bingo in the home. They also said they had regular visits from relatives and spent time in the garden when the weather was nice. Their comments included, “I feel the staff respect me, they don’t impose things on me.”, “The staff are good as I can’t do anything for myself.”, and “I like the food, there’s lots of choice.”

We saw three people in one of the lounges being visited by a dog under a ‘pets as therapy’ scheme. All clearly enjoyed this and one person was seen stroking the dog when it lay on the sofa next to them. One person told us this visit meant a lot to them as they used to have a dog.

People told us they felt safe in the home and knew who to speak to if they had any concerns. One person said they had had a problem with a ‘bossy’ member of staff but this had been resolved as soon as they told the acting manager about it. Another person told us, “Yes I feel safe here, I know the staff are here to look out for me.”