We inspected the service on 26 and 27 April 2017. Day one of the inspection was unannounced. At the last inspection in February 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Ashfield (Skipton) is a care home without nursing for up to 30 older people, some of whom maybe living with dementia. The home is arranged over two floors which can be accessed via a lift. There is also a separate unit for people living with dementia. The home has a garden which people can access and it is close to local amenities. At the time of our inspection 18 people lived at the service.

We saw the registered provider had worked to develop a new care plan system which would improve the records relating to risk assessment and mental capacity assessment for people. The registered provider displayed a positive attitude towards continuous improvement. We discussed with the registered manager our findings and the areas of improvement still required in relation to medicines, training compliance and the quality assurance system. The registered manager explained the registered provider was keen to make such improvements. People and their families were positive about the leadership of the service.

We saw staff recruitment was safe which ensured candidates were suitable to support vulnerable people. Staff were aware of the signs of potential abuse and how to report their concerns. Staff told us they received appropriate training and support to enable them to perform their role. We saw some records to confirm this.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People were happy with the choice of food they received and we observed a positive mealtime experience. People were supported to have access to healthcare support and their health needs were monitored well by staff.

People and their relatives told us they found staff to be caring, kind and friendly. We observed positive and warm interactions between staff and the people who used the service. People were offered choices and were supported to maintain their independence.

People’s preferences were recorded in their care plans and staff were aware of them when delivering support. People had access to a wide range of activities, which included their own personal hobbies and access to the community.

People, their families and members of staff had opportunities to provide feedback on the service and their views were listened to and acted upon. This meant the service was run in the best interests of the people who lived there.

We spoke with eight visitors, seven people who used the service and some of the staff on duty. Before people received any care or treatment they were routinely asked for their consent. People told us they were involved in decisions about their daily lives and specific care needs.

On the whole, people’s care plans contained a level of information that ensured their needs were being met. However, not all information was being followed up in relation to people who had lost weight and some care plans had not been reviewed in a timely way. This meant that people’s care needs could be overlooked. People told us they were happy with the care provided. One person told us, “I am more than satisfied with the care here.”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough staff on duty to meet people’s needs. Staff were receiving training on a regular basis and this was monitored by the manager.

There were quality monitoring programmes in place, which included people giving feedback about their care and treatment. This provided a good overview of the quality of the service provided and meant the quality of the service was being kept under review.

We spoke with ten people who used the service and one visitor. Everyone told us they were satisfied with the care they received. We saw records that showed people were involved in developing their care plans. In some instances relatives had also been involved, if the person was unable to give their views. People said they understood their care plans and that staff had explained things to them in detail. We also saw how staff worked with people, at their own pace, to make sure they knew what support was needed and how best they could meet that need.

We found that all of the records we reviewed were accurate, up to date and had been regularly reviewed and evaluated.

We looked at staff records and found staff were recruited using a robust system and saw there were good systems in place to ensure staff were well supported in their work.

People told us they thought that staff were knowledgeable regarding their individual care needs. They said they were treated well and their experiences in the home were positive. Five people told us that if they had a complaint they would talk to the manager and they were confident any issues would be dealt with properly.

Staff talked positively about their work. Staff said they made every effort to provide a person centred service and that they worked as an effective team.

People were protected against the risks associated with medicines because appropriate arrangements in place to manage medicines.

People we spoke to told us that they feel well supported by the staff at the home.

They also told us that they felt they were kept up to date with information and could take part in meetings and activities as and when they wished.

During a visit to the service, people told us that the staff always consulted with them about their care. However, some people said they had not seen care plans and were unsure about all the choices available to them.

People said staff treated them well and respected their dignity. They felt that they could approach the staff at the home and felt able to raise concerns.

People said that they enjoyed the meals and there was always a good choice, they told us that they were happy with the environment and the home was kept clean and tidy.

Relatives told us that they were pleased with the care at the home and were always made to feel welcome.

We undertook this unannounced inspection on the 10 February 2015. We also returned on the 16 February 2015 to complete the inspection. We last inspected Ashfield (Skipton) on the 29 September 2013. At that inspection we found the home was meeting the regulations that were assessed.

Ashfield House is owned and managed by North Yorkshire County Council. The care home is registered to provide personal care for up to 30 people and is within a short drive of the centre of Skipton. It is a purpose built two-storey care home and is set in large grounds and has enclosed gardens. There is a small unit, which can accommodate five people living with dementia. There is also a day centre attached to the service.

The home employs a registered manager who had worked at the home for over two years. 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 service was safe. People who used the service spoke positively about the care they received at Ashfield and they said they felt safe. We saw there were systems and processes in place to protect people from the risk of harm.

Medicines were administered, stored and disposed of safely and people using the service received their medicines as prescribed.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show that staff employed were safe to work with vulnerable people.

Staff we spoke with understood how to make an alert if they suspected anyone at the home was at risk of abuse. Training had been given to staff about safeguarding procedures.

Safety checks were carried out within the environment and on equipment to ensure it was fit for purpose. We found that the main open plan lounge/dining area was sometimes cold and people told us that they were cold during one of our visits. We have asked the registered provider to make improvements.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves.

Staffing levels at the home were flexible to ensure people who used the service had the support they needed.

People were provided with nutritious food. Assistance and prompting was given by staff where necessary to assist people. Adapted cutlery and crockery were available to people for them to use to help maintain people’s independence.

Staff were seen to be attentive and kind to people and they respected people’s individuality, privacy and dignity.

Care plans were person centred and up to date. Risks to people’s health and wellbeing had been identified. These risks were being monitored and reviewed which helped to protect people’s wellbeing. However, we found that risk assessments we looked at needed some improvement as staff at the home were recording identified risks in different areas of people’s care plans. This meant that records were not kept consistently, using the same template which would make any changes to people’s care difficult to monitor.

Activities took place in the main part of the home but not always in the small dementia care unit.

The service was well led. The registered manager had an effective quality assurance system in place which ensured that the home remained a pleasant place for people to live.

We received information from Healthwatch. They are an independent body who hold key information about the local views and experiences of people receiving care. CQC has a statutory duty to work with Healthwatch to take account of their views and to consider any concerns that may have been raised with them about this service. We also consulted the Local Authority to see if they had any concerns about the service, and none were raised