About the service:

Ashgrove Residential Home is a residential care home providing accommodation and personal care to 21 people, at the time of the inspection.

People’s experience of using this service:

• Medicines were not being managed safely. We found some people had missed their medicines and some staff competency was not assessed to identify if they were competent to manage medicines.

• Risks associated with some people’s needs had not been assessed.

• There was not an effective system in place to quality assure risk assessments and medicine management to ensure shortfalls could be identified and action taken.

• Some people and relatives raised concerns with staffing levels. There were no systems in place to calculate staffing levels contingent with people’s support needs. We made a recommendation in this area.

• Some staff had not completed essential training to perform their roles effectively.

• Staff felt supported by the management team.

• People were supported with their nutritional needs and had choices with meals.

• The staff worked well with external health care professionals and people were supported with their needs and accessed health services when required.

• People continued to receive care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy.

• Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

• People’s independence was promoted.

• Care plans were person centred and detailed people’s support needs.

• More information is in our full report.

• We identified two breaches of Regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Rating at last inspection:

• At the last inspection on 21 July 2016 the service was rated ‘Good’. At this inspection, the rating for the service has reduced to ‘Requires Improvement’.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The inspection took place on 21 and 25 July 2016 and was unannounced on 21 July. The service was not meeting legal requirements relating to premises, equipment, infection control, record keeping and quality assurance at our last inspection on 30 April 2015. During this inspection the service met all legal requirements.

Ashgrove Residential Care Home provides accommodation and support with personal care for up to 26 older people. The service supports people living with dementia. On the day of our visit there were 24 people using the service. 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.

People told us they were cared for by staff who were friendly, polite and respected their wishes. They told us they were treated with dignity and respect and felt safe living at Ashgrove. We found some concerns with the environment; however these were addressed straight away. We recommended best practice guidelines to be followed in relation to health and safety and maintenance.

Medicines were managed safely with the exception the medicine room temperatures not always being recorded as checked although there was a room thermometer. The proprietor ensured a new record sheet was in place and informed staff on the need to check this daily.

Staff had attended relevant training and were aware of the procedures in place to protect people from harm. They knew how to recognise and report abuse. Staff were aware of the procedures to follow in the event of a fire or a medical emergency. They explained the regular health and safety checks in place, the incident and accident procedure and the risk assessments in place in order to mitigate risks such as falls, pressure sores and choking.

People told us that there were enough staff during the day but said at night the staffing was sometimes challenging depending on the needs of people using the service. We reviewed Rotas and found that the staffing levels were currently two staff at night which was usually ok but sometimes difficult if someone was unwell. The manager said they lived close to the service and could be called upon if needed out of hours.

There were safe recruitment practices in place to ensure that only staff who had undergone the necessary checks and had suitable skills and experience were employed. Staff underwent a comprehensive induction and annual training program was offered to keep staff up to date with practice. Regular supervision and annual appraisal was in place to ensure staff had the opportunity to reflect on practice and identify any personal development needs that would enable them to deliver safe and effective care.

People told us they were happy with the food choices available and told us that the chef had been changed last year as they were not happy. They told us they felt free to express any concerns or issues they may have related to the care received.

Care plans were person centred and reflected people’s preferences. These were reviewed and updated regularly. Where people lacked capacity to consent appropriate guidelines were followed based on the Mental Capacity Act (2005).

People told us the registered manager was approachable and that they thought the service was well run. There were systems in place to ensure the quality of care delivered was maintained and improved. People were given the opportunity to be involved in running the service at regular “resident meetings.”

The inspection was unannounced and took place on 30 April 2015. The service was not meeting legal requirements relating to safe management of medicines at our last inspection on 17 February 2014. During this inspection, we found that the provider now met requirements relating to medicines management.

Ash Grove Residential Care Home provides accommodation and support with personal care for up to 26 older people. The service supports people living with dementia. On the day of our visit there were 22 people using the service.

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.

People and their relatives told us they felt safe. However, we found that care was not always delivered in a clean and safe environment. The premises were not well-maintained and equipment was not always clean. Staff could not use evacuation equipment. Health and safety was not always adhered to. Fire exits were blocked and cupboards with potentially harmful substances were kept unlocked.

Although there were safe recruitment practices and enough care staff, we found that the cleaning and maintenance staff did not have enough time allocated to cleaning and maintaining the service.

We recommend that the cleaning and maintenance staffing schedules are reviewed in order to meet the needs of the service.

Consent to care and treatment was not always sought in line with legislation and guidance. Staff were aware of the need to promote choice but had limited knowledge about best interests decisions, deprivation of liberty safeguards (DoLs) and how the Mental Capacity Act 2005 applied to their daily work.

People were supported to have sufficient amounts to eat, drink and maintain a balanced diet.

People told us that staff were caring, kind and helpful. We observed interactions between staff and people and found that staff had built a good rapport with people.

People’s privacy and dignity was respected and promoted. People told us that staff addressed them appropriately and always asked people their preferences before they delivered care.

We found that before people started to use the service they were assessed and care plans were developed to enable staff to support people.

People told us they would not hesitate to raise their concerns with the manager. Complaints were acknowledged and responded to in a timely manner.

People, their relatives and staff told us they could approach the registered manager or their deputy at any time. They felt it was a well-managed service.

The quality of care delivered to people was monitored regularly. Although feedback from people was sought it was not always evaluated and improvements made to the service as a result.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.

People’s needs were assessed and care was planned and delivered in line with their individual care plan. People we spoke with expressed satisfaction with the care and support they received. One person said "staff are very kind. Everyone has been nice here." Care plans were in place which set out how to meet people's individual and assessed needs. People had access to GP's and opticians although they did not have routine access to dental care.

People were supported to be able to eat and drink sufficient amounts to meet their needs. They told us the food was good and that they were provided with a choice of food. One person said they had “lovely food” and another said “the cook always asks what I want for dinner.”

We found the physical environment was suitable to meet the needs of people who used the service. Steps had been taken to ensure the premises were safe. For example fire exits were free from obstruction and clearly signed. The service had a complaints procedure in place. We found that complaints received were responded to appropriately.

Medications were stored securely. However, we found errors with the recording and administration of medication, which could impact on people's health, safety and welfare. This must be addressed.

People were central to their care plans and their consent or that of their relative or next of kin was sought if they were unable to make their own decisions. Care was delivered in a personalised way to people and was regularly reviewed. Staff were provided with guidance from health and other professionals to ensure that people who use services were provided with support from the most appropriately qualified person. Risk assessments took into account people's wishes and these were respected. People were safeguarded from abuse as the provider had put in place steps to minimise risk to people and staff were appropriately trained to support people using services. There was sufficient number of staff to provide care. The provider had put in place an effective monitoring system.