This inspection took place on 23 August 2017 and was unannounced. At our last inspection the overall rating for Ashdene Care Home was 'requires improvement'. Ashdene Care Home provides care for people who are living with dementia. It provides accommodation for up to 41 people who require personal and nursing care. The service provides care on two storeys. At the time of our inspection there were 40 people living at the home.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered safely however they were not consistently managed safely.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had not been consistently completed. This issue had been identified at our previous inspection and the provider had failed to fully address the issue.There was a breach of Regulation 11. You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular supervision and appraisals People were provided access to a range of leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. However the provider had failed to identify the issues we identified at our inspection regarding medicines. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

The inspection was carried out by a CQC inspector. We spoke with four people who used the service and four visiting relatives. We gained information about the service from reviews of records held at the care home and discussions with the provider, registered manager, four care workers and the activities co-ordinator. The views expressed directly to us by people who used the service were limited to varying degrees by their experience of health conditions that affected their understanding and communication. Below is a summary of what we found.

Is the service safe?

All of the relatives we spoke with told us they trusted service staff and had not had any reason to raise concerns about the care provided. One person said, “(My relative) is safe here.” Another told us, “I am very observant and will tell them straight if I have any problems or complaints.”

Staff understood how to recognise and report any concerns they might have about people’s safety. We saw staff received training in the protection of vulnerable adults and had the skills and knowledge required to ensure people’s health and safety in areas such as moving and handling.

We looked at systems to ensure people’s health and safety including accident and incident reporting and the management of fire risk and evacuation. We saw these issues were monitored and reviewed on a regular basis.

We saw the care people received was safe because staff understood people’s right to choose how their care was provided. Where this was not the case, as a result of a diagnosed condition such as Alzheimer’s disease, there were systems in place to ensure valid consent was sought and provided.

The manager understood their legal duty and knew how to refer people who might be at risk of receiving inappropriate care, for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS).

Is the service effective?

Relatives told us they were happy with the service provided. One told us the care home was, “The best (their relative) had been in.”

People’s needs were assessed prior to moving to the care home and were reviewed regularly. We saw people’s care was more likely to be effective because it was planned based on their individual needs.

Staff told us the way people’s care was planned helped them to understand people’s needs and provide effective care.

We saw from records, conversations and observations during our visit that staff provided care effectively and in the ways described in people’s plans of care.

Is the service caring?

People told us they found service staff to be kind and caring. One relative said the, “Staff were all friendly and helpful.” Another said whenever they visited they found

their relative and other people who received care to be, “Relaxed and happy.”

We observed staff interacting with people in a warm and caring way. We heard laughter and singing during our visit and noted staff working to provide care to people with patience and in ways that protected their dignity.

We saw from a comments book and a recent survey of people’s opinions that most of those who contributed praised the attitudes of staff. Recent comments included, “Thanks for the wonderful care.” And, “It’s a pleasure to come and see my (relative).”

Care records we looked at included information about people’s lives and families. They conveyed a sense of what was important to the person. We saw these wishes reflected in the way activities were organised and the way care was provided.

Is the service responsive?

People told us staff were approachable and responded positively to requests for information or help. One relative told us, “Staff and the manager are always available.” Another said that when they had issues they needed to discuss, “Staff give you an answer.”

The activities co-ordinator told us they were provided with the materials and support to offer a programme of activities that included everybody who received a service and reflected people’s interests and wishes. They said if they asked for extra resources the manager and owner responded positively. Staff we spoke with told us colleagues were positive in helping others. During our inspection we noted care workers helping with recreational activities people were enjoying.

We noted from care records we looked at that concerns raised about people’s health and welfare were addressed quickly and effectively. Medical support to ensure regular and responsive health care included a weekly GP surgery provided at the care home by one local GP practice.

Is the service well-led?

Staff we spoke with said they enjoyed their work and felt well supported by the manager of the service.

Staff told us about initiatives to encourage people’s families and friends to visit and join in activities at the care home. Activities have included family teas and the hosting of wedding anniversary celebrations for people who used the service, their partners and families. One member of staff told us the manager was very good at engaging and encouraging family involvement. We saw that each year family’s views about the quality of the service were sought through the circulation of a questionnaire.

We found that the service consistently monitored and reviewed its own practice in order to ensure the care home was a safe place for people to live and a good place to work.

We used a number of different methods to help us understand the experiences of people using the service, because some of the the people using the service had complex needs which meant they were not able to tell us their experiences. However we did speak to three people living at the home as well as visitors and other professionals who were in the home on the day of our visit.

One visitor told us, " I visit most days.She is well looked after by good staff. If she needs anything I just have to ask." Another said, " Staff are approachable. Dad is safe here."

Many of the people who live at Ashdene have dementia and therefore we were unable to get some people's views. However, we spoke with several people who live in the home who told us “I have lived here for six months, I have settled in very well. I have no complaints at all.”

Another person said “It’s very nice here, they look after me very well. The carers are very nice, it’s like one big family.”

We spoke with two relatives who said “the care here is very good, in fact it’s brilliant.” Another relative said “I am relieved that we have found somewhere safe for my relative, we have had a few issues with the laundry but understand that this is difficult to manage in a care home. The main thing is that the people are well looked after.”

This was an unannounced inspection carried out on 16 and 17 December 2015.

Ashdene Care Home can provide accommodation for up to 41 older people who live with dementia and who need personal care. There were 40 people living in the service at the time of our 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.

The arrangements used to ensure that there were always enough staff on duty were not robust. Staff knew how to report any concerns so that people were kept safe from abuse, people had been helped to avoid having accidents and medicines were safely managed. Background checks on new staff had been completed before they started work.

Staff had received training and support and knew how to provide people with the assistance they needed. People were pleased with the meals they received and staff ensured that people had enough nutrition and hydration. Staff recognised when people were unwell and had arranged for them to receive the necessary healthcare services.

The registered persons and staff were not consistently following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken all of the necessary steps to ensure that people’s rights were protected.

People were treated with kindness and compassion. Staff recognised the importance of promoting people’s right to privacy and the arrangements for maintaining confidentiality were robust.

Staff promoted positive outcomes for people who lived with dementia. People had been consulted about the care they wanted to receive and had been supported to pursue their hobbies and interests. Staff had supported people to express their individuality, people had been helped to meet their spiritual needs and there was a system for resolving complaints.

Some quality checks had not been completed and people had not been fully involved in the development of the service. However, people had benefited from staff acting upon good practice guidance, steps had been taken to promote good team work and staff had been encouraged to speak out if they had any concerns.