This inspection took place on 29 March and 9, 12 April 2018. The first day of the inspection was unannounced.

Ashcourt Care Home is a ‘care home’. 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. Ashcourt is a purpose-built care home with bedrooms over two floors in a suburban neighbourhood of Liverpool. The home had 42 en-suite bedrooms, all for single occupancy. The home had two lounge areas, a dining area, accessible gardens, a conservatory, a smoking room and accessible bath and shower rooms on each floor. Each floor was accessible by staircases and a passenger lift.

The home was registered to provide care and accommodation for up to 42 people. At the time of our visit 38 people were living at the home. Ashcourt Care Home provides residential care for older people.

The home required 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. A new manager had been in place for two months, they had not yet applied to become registered with the CQC.

During our previous inspection in October 2016 we had found breaches of regulation 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the service was ‘requires improvement’. Following the inspection, we issued a warning notice for the breach of regulation 12. We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions; ‘Is the service safe?’ ‘Is the service effective? ‘Is the service caring? ‘Is the service responsive?’ and ‘Is the service well-led?’ To at least a rating of good.

At the previous inspection there were concerns with risk assessments and some of the safety checks of the building were also not kept up to date. Some people’s care plans did not reflect their support needs, reviews of the care plans did not show involvement from people or their relatives. Activities at the home were limited. Management’s audits had not highlighted these problems and the service provided to people did not follow the principles of the Mental Capacity Act 2005 (MCA).

At this inspection we saw that there had been improvements made in these areas and the service was compliant with all of the health and social care regulations. The breaches we identified in October 2016 had been addressed, the overall rating is now ‘good’.

People and their relatives told us that they felt safe living at the home. One person’s relative told us, “I feel mum is safe when I am not with her. I feel confident that they care as I would.” Feedback from people’s relatives and visiting health care professionals was that staffing levels had improved. During our visit we saw that there was enough staff to meet people’s needs safely.

People told us that the staff were caring and friendly towards them. One person told us that they thought the staff were, “Very good and friendly.” Another person told us, “They have all been very nice.” A third person told us that staff stop and take the time to ask people how they are.

Staff received training appropriate to their role. They told us that they felt well supported and effective in their roles. We saw that trained staff administered people’s medication safely.

We saw that the service had appropriate safeguarding policies in place, new staff were recruited safely and staff received training in safeguarding vulnerable adults.

People told us that the home’s environment and their rooms were nice, clean and well kept. There was ongoing improvements being made to the home’

Our inspection took place on 12 October 2016 and was unannounced. At our last inspection in April 2013 we found the provider was meeting all the standards we looked at.

Ashcourt Care Home is a residential care home situated in Knotty Ash, a residential area in the suburbs of Liverpool. The bedrooms are all single occupancy with ensuite facilities and there is ample parking and large well-kept gardens to the front and rear of the building. There are several lounges, a dining room and a number of bath and toileting facilities on both floors.

There was a registered manager in post at the time of our inspection. This person was on annual leave. 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.

Care plans contained risk assessments related to people’s care and support needs, however these were not always completed fully clearly identifying the nature of possible risks or how care and support should be provided in ways which minimised the risk. For example, in all care plans we looked at the falls risk assessment did not draw any conclusion about the level of risk or how this risk could be reduced.

Care plans were reviewed at monthly intervals, with notes to confirm what, if anything had changed. However, we did not always see evidence of people’s involvement in the review process.

The monitoring tools used to identify people at risk of malnutrition were being used to record people’s weights on a monthly basis but we saw someone had lost ten percent of their body weight over two months, but there was no identification of risk or evidence any action had been taken.

We saw fire alarm tests and the servicing of the fire extinguishers were overdue. Staff told us they had received fire safety training, and records we looked at confirmed this.

We saw staff followed the correct procedure for administering medicines and supported people well. However some staff who administered medicines had not had their competency assessed checked regularly. Staff applied cream and lotions to people when this was required. There were no record to show where on the body this should be applied and how often.

Staff told us communication was a problem, for example a person had shingles and this information was not relayed to all concerned.

Appropriate background checks were carried out before new staff began working in the service.

The deputy manager and staff did not fully understand the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. We found staff did not fully understand capacity, which meant people may not be receiving appropriate support to make decisions.

We saw there was a programme of training in place which included mandatory training. A programme of regular supervision meetings and annual appraisals was in place.

The catering staff had a good understanding of people’s dietary needs. We saw the food looked appetising and was well presented. People we spoke with told us they enjoyed the meals provided and there was always a good choice. Comments included, “The food is very good and there is always a good choice” and “The food and service is first class.”

People told us they were treated with kindness and compassion. One person said, “Very happy. The staff are very kind. It’s not what I thought it would be like, much better.” Another person said, “Staff are very courteous. I’m happy with everything.”

People told us activities were limited in the home. One relative spoken with said they had selected the home on the basis of its cleanliness and the range of activities apparently offered from Monday to Friday.

We saw the provider had systems in place to ensure any complaints or concerns were recorded and

During our inspection we used a number of different methods to help us understand the experiences of people living at Ashcourt Care Home. This was because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke individually with five of the people living there, three relatives and a visiting healthcare professional. We also spent time observing the support provided by staff. We observed staff being kind, caring and respectful at all times in their interactions with the people they cared for. Everyone we spoke with was happy with the care and support provided at Ashcourt. Some comments made were:

“It’s very good here, I’m very happy”.

“It’s lovely here, like a hotel”.

“I came from another place which was horrible, this is like a palace”.

“The meals are excellent”.

There were enough skilled and experienced staff to be able to meet the needs of the people who lived at Ashcourt in a timely manner. The organisation had systems in place to keep the people who used the service safe and monitored the quality of the service provided on a regular basis.

People using the service told us that the care they have received at Ashcourt “couldn’t be better” and that they were “very well looked after here”. Residents and relatives told us that the staff were very friendly and approachable and have always been very respectful towards them.

People said that staff were very caring and told us that “if you want anything it is always there for you”

People living in the home appeared relaxed and comfortable in their surroundings and they told us that they felt safe living at Ashcourt and were treated well by the staff.