This inspection took place on 15 May 2018 and was unannounced.

Ashfield House 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. This service provides accommodation and personal or nursing care for up to 25 people. However, at the time of our inspection, the provider did not have anyone living at the home with nursing needs. There were 17 people living at the home at the time of our inspection, all of whom received residential care.

There was a registered manager in post, who was present during our inspection. 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.

At the time of our last inspection undertaken in October 2017, we rated the service as Requires Improvement. Breaches of Regulation were identified in relation to person-centred care; staffing; good governance; and failure to notify. At this inspection, we found some improvements had been made and the provider was no longer in breach of the Regulations regarding person-centred care, staffing and failure to notify. However, we found the provider remained in breach of the Regulation regarding good governance. We also identified an additional breach in regard to a failure to display the current rating.

Records associated with people's care were not always complete or accurate. Gaps were identified in records in regard to people's skin health monitoring and their dietary preferences. Although care plan audits had been carried out by the provider, these shortfalls had not been identified.

Where people had been identified as losing weight, it was not clear what, if any, action had been taken.

The provider had not ensured the current CQC rating for Ashfield House was visibly displayed for people and visitors. The previous rating was displayed, which was not reflective of the service's current position.

People received their medicines in line with their current prescriptions. Medicines were stored securely. Prescribed creams contained their opening dates, so staff could monitor these and ensure they were within their shelf-life.

There were enough staff to safely meet people's needs. The provider followed safe recruitment practice when appointing new staff.

Staff understood their roles and responsibilities in regard to protecting people from abuse and harm.

Staff received ongoing training and development in their roles, and they understood key legislation underpinning their practice.

People were able to navigate their way around their home and the environment was dementia-friendly.

People enjoyed positive and respectful relationships with staff. People's dignity was maintained. People's independence was promoted as much as possible.

There were in-house, and some external, social and leisure opportunities for people to enjoy.

People's care plans captured their preferences, wishes, needs and interests, and staff used these to inform their practice. There was a system in place for responding to and acting on feedback, complaints and suggestions.

Staff felt supported and motivated in their roles. Links had been established with the local community for the benefit of people living at Ashfield House.

Ashfield House is located in Leominster, Herefordshire. The service is registered to provide accommodation and care for older adults, as well as nursing care.No one living at the home was receiving nursing care at the time of our inspection. On the day of our inspection, there were 18 people living at the home, some of whom were living with dementia.

We previously inspected this service on 17 August 2015 and the rating was Good. At this inspection, we identified breaches of Regulation. These were in relation to person-centred care, dignity and respect and good governance. You can see what action we asked the provider to take at the end of this report.

The inspection took place on 30 October 2017 and was unannounced.

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. Registered providers and registered managers 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.

People's medicines were not always stored in accordance with the prescriber's directions, or in accordance with current best practice. People's medicines were not always signed for by staff, which made it difficult to know whether some medicines had been given.

Staff were deployed as cleaners as well as carers, which sometimes impacted upon the care they were able to provide. People were not always treated with dignity and respect.

People could not always enjoy their individual hobbies and interests. People were not able to go out for day trips when they wanted to, unless taken out by family members. People's care plans were not always reflective of their individual preferences, likes, dislikes and interests.

Quality assurance measures were in place, but these were not effective in identifying shortfalls in the service. Care records were sometimes inaccurate or had not been completed.

People were protected from harm and abuse. Risk assessments were in place in regard to individuals' needs and these were known and followed by staff.

People's weight was monitored and where there were concerns, appropriate action was taken. People had access to healthcare professionals, and their changing needs were responded to. People enjoyed the meals provided.

There was a system in place for capturing and acting on complaints and feedback. Staff felt valued and supported in their roles.

This inspection was carried out on 17 August 2015 and was unannounced.

Ashfield House provides accommodation and personal care for adults over 65 years.

At the time of our inspection there were 14 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 and associated regulations about how the service is run.

We saw that staff had good relationships with staff. Staff spoke in a way that gave people dignity and respect and the atmosphere of the home was calm and relaxed.

People told us that they liked living at the home and spoke positively about the registered manager and the staff. People felt that staff knew their needs and were kind and caring and they told us that support was available when they needed it. People told us that they were supported to take their medicines, and we found that their medicines were managed safely and that people received their medicines in line with their prescription.

People told us that they were able to choose what they wanted to do and happen regarding their care and treatment. Where people did not have the capacity to make specific decisions themselves these were made in their best interests by people who knew them well.

People said that they enjoyed the food they at the home and they were able to make choices about what they wanted to eat. We saw that people had choice of fresh nutritious food, and where recommendations had been made by other professionals regarding people’s diet or health needs these had been acted upon.

People said that if they had any concerns they were able to speak staff. They found the staff and management approachable, willing to listen to their views and opinions. Feedback from the people that lived there and their relatives was gathered on a regular basis and any areas identified for action were acted upon. Also a range of audits and checks were completed regularly to ensure that good standards were maintained.

We were shown around the building by the registered manager. All the rooms were furnished and decorated to a good standard. The bedrooms were all well-furnished and people had their own possessions. The bathroom and toilet facilities were well equipped and modern. The lounge and dining rooms were warm and comfortable. We saw that there was a very good standard of cleanliness and hygiene and the building was maintained. The registered manager told us the provider had a programme of refurbishment and had applied for planning permission for the provision of an extension to the building.

We observed that the staff supported people in a friendly and polite way. The staff showed people respect and made sure their dignity was maintained. We saw that the staff spent time supporting people who needed assistance.

We spoke with six of the thirteen people who lived at Ashfield House. They told us that they were very comfortable and the staff looked after them well. They said they were happy with the food provided and said that the cook was “wonderful”. Another person told us, "The food is excellent and I really enjoy it". Two of the people we spoke with said they preferred to stay in their rooms. When they wanted to go downstairs they said that they only had to call and someone would be there to help them.

We spoke with three members of staff and the registered manager during our visit. The staff we spoke with demonstrated that they were very proud of the standards of care they provided. They said that it was very important to them to ensure the home was clean and that the people had choice in their food and daily living.

People who use the service said that they were well looked after. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. They said staff talked to them about how they liked their support to be provided.

Staff provided health and social care support well. Community services were accessed to support people when necessary.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. People’s relatives told us that staff were around and available to talk to when they visited. They said that the staff were friendly and always acted professionally. One person said that they “The girls are very, very good” and another said, “Yes, it’s very nice”.

People we talked with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The home’s management held regular meetings with the people to find out what they thought about how their care was delivered.

We were accompanied on our two visits to Ashfield House by a volunteer from Herefordshire LINk (Local Involvement Network). The LINk have a role in the monitoring of health and social care services which they fulfil by carrying out ‘enter and view’ visits to hospitals and care homes. The volunteer came with us on this visit because the local LINk wanted to understand more about our role and how we check compliance during our visits to services. The volunteer and inspector met before the visits to discuss how this ‘shadowing’ opportunity would be organised and important issues such as confidentiality and their role during the visits. The volunteer did not make notes but gave verbal feedback to our inspector throughout the two visits and at the end of the inspection. We have taken their views and observations into account in our report.

Ashfield House is a care home for older people which caters mainly for people with dementia who do not have significant behavioural difficulties which may be challenging to staff. The home has just 14 places and the affect of this on the care provided was reflected in what we saw and what people told us.

We found that the atmosphere at Ashfield House was friendly and welcoming. During both of our visits we saw people looking relaxed, cheerful and lively. People greeted one another and spoke to the people they were sitting by in the sitting room. There was a lot of laughter and we saw that people were at ease in the company of the care staff and manager.

We saw examples of good practice during our observations and in the records we looked at. For example, we looked at the care information about a person who had been very unwell and saw that they had received attentive care from staff and was now much better. Each time we raised a query with staff about an aspect of a person’s care which seemed to be a concern, they were able to tell us what was being done about it.

We found that the quality and quantity of food was good with an emphasis on home cooking. The cook was aware of the role good nutrition plays in the health of older people and of those with dementia in particular. The cook knew people living at the home individually and was knowledgeable about their dietary needs and likes and dislikes.

Information about how to recognise and report abuse was available for people living at the home, for visitors and for care staff. Training is provided to care staff about adult safeguarding and the senior staff we spoke to knew about how to report concerns about abuse to the local authority adult safeguarding team.

New staff do not start work at the home without the required checks being done to minimise the possibility of unsuitable people being employed and the manager is clear about her responsibilities in this respect.

The manager is also the owner of the home and is very involved in the day to day running of the service and the care that people receive. She has systems in place to help her monitor risks such as those relating to people having falls and the regular auditing of medicines. She has obtained a wide range of training and reference material available to refer to and for staff to use for training purposes. She has bought new computer equipment assisted by a care related grant. She told us that she hopes this will help to develop the standard of the care records in the home and give care staff access to a wider range of training opportunities.