This inspection took place on 31 January 2017 and was unannounced. Ascot House - Nottingham provides accommodation and personal care for up to 20 people with dementia or mental health needs. On the day of our inspection 18 people were using the service.

The service had a registered manager. 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.

Staff understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Risks to people’s health and safety were regularly assessed and action taken to reduce the risks.

There were sufficient numbers of staff employed and people’s needs were met in a timely manner because staff were organised and well deployed. People received their medicines when they needed them and medicines were stored and recorded appropriately.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. There were systems in place to ensure people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received.

Staff felt well supported and were provided with relevant training to effectively meet people’s needs. There was a plan in place to ensure any gaps in training provision were rectified. People had access to sufficient quantities of food and drink and told us they enjoyed the food. People had access to a range of healthcare services and staff followed the guidance that was provided.

There were caring and friendly relationships between staff and the people living at Ascot House - Nottingham. People made decisions about how they lived their lives and staff enabled them to do so. People were treated with dignity and respect by staff and their right to privacy was upheld.

People felt that care was person-centred and staff responded well to any changes in people’s needs. Care plans provided up to date and relevant information about people’s care needs. Activities were provided although people often chose not to participate. People told us they would feel comfortable making a complaint and knew how to do so.

There was an open and transparent culture at the home, people and staff felt comfortable speaking up if they wanted to. The registered manager and deputy manager worked together to provide clear leadership to staff. People were able to provide their opinion on the quality of the service they received and their views were acted upon. Effective quality monitoring systems were used to identify areas of improvement and ensure that action was taken.

On the day of our inspection some people had been accompanied by staff to a local farm. The people who had been on the outing told us they had enjoyed going out. Two of the people we spoke with told us that they would appreciate more activities being provided in the home. We looked at two people's care plans and found that they did not always fully reflect people's needs.

We spoke with four people who were using the service. One person said, “I feel safe here, it’s fine. I tell staff if there’s a problem.” People's care plans did not always provide sufficient guidance to staff in how to prevent incidents occuring between people using the service.

We saw that improvements had been made in relation to the cleanliness and maintenance of the premises. However further action was required to become compliant. Procedures were not in place to ensure that all appropriate pre-employment checks were carried out before staff could start work.

Effective systems were not in place to reduce the risk and spread of infection. One person, who uses the service, told us, “Cleanliness is terrible. Communal areas aren’t really kept clean and could be improved on. Staff are clean and hygienic.” During our tour of the premises we observed that the environment in communal and individual bedrooms did not always appear clean or maintained in a hygienic manner.

The provider had appropriate arrangements in place to manage medicines. Staff we spoke with were able to clearly describe the procedures for the administration of people’s medications. We observed medication rounds and saw that staff followed medication administration procedures.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. Shortfalls in both internal and external maintenance of the building may adversely impact on the safety of people who use the service. One member of staff told us, “The home is old fashioned looking. The décor could be updated.”

Throughout the home, we saw windows which did not fit into frames, leaving gaps. This meant the windows did not provide residents with adequate protection from adverse climatic conditions. During our tour of the premises we observed that the premises were not fully maintained.

There were enough qualified, skilled and experienced staff to meet people’s needs. One resident told us, “There are enough staff on for every shift."

We observed that staff were polite and respectful of people using the service and were offering people choices about how they wished to spend their day.

During our visit we spoke with four people who were using the service. Each person said they were happy with the care and support they received. One person said, “It’s alright here, staff help me when I need it, otherwise they let me get on with it. That’s just the way I like it.” Another person told us, “I get to go out to the pub once a week.” Another person said, “I like the food here, it’s really nice. There are some games and activities but I’m not really bothered about that.”

During our visit we spoke with four people who were using the service. Each of the people we spoke with told us they felt safe living in the home and did not have any concerns about any staff. One person said, “Yes I have always felt safe living here.”

Resident’s meetings were also being held every two months and we saw the minutes of previous meetings. These confirmed that people were given the opportunity to raise any queries and make suggestions.

We asked people who use the service if they were satisfied with the standard of cleanliness throughout the home, comments included “I have been here for fifteen years, if I wasn’t happy I wouldn’t be here would I, I am very satisfied, my room is cleaned every day, I have nothing to complain about”, and “I am happy with everything in the home, the food, the cleaning, to be frank it’s all A1 including the cleaning”.

People who use the service confirmed that locks are fitted to their bedrooms to promote their privacy and safely. Comments included, “I can lock my room if I want to but I don’t, that’s my choice” and “I have been here for fifteen years and have always been able to lock my room if I want to”.

This Inspection took place on 20 and 21 October 2014. Ascot House can accommodate up to 20 people. The service is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. The service is for males only. There were 16 people using the service when we inspected.

The service is managed by the registered provider, so does not require a registered manager. Registered providers are ‘registered persons’ who have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 4 July 2013 we asked the provider to make improvements to the assessment and delivery of care, the management of infection, the process of recruitment checks and the maintenance of the environment. We found at this latest inspection that the provider had made the improvements in line with the action plan they provided us with.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA and aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The manager confirmed that people were not subject to any DoLS at the time of our inspection.

The human rights of people who lacked mental capacity to make particular decisions were not always protected. Decisions made in their best interests were not recorded to show if they were the least restrictive of their human rights.

You can see what action we told the provider to take at the back of the full version of the report.

There were procedures in place to protect people from the risk of abuse and keep them safe. The manager made safer recruitment decisions and made sure staff knew how to respond if they had concerns about people’s safety. People were treated as individuals and felt they could come and go as they wished. Staff knew them well and understood their individual preferences and respected their choices.

People were assessed for any risk to their health and wellbeing and their medicines were managed safely. They had access to services such as mental health community professionals to monitor their mental health. Sufficient quantities of food and drink were provided and people had their nutrition and hydration requirements monitored regularly.

The environment was warm and clean. Continuous improvements to the environment were being made. There were sufficient staff with the right skills to provide a consistent level of care. The provider trained and supervised the staff to make sure they were not left in situations they did not have the skills to manage. People told us that they found the manager and deputy manager approachable and would know how to raise any concerns. The provider monitored the quality of the service provided and gave people opportunities to have their say in how the home was managed.