Ashgrove Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The provider is registered to provide accommodation and nursing care for up to 57 people, including older people. People live in two separate units, Ashgrove and Coppice. The provider provides care for people with dementia, some of whom are supported in Coppice. At the time of our inspection there were 45 people living at the home.

The inspection was undertaken on 18 and 23 May 2018. .

There was a registered manager in post and they were present during this 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 previous inspection on the 27 January 2017 the provider had an overall rating of ‘requires improvement.’ At this inspection the provider had achieved an overall rating of ‘good’ as they had made significant improvements.

People told us they felt safe when staff supported them with their needs and staff applied their training when using equipment to ensure people were safe and comfortable. Staff practices were consistent in monitoring people’s care needs so risks to people from avoidable harm were reduced. The registered manager kept staffing arrangements under review to ensure people’s needs were supported in a safe and timely manner. Recruitment checks had been completed before new staff were appointed to make sure they were suitable to work with people who lived at the home.

People were happy with the support they received from staff when taking their medicines as prescribed. Staff practices around the administration and management of people’s medicines reduced the risks of people not receiving their medicines as prescribed to meet their health needs.

Staff received and induction and on-going training to meet the specific needs of people who lived at the home. People were supported to stay well and had access to health care services and enjoyed their mealtime experiences with the registered manager ensuring staff’s main focus at mealtimes was the care needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies, procedures and staff training supported this least restrictive practice.

People appreciated the support they received to make their individual rooms as homely as possible. The physical environment and facilities in the home reflected people's requirements with redecoration on-going to enhance people’s wellbeing. Systems were in place to ensure effective infection prevention and control.

People felt staff were caring towards them and staff had developed respectful relationships with people. People’s privacy and dignity were respected by staff who enjoyed their work and wanted to provide people with the best possible outcomes. People were given encouragement to make their own decisions about their day to day care when they needed it. People's rights to dignity and privacy was understood and acted upon by staff.

People were provided with fun and interesting things to do although the registered manager had identified plans for further improvements to support people with dementia. Staff provided end of life care in a sensitive and centred on each person.

People who lived at the home and their relatives were supported by the management and staff team to raise any complaints they had. The registered provider had a complaints procedure which included investigating and taking action when complaints were r

The inspection took place on 24 and 25 January 2017 and was unannounced. At our last inspection in November 2015 we found that the provider ‘required improvement’ overall. We found concerns with the level of staffing, not enough activities being available for people and quality assurance checks on the service were not effective in identifying areas for improvement.

Ashgrove Nursing Home is registered to provide accommodation and nursing support for up to 57 older adults with a variety of health conditions including dementia. On the day of our inspection there were 47 people living in the home. There were 30 people living in the nursing unit with eight beds allocated as a short stay for people leaving hospital managed through the Clinical Commissioning Group (CCG) and 17 people living in the residential dementia unit. A manager had recently been appointed and was in the process of applying to register to manage the service. 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.

People felt safe within the service. Staff knew how to keep people safe and had received the appropriate safeguarding training to do so. There was insufficient staff to keep people safe within the dementia unit. People were administered their medicines as it was prescribed.

Staff had the skills and knowledge to support people appropriately. People were supported by staff in a way that ensured their human rights were protected within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The provider needed to make improvements to how people knew what choices of meals were available to them, but people were able to get enough to eat and drink. Where people needed to see health care professionals this was available to them.

People had a mixed view as to whether staff were consistently kind and caring towards them. People’s independence and privacy was respected, however we found that people’s dignity was not always being respected. An advocacy service was not available to support people who needed to make choices and decisions as to how they were supported.

The provider had an assessment and care planning process in place which involved people in identifying their support needs. We found that people’s support needs were being reviewed. While we found that people were able to take part in activities, this was not consistent or appropriately linked to their interests and hobbies.

The provider had a complaints process in place to enable people to raise complaints. We found that spot checks and audits were taking place by the manager and provider however these were not consistently effective in identifying areas of concern.

People were able to share their views on the service they received by completing a quality assurance questionnaire. We saw that where actions were identified these were being discussed with people.

On the day of our inspection we found that 47 people lived at Ashgrove Nursing Home. We met and spoke with six people and three relatives. We spoke with the registered manager, the provider and three members of care staff. We looked at four people's care records and four staff files. We reviewed the provider's policies.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "It's a friendly, homely place and the care is excellent". Another person told us, "The food is great, the people are nice and I get everything I need".

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that staff were supported to carry out their role and trained to meet people's needs. Staff told us they were given opportunities to develop their skills beyond their core training.

We found that systems were in place to deal with complaints. This meant that people had their concerns listened to and acted upon.

We carried out this inspection to check on the care and welfare of people. There were 45 people living at the home on the day of the inspection. The accommodation was split into two units. A dementia unit where there were 18 people living and a nursing unit where there were 33 people living. We spoke with two people, two relatives, and two members of staff.

On the day of the inspection the home was having its main lift replaced and planned refurbishments were underway as part of improving the home's facilities.

People told us that staff were supportive. Relatives told us that people’s dignity, privacy and independence was respected. We saw staff knocking bedroom doors before entering and people spending time alone in their rooms. One person said, “I am able to do things how I want for myself”.

One person said, “We have a laugh with the staff”. People told us that staff knew how to care for them and they loved living at the home. Relatives told us the care delivered was at times on a one to one basis with people.

Records showed that systems were in place to keep people safe. Relatives had no concerns for people’s safety.

The provider had a system in place to check that only suitable staff worked in the home.

Records showed that appropriate quality audits were being done as part of ensuring the quality of the service. We saw that people living there were able to share their views on the service regularly.

The inspection took place on the 18 and 19 November 2015 and was unannounced. At our last inspection on the 4 February 2014 the provider was compliant with the regulations inspected.

Ashgrove Nursing Home is registered to provide accommodation and support for 57 older adults who may have dementia. On the day of our inspection there were 46 people living at the home. There were 31 people living in the nursing unit with 8 beds allocated as a short stay for people leaving hospital managed through the Clinical Commissioning Group (CCG) and 15 people living in the residential dementia unit. 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.

People told us they felt safe. The provider had the appropriate safeguarding procedures in place so staff knew how to keep people safe.

People told us there was not always enough staff. We found that there was a number of vacant job positions which led to there not always being enough staff.

The provider did not ensure that an appropriate running balance of medicines were kept so they could monitor that people were receiving the correct amount of medication.

Staff received support and training to ensure they had the skills and knowledge to support people appropriately.

The provider had taken the appropriate action to ensure they met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People told us that staff were kind and compassionate towards them, but our observations did not always reflect this throughout the home.

People were able to make decisions about the support they received from staff.

People’s dignity and privacy was not always respected.

Activities were not consistently made available to people by staff and they did not all know what people’s preferences, likes and dislikes were.

People told us that if they had a complaint they would speak to the staff or registered manager.

We found that the quality assurance system were not effective in identifying concerns within the service where improvements could be made.

The provider ensured systems were in place so people were able to share their views on the service. An action plan was being used to identify what the provider did about the views people shared.