Ashby House – Milton Keynes 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.

Ashby House is in a residential area of Milton Keynes and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for older people who may also be living with dementia and can accommodate up to 64 people at the service. When we visited there were 51 people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the registered manager and senior team, and had one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before their care was provided. 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 supported this practice

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and could contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Ashby House is registered to provide accommodation and support for 64 older people who require nursing or personal care, and who may also be living with dementia. On the day of our visit, there were 53 people living in the service.

We carried out this inspection on 21 April 2016, to check that improvements had been made following our comprehensive inspection on 22 April 2015. This inspection was unannounced.

The service 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.

Although there were systems in place in respect of the Mental Capacity Act 2005 (MCA) these were not always used appropriately to ensure that decision specific assessments were completed for people.

Staff were supported through a system of induction and on-going training, based on the needs of the people who lived at the service. They also benefitted from additional support within regular supervision sessions which enabled them to discuss any concerns and training and development needs. However, the content of these supervision could have been more meaningful; and it was not always easy to determine when action had been taken following identification of action points for progression.

People felt safe in the service and confirmed that staff kept them safe and free from harm. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential neglect or abuse. Appropriate action was taken to keep people safe, minimising any risks to their health and safety. Personalised risk assessments had been implemented to reduce the risk of harm to people. Staff understood how to manage risks to promote people’s safety, whilst enabling them to take positive risks in an effort to maintain their independence. Accidents and incidents had been recorded and the causes of these analysed, so that preventative action could be taken to reduce the number of occurrences.

Robust recruitment checks were completed to establish that staff were safe to work with people before they commenced employment. There were adequate numbers of staff on duty to support people safely and ensure people had opportunities to take part in a range of activities. Systems and processes in place ensured that the administration, storage, disposal and handling of medicines were suitable for the people who lived at the service.

People’s consent was gained before any care was provided and the requirements of Deprivation of Liberty Safeguards were met. People had a wide choice of nutritious food based upon their specific preferences and dietary requirements. Referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being.

People felt that staff were kind and caring and supported them well. Staff engaged with people in a friendly and compassionate manner. They assisted them as required, whilst encouraging them to remain as independent as possible. Staff treated people with dignity and respect and understood their specific needs and wishes. Advocacy services were accessed to enable people to have a voice when this was appropriate.

Care plans guided staff as to the specifics of care required by people, and took into account personal preferences, likes and dislikes. Relatives were involved in the review of people’s care needs and were kept informed of any changes to a person’s health or well-being. People were supported to undertake activities both inside and outside of the service to keep them engaged. The service also had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where requir

We carried out this inspection to check if the provider had made the improvements we had asked them to make when we inspected in April 2014 to their record keeping. Our inspection was carried out by one inspector who visited the service unannounced on 29 September 2014.

During the inspection we sought answers to five key questions. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff supporting people who used the service, the manager and from looking at records. Because this inspection focussed specifically on record keeping and we looked at records for people who were unwell, we did not discuss the adequacy of their records with them. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider had taken action since our last inspection to reduce the risk of unsafe or inappropriate treatment arising from a lack of proper information about them. We found that records to support staff in meeting people’s health and care needs were in place.

Is the service effective?

Staff we spoke with were knowledgeable about the needs of people who used the service, which enabled them to provide safe and effective care.

Is the service caring?

Discussions with staff demonstrated that they were committed to helping to ensure that people received the care and support that met their individual needs. We also heard staff speak to people who used the service with respect and approach people in a caring manner.

Is the service responsive?

The provider responded to concerns raised about record keeping during the last inspection and as a result improvements have been made. During our inspection we heard staff responding to and acting on changes to people’s health. Examples included; request for visits from a GP, a tissue viability nurse and a speech and language therapist. We also heard care staff act swiftly to locate the nurse on duty to review one person when their health deteriorated suddenly.

Is the service well-led?

We found the service was well managed. A deputy manager had recently been appointed to support the registered manager, with particular responsibilities for clinical care. Improvements had been made to the accuracy of people’s care records since our last inspection. We saw that systems were in place for reviewing care records and addressing any shortfalls. This helped to reduce the risk of people receiving unsafe or inappropriate care.

During our inspection of Ashby House we set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people's needs were assessed before they were admitted to Ashby House. The environment that was clean and hygienic. There were sufficient numbers of experienced and competent staff on duty to meet people's care needs.

Is the service effective?

We saw that staff received appropriate training and support to do their job safely and effectively. We spoke with staff and observed them going about their duties and found that they had sufficient knowledge of people’s care needs to enable them to provide personalised care.

Is the service caring?

We heard staff speaking to people politely and respectfully. We observed the staff worked at people's own pace when providing care. They encouraged people to make their own decisions and exercise independence according to individual capabilities. People using the service spoke highly of staff saying they were treated with kindness, dignity and respect.

Is the service responsive?

The provider listened to people's comments and took action to continually improve the service.

Is the service well-led?

The provider had appropriate quality assurance processes in place to regularly monitor people’s care. However we identified that some care plans and care monitoring records did not accurately reflect people’s current needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

We spoke with people who use the service and they told us that they were happy at Ashby house. One person told us that they were able to go out on trips back to their old house and see a pet which they found liberating. One person told us that the food was nice and that there was plenty of it.

We spoke with people's relatives who told us that they were happy with the home and that they felt their family member was well looked after.

We found some concerns in relation to record keeping at the home.

We spoke with people who use the service and they told us that things were good at the home and they enjoyed living there.

We spoke with people who use the service and they told us that things had improved within the home and that they were happier than before. One person told us that the home was much cleaner and cleaning in their room had improved. We found concerns around the care and welfare of people using the service and record keeping.

We spoke with people who use the service and received mixed comments. One person told us that they found the home relaxing and that the food was nice with plenty of choice.

Another told us that they were given food that they didn’t like and were left feeling hungry. One service user told us that when they called out for assistance they were ignored by staff walking past. We found concerns in relation to cleanliness and infection control.

We inspected Ashby house during an outbreak of Diarrhoea and Vomiting (D&V), which had been ongoing since 13 May 2012.

People said they were happy at the home; had been involved in planning their care and had agreed the care received. One person said that she was meeting with the social worker to review her mothers care plan. One person said that since arrival at the home he has seen his father make progress.

People said the staff were professional and friendly. People identified no concerns about staffing levels at the home; although it was recognised that staff could be busy at times.

People said personal care was good and that they had attended appointments outside of the home specific to their needs.

Relatives of people using the service said the home provides activities.

People said they liked the food. Three relatives gave very positive feedback about the home’s food and how individual dietary needs had been met.

People said the home was clean. One person said her mother’s room was always clean and laundry services had been efficient.

During our inspection in April 2015, we found that people were not protected from the risks of infection, as there were ineffective cleaning processes in place. Communal areas within the service, and people’s bedrooms had not been cleaned effectively. We found that cleaning within the service was not satisfactory or robust. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also identified that the systems in place for assessing risk factors for people were not robust. Risks around people’s needs were not always recognised or appropriately assessed. As a result of this, the care and support provided to people could have been compromised. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We further identified that the systems in place for medication management were not robust. The systems and processes used for recording, administration and disposal of medication were not safe. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition to the above breaches, we also identified that the systems in place for monitoring record keeping and ensuring that people’s individual records were up to date were not used effectively. Care records and risk assessments had not consistently been updated which meant they were not reflective of people’s current needs. This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by 14 August 2015.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ashby House Nursing Home’ on our website at www.cqc.org.uk.

Ashby House Nursing Home is registered to provide accommodation and support for 64 older people who require nursing or personal care, and who may also be living with dementia. On the day of our visit, there were 52 people living in the home.

The inspection was unannounced and took place on 14 and 15 September 2015.

The service did not have a registered manager. Management cover was being provided by a general manager who had submitted their application to the Care Quality Commission to become the 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.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that appropriate standards of cleanliness and hygiene had been maintained. Staff had reviewed their practice in respect of cleaning, and had worked hard to ensure this was now more thorough.

We reviewed the medication systems in place, and found that these had been strengthened. The processes in place were more robust and more regular audit checks were taking place of all aspects of the medication systems, including recording and disposal. Because of this issues were now identified and addressed in a timelier manner.

We also reviewed people’s risk assessments and care plans to ensure they had been updated in accordance with any changes in their care needs, or general condition. We found that steps had been taken to review care records on a monthly basis so that they remained reflective of people’s care and support needs.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe and well-led at the next comprehensive inspection.