This inspection took place on 6 and 7 November 2017 and was unannounced. A previous inspection, undertaken in July 2015, found there was one breach of legal requirements but rated the service as ‘Good’ overall. We carried out a further focussed inspection in February 2017 where we found the home had dealt with the breach and was meeting all regulations.

Ashington Grange 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. The home is registered to provide support for up to 59 people over three area. The lower floor predominantly supported people with nursing care issues. The upper floor is divided into two units, one supporting males and one supporting females, who have a cognitive impairment or mental health issue. At the time of the inspection there were 51 people living at the home.

The home had a registered manager who had been registered since February 2015. 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 safe living at the home and staff had a good understanding of safeguarding adults procedures. The registered manager was able to describe lessons learned from previous safeguarding events. Maintenance of the premises had been undertaken and there was evidence of safety checks and risk assessments being carried out. People had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. Some people and staff members told us there were times when more staff would be helpful, but overall there were enough staff at the home. We found minor issues with the recording of some medicines at the home, which were addressed immediately. We found the home to be maintained in a clean and tidy manner.

Staff had an understanding of issues related to equality and diversity and what it meant for people using the service. They told us they had access to a range of training and updating and records confirmed this. They confirmed they had access to regular supervision and an annual appraisal. The registered manager described how technology was being used to enhance care delivery.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We found some the registered manager had system in place to review and resubmit DoLS applications. People were asked for their consent on a day to day basis. Where this was not possible there was evidence of best interest decisions being made.

People were happy with the quality and range of meals and drinks provided at the home. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements. Risks associated with diet and weight loss were monitored.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. We observed staff had positive interactions with people throughout the time of the inspection. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. Relatives told us they were regularly involved in care decisions.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health s

We carried out an unannounced comprehensive inspection of this service on 21 and 22 July 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 11(Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashington Grange on our website at www.cqc.org.uk.

We found action had been taken to address the shortfalls identified at our last inspection and the provider was now working within the principles of the Mental Capacity Act 2005 (MCA).

People's capacity to make decisions had been assessed. Records of mental capacity assessments and best interests decisions were detailed. People's choices and decisions about their care and treatment were respected. All staff had received additional training in MCA, and how it was applied in practice was discussed regularly at both group and individual supervisions sessions.

This meant that the provider was now meeting Regulation 11.

We have changed the rating of the effective domain from 'requires improvement' to 'good'. This was because records showed the improvements had been sustained over a significant period of time. This has not affected the overall rating for the service which remains at 'good'.

We spoke with five people about their experiences of the care and support they had received. People spoke positively about the service they received at Ashington Grange. One person said, “They look after us well, we get plenty to eat and we are very comfortable.” Another person told us, “The staff are really nice and we have a bit of laugh. There is always something to do or someone to talk to. I am well looked after.”

We saw relationships between staff and people were good and there was a relaxed atmosphere. People’s privacy, dignity and independence were respected.

We saw staff delivered care in a calm and pleasant manner. We found they were aware of people’s needs. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The home was clean. We saw there were effective systems in place to reduce the risk and spread of infection.

People received care in a calm and unhurried manner. There were enough qualified, skilled and experienced staff to meet people’s needs.

People were asked their views about the service. Systems were in place to monitor the quality of the service.

We spoke with six people about their experiences of the care and support they received from this service. They said they received a good service. One person told us, “The staff are wonderful, they are always cheerful and kind.” Another person said, “I like living here I don’t think I could manage at home now. Staff are very good and they know what support I need. The food is good and there is a good choice.” People said activities and outings were planned to suit their needs.

We saw relationships between staff and people were good and there was a relaxed atmosphere. People told us that staff spoke to them respectfully and they were consulted about their care preferences. We saw good interactions between staff and people during our visit.

Individual records were detailed and provided clear information about the care and support provided.

The provider had in place appropriate systems to manage medicines safely and this protected the people living in the home.

The provider used questionnaires to seek the views of people about the service. Information collected was used to help plan changes and improvements.

Quality monitoring systems were in place and these took account of people’s views about the service.

Ashington Grange provides residential and nursing care for up to 59 people. At the time of the inspection 43 people were accommodated at the home, some of whom were living with dementia.

This inspection took place on 21 and 22 July 2015. The inspection was unannounced.

The provider, HC-One, had two services on one site, Ashington Grange which is a nursing home and Moorhouse Farm which is a residential home. We inspected both services at the same time. The same staff were used across both services and the same management structure was in place. Our findings for Moorhouse Farm are discussed in a separate report.

The last inspection we carried out at this service was in April 2014 when we found the provider was not meeting one of the regulations we inspected. This breach of regulation related to assessing and monitoring the quality of service provision. At this inspection we found improvements had been made to the systems in place to monitor the quality of the service and this breach in regulation had been met.

A registered manager was in place. 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 were safe in the home. Staff had undertaken training in how to respond to safeguarding issues and concerns and were able to describe to us the correct process to follow. We saw where concerns had been raised these had been shared promptly with the local authority safeguarding team.

Risks had been assessed and where possible action had been taken to reduce the likelihood of the risk occurring. Accidents and incidents were monitored to ensure staff response had been appropriate.

People, their relatives and staff told us there were enough staff to meet people’s needs. We saw staff were able to respond to people’s requests quickly. Recruitment processes were in place to ensure checks on candidates’ character were undertaken before staff began working in the home. Checks were in place to check nurses’ qualifications and registration were up to date.

Medicines were managed appropriately.

Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired. Staff had received a range of training in care and welfare subjects in addition to training specific to the needs of people they supported, such as dementia, end of life and mental capacity training. Nursing staff attended training relevant to their experience. Care workers and nurses received regular supervision sessions and a yearly appraisal.

The principles of Mental Capacity Act 2005 (MCA) were not always followed. Some people had capacity assessments completed which were not decision specific and had been carried out by only one nurse. Where decisions had been made on people’s behalf, documentation had not been completed to evidence that their capacity had been assessed or that the decision had been made in their ‘best interests’.

Do not attempt to resuscitate documentation within some people’s care records were out of date, meaning they were invalid.

Where restrictions were in place to keep people safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards.

People spoke highly of the food in the home. A choice of food was available at every meal and food was on offer throughout the day.

The home was spacious and considerations had been made to improve the environment for people living with dementia. Some areas of the home were tired looking or impersonal. A large scale refurbishment plan was in place and due to commence in the months after our inspection. The manager told us improvements would include better signage, bringing the home up to date and making it more homely. People and their relatives were to be consulted on the improvement plans and included in decision making about colour schemes and decoration.

All of the people we talked with, and their relatives spoke highly of the staff and how well they cared for them. Staff had good relationships with people, they responded with a gentle and kind manner when they were distressed.

During mealtimes staff were attentive, caring and considered people’s individual needs. People were encouraged to be independent by staff who recognised their needs and responded in a personalised way with practical solutions. Where people did need help from staff with their meals, this was provided in a dignified way. The manager told us considerations had been made to make mealtimes as enjoyable as possible, such as thinking about different ways to present the food. For example, by using traditional boxes and people eating ‘on their knee’ rather than at the table when having fish and chips.

Activities staff showed creativity in devising an activities schedule planned to meet the different interests of all of the people in the home. We saw busy and louder activities brought people together in the main lounge of the home, whilst staff engaged with people one to one or in smaller groups in other areas of the home, either playing games, chatting, or gardening outside. People were given the opportunity to travel to the nearby coast where they home had hired a beach hut for two days a week over the summer and a caravan for a week at the start and end of the summer for people to go out and enjoy their local area.

Staff told us they enjoyed working at the home and we saw they treated people with dignity and respect. Staff knocked on doors and waited to be invited inside before entering people’s bedrooms and addressed people politely.

Staff supported people to reach their goals. Staff had helped one person to manage their own care needs. Spending time talking through their medicines and equipment they used in preparation for them returning to their own home. Plans were in place to ensure that people were cared for as they wished as they approached the end of their lives.

People, relatives and health professionals told us that the home was responsive to people’s needs. Care records were detailed, specific and individual to the person receiving care. Assessments had been carried out to determine people’s needs and were regularly reviewed. Staff we spoke with were knowledgeable about people needs and how best to support them.

People and relatives’ feedback was encouraged through regular meetings and a yearly survey. Complaints had been investigated and responded to. The home had received nine compliments since January 2015.

Improvements had been made to systems in place to monitor the quality of the service since our last inspection. People, relatives and staff spoke highly of the new registered manager and told us about the improvements she had made to the home.

Staff we spoke with told us they felt valued. They explained how communication between the three units in the home had improved.

Audits and checks were carried out regularly to monitor the quality of the service. The manager assigned some of these checks to care staff and nurses so all staff were aware of the standards which were expected.

We found one breach of regulations. This related to the Need for Consent. You can see what action we told the provider to take at the back of the full version of the report.