This unannounced inspection took place on 13 and 16 April 2018.

Three Ashes Residential Care Home is a ‘care home’ for up to 11 older people, some of whom were living with a physical or sensory disability. 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. Three Ashes is registered for older people living with dementia, physical disability and/or sensory impairment. At the time of this inspection 9 people were living there.

Accommodation at Three Ashes is provided over two floors with bedrooms located on the ground and first floors. The ground floor was wheelchair accessible. A stair lift was fitted to assist people with limited mobility to access the first floor. Most bedrooms had en-suite facilities with a shower and a communal bathroom was located on the first floor. Two lounge areas, one in a large conservatory overlooking the extensive gardens, were located on the ground floor and a dining area was situated, open plan, between the two lounges.

Three Ashes has changed ownership twice since our last inspection in November 2015 but the legal entity remained the same. At our last inspection in 2015 the service was rated Good. The home has been under the current ownership since August 2017. Staff working at Three Ashes at the time of the sale transferred across to the new owner, remaining in post at the home.

There had been no registered manager in post at Three Ashes since February 2018. A registered manager is a person who has registered with the Care Quality Commission (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. The service was being managed by the provider’s representative until a new registered manager was appointed.

During this inspection we identified two breaches of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. The service has been rated ‘Requires Improvement’ overall.

People were not always supported by staff who had received the training and support they needed to carry out their duties effectively. The systems and processes in place to monitor the safety and quality of the services provided to people were not always effective in identifying and addressing shortfalls. Complete records of the care and treatment provided to people had not always been kept. We recommend that the service review good practice guidance for managing medicines in care homes and take action to update their practice accordingly.

Risks to people were managed with the support and guidance of health professionals to ensure people remained safe. There were enough suitable staff to meet people's needs. Staff worked openly with other agencies to safeguard people from harm. The building and equipment were appropriately maintained and people were protected from risks associated with cross infection.

People benefitted from a stable and caring staff team who knew them well. They were supported to access appropriate health care. Staff took a personalised approach to meeting people’s needs and outcomes for people were good. People’s preferences were taken into account by staff when providing care and people were offered choices in their day to day lives. People’s privacy was respected and they were treated with dignity and kindness. People were supported to maintain relationships with others who were important to them. People received good end of life care.

People's views about the service they received were sought and these were used to improve the service. People were able to raise complaints and these were responded to promptly. The culture at the home was open and transparent. Staff and managers worked together to provide a fri

At our last inspection on 9 October 2013, we found the provider to be non-compliant with three outcomes (safeguarding, quality monitoring and record keeping). The provider sent us an action plan which detailed what the provider planned to do to achieve compliance and a date by which they intended to complete their actions. This inspection was to follow up on these actions. We did not speak to people who used the service during this inspection. We did speak with staff and looked at the care files for eight people.

We found staff had received additional safeguarding training and the manager completed monthly audits to check the staff’s understanding. We found meetings took place with staff and people who used the service. The minutes of these meetings showed a wide range of topics were discussed and opportunities for feedback were present. A satisfaction survey had been completed since our last inspection. The results from this survey were mainly positive from both people who used the service and their relatives. The provider had reviewed the care files for people who used the service. We found these to be person centred, up to date and reflected people’s needs.

During our visit we spoke with the seven people who used the service. People told us they liked living in the home and enjoyed other people’s company. One person told us, "it's been very nice, can't complain, the food is very good." Other people told us they could make choices about their daily living. A visiting health professional told us there was a, "very soothing environment (within the home) for residents who have dementia."

Staff we spoke with told us they felt supported by their manager through informal supervision during the course of their day-to-day work.

Care records did not accurately reflect people's needs or contain sufficient detail for staff to follow. This meant that people living in the home were at risk of receiving care or treatment that was inappropriate or unsafe.

There was a risk that people may not be protected from abuse. This was because the provider’s safeguarding policy did not provide staff with information about when and how to contact the local authority’s safeguarding team. None of the evidence reviewed demonstrated that the provider had established routine and robust processes for seeking people’s views or for monitoring the quality and standard of services provided.

This inspection took place on 3 and 4 November 2015 and was unannounced. Three Ashes Residential Care Home provides accommodation for up to 11 people. At the time of our inspection there were 11 people living there.

There were six people living with dementia in the home. People had bedrooms with en suite facilities. They also had access to a shared bathroom as well as living and dining areas. The grounds around the home were accessible to everyone.

Three Ashes Residential Care Home had a registered manager. 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 had high expectations of the standards of care to be delivered and staff endorsed this making sure people were able “to continue to live the life that they want to live” . Quality assurance systems gave people, their relatives and staff the opportunity to provide feedback and their views about the service provided. This was used to progress and drive through improvements. National developments and best practice guidance were actively implemented within the service to improve people’s experience of care.

People living at Three Ashes said they were “lucky” to live there and it was a “good place to be”. Relatives confirmed this saying “care is exemplary” and “Nothing but kindness and care”. People’s care was individualised and reflected their preferences and lifestyle choices. They and those important to them were involved in reviewing their care and kept up to date when people’s needs changed. Staff had a good understanding of people’s needs and provided care and support with dignity, compassion and light heartedly. The atmosphere in the home was cheerful, with staff positively interacting with people, reassuring them when needed and supporting them to be independent in their day to day lives.

People felt safe living in the home and knew how to raise concerns or any worries they may have. Staff and the registered manager were open and accessible, listening to people and responding to them respectfully. Safe procedures were in place when recruiting staff to make sure they had the skills, knowledge and competency to support people. Staff said they worked well as a team and had access to a range of training as well as courses specific to people’s needs. Staff understood how to keep people safe, whether through protecting them from abuse or minimising risks from injury. People were supported to stay well through a healthy diet, access to health care professionals and through the safe administration of medicines.

People enjoyed a range of activities at home and within the wider community. They liked to go out for day trips and visiting people in other homes operated by the provider to join in with their celebrations and activities. Care was taken to prevent them from being socially isolated with children from local schools visiting as well as local people being invited to take part in developing the large gardens around the home. Visitors said they were always made to feel welcome and feedback from one relative confirmed staff are “an excellent example to those employed in the care sector”.